CORRECTIVE OSTEOTOMY FOR MALUNITED, VOLARLY DISPLACED FRACTURES OF THE DISTAL END OF THE RADIUS

Twenty-five patients who had had an opening-wedge osteotomy for the tr eatment of a malunited, volarly diplaced fracture of the distal end of the radius were studied retrospectively. The indications for the oper ation were pain and functional limitations rather than the degree of a natomical deformity. Fifteen patients were men and ten were women; the ir average age was forty-six years (range, twenty-one to eighty-four y ears). Preoperative radiographs revealed an average ulnar inclination of 14 degrees, an average ulnar variance of five millimeters, and an a verage volar inclination of 24 degrees. Extension of the wrist average d 25 degrees; flexion of the wrist, 53 degrees; supination of the fore arm, 41 degrees; and pronation of the forearm, 64 degrees. The average grip strength was a force of seventeen kilograms compared with a forc e of forty kilograms compared with a force of forty kilograms in the c ontralateral hand. At an average of sixty-one months (range, eighteen to 114 months) after the osteotomy, supination of the forearm had impr oved to an average of 69 degrees and pronation had improved to an aver age of 75 degrees (p < 0.05 for both), Extension of the wrist had impr oved to an average of 55 degrees, and grip strength had improved to a force of thirty kilograms (p < 0.05 for both), Volar inclination avera ged 5 degrees; ulnar variance, zero millimeters; and ulnar inclination , 22 degrees, A reoperation was performed in eleven patients, Seven pa tients had removal of the hardware only two had a procedure involving the distal radioulnar Joint, one had a procedure because the site of t he osteotomy had not healed, and one had a median-nerve release. The f unctional result was rated as very good in ten patients, good in eight , fair in three, and poor in four.