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Randomized Controlled Trial
. 2020 Jul;44(7):1353-1365.
doi: 10.1007/s00264-020-04605-x. Epub 2020 May 29.

Functional outcome after corrective osteotomy for malunion of the distal radius: a randomised, controlled, double-blind trial

Ingrid Andreasson  1   2 , Gunilla Kjellby-Wendt  3   4 , Monika Fagevik Olsén  3   4 , Ylva Aurell  5   6 , Michael Ullman  7   8 , Jón Karlsson  7   8
Affiliations
Randomized Controlled Trial

Functional outcome after corrective osteotomy for malunion of the distal radius: a randomised, controlled, double-blind trial

Ingrid Andreasson et al. Int Orthop. 2020 Jul.

Abstract

Purpose: The purpose of this randomised, controlled, double-blind trial was to evaluate functional outcome during the first year after corrective osteotomy for malunited distal radius fractures, with or without filling the osteotomy void.

Method: Patients were randomised to receive a HydroSet bone substitute or no graft. Cortical contact was maintained and stabilisation of the osteotomy was carried out with a DiPhos R- or RM Plate. To evaluate subjective functional outcome, the Patient-Rated Wrist Evaluation (PRWE), the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH), the Canadian Occupational Performance Measure (COPM) and the RAND-36 were used. Moreover, range of motion and grip strength were measured by blinded evaluators. Evaluations were made pre-operatively and three, six and 12 months post-operatively.

Results: There were no significant differences between the groups at any time point post-operatively with respect to any of the PROMs that were used or range of motion or grip strength (p > 0.05). In both groups, there was a significant improvement at the 12-month follow-up compared with pre-operatively for the PRWE, the Q-DASH and the COPM satisfaction scores. The RAND-36 revealed no significant differences except for two domains, in which there was an improvement in the treatment group (p < 0.05). For grip strength and for range of motion in all movement directions, except dorsal extension, there was a significant improvement in both groups (p < 0.05).

Conclusion: There is no significant difference in functional outcome during the first year after corrective open-wedge distal radius osteotomy, where cortical contact is maintained, regardless of whether or not bone substitute to fill the void is used.

Keywords: Corrective osteotomy; Distal radius; Grip strength; Malunion; Range of motion; Subjective outcome.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Image of the wrist of a woman aged 48 years suffering from a malunion of the distal radius
Fig. 2
Fig. 2
Pre-operative radiograph of malunited distal radial fracture scheduled for osteotomy with bone substitute. a AP view. b Sagittal view
Fig. 3
Fig. 3
Post-operative radiographs after open osteotomy using bone substitute. a AP view. b Sagittal view
Fig. 4
Fig. 4
Radiographs at 12 months control after osteotomy using bone substitute. a AP view. b Sagittal view
Fig. 5
Fig. 5
Pre-operative radiograph of malunited distal radial fracture. a AP view. b Sagittal view
Fig. 6
Fig. 6
Post-operative radiographs after open wedge osteotomy. a AP view. b Sagittal view
Fig. 7
Fig. 7
Radiographs at 12 months control after open wedge osteotomy. a AP view. b Sagittal view
Fig. 8
Fig. 8
Flow diagram
See this image and copyright information in PMC

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