Carpal Malalignment in Malunion of the Distal Radius and the Effect of Corrective Osteotomy

Abstract

Introduction Malunions of the distal radius often induce carpal malalignment. Two different types can be distinguished: an adaptive midcarpal malalignment (so-called CIA wrist: carpal instability, adaptive) and a radiocarpal malalignment (dorsal translation of the whole carpus). The effect of distal radial osteotomy on the carpal alignment has hardly been studied.

Material and Methods 31 wrists in 31 patients (mean age 44 years) with malunion of the distal radius after a Colles fracture were treated with a corrective osteotomy. The patients were divided on basis of effective radio-lunate flexion (ERLF) in the two patterns of carpal malalignment. The radiographic changes were evaluated.

Results There were 20 patients with midcarpal malalignment (ERLF ≤ 25°) and 11 with radiocarpal malalignment (ERLF > 25°). There was a correction of radial tilt and ulnar variance in both groups. There was a significant improvement of the carpal alignment in the midcarpal malalignment group, up to normal parameters. Neither age nor delay between fracture and osteotomy correlated. In the radiocarpal malalignment group a significant effect on the ERLF was observed. In the patients with dorsal plating 70% of the hardware had to be removed.

Conclusion Distal radial osteotomy is a reliable technique for correction of the deformity at the distal end of the radius and carpal malalignment.

Keywords

carpus - distal radius fracture - instability - malunion - osteotomy

• References

• 1 Cooney III WP, Dobyns JH, Linscheid RL. Complications of Colles' fractures. J Bone Joint Surg Am 1980; 62 (4) 613-619
• 2 Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am 2006; 88 (9) 1944-1951
• 3 Bickerstaff DR, Bell MJ. Carpal malalignment in Colles' fractures. J Hand Surg [Br] 1989; 14 (2) 155-160
• 4 Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 1972; 54 (8) 1612-1632
• 5 Taleisnik J, Watson HK. Midcarpal instability caused by malunited fractures of the distal radius. J Hand Surg Am 1984; 9 (3) 350-357
• 6 Gupta A, Batra S, Jain P, Sharma SK. Carpal alignment in distal radial fractures. BMC Musculoskelet Disord 2002; 3 (3) 14
• 7 Park MJ, Cooney III WP, Hahn ME, Looi KP, An KN. The effects of dorsally angulated distal radius fractures on carpal kinematics. J Hand Surg Am 2002; 27 (2) 223-232
• 8 Minami A, Ogino T. Midcarpal instability following malunion of a fracture of the distal radius. A case report. Ital J Orthop Traumatol 1986; 12 (4) 473-477
• 9 McQueen MM, Wakefield A. Distal radial osteotomy for malunion using non-bridging external fixation: good results in 23 patients. Acta Orthop 2008; 79 (3) 390-395
• 10 McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br 1996; 78 (3) 404-409
• 11 Sennwald G, Fischer W, Stähelin A. Malunion of the distal radius and its treatment. Apropos of 122 radii [in French]. Int Orthop 1992; 16 (1) 45-51
• 12 Verhaegen F, Degreef I, De Smet L. Evaluation of corrective osteotomy of the malunited distal radius on midcarpal and radiocarpal malalignment. J Hand Surg Am 2010; 35 (1) 57-61
• 13 Fernandez DL. Reconstructive procedures for malunion and traumatic arthritis. Orthop Clin North Am 1993; 24 (2) 341-363
• 14 Batra S, Gupta A. The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury 2002; 33 (6) 499-502
• 15 Jupiter JB, Ring D. A comparison of early and late reconstruction of malunited fractures of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (5) 739-748
• 16 Hove LM, Mölster AO. Surgery for posttraumatic wrist deformity. Radial osteotomy and/or ulnar shortening in 16 Colles' fractures. Acta Orthop Scand 1994; 65 (4) 434-438