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Fixed-angle volar plates in corrective osteotomies of malunions of dorsally angulated distal radius fractures.

OBJECTIVE
The aim of the study was to evaluate the radiological and functional outcomes of corrective osteotomy of malunited, dorsally tilted distal radius fractures, using fixed-angle volar plates.


METHODS
We conducted a prospective study on 17 (10 male, 7 female; mean age: 41 years; range: 18 to 67 years) consecutive patients who were referred to our institution for treatment of a symptomatic malunion of the distal radius. The mean time from fracture to osteotomy was 4.4 (range: 2 to 7) months. Eight (45%) of the malunited fractures were on the dominant wrist. All patients were treated with an opening wedge osteotomy with a fixed-angle volar plate and cancellous bone grafting. Radiological measurements were performed pre- and postoperatively, including ulnar variance, radial inclination, and radial tilt. The degree of degenerative changes in the radiocarpal joint was assessed according to the criteria of Knirk and Jupiter. Forearm pronation/ supination and wrist flexion/extension range of motion and grip strength were measured and compared with the opposite healthy side. Functional evaluation was performed with a Turkish version of the Q-DASH (Disabilities of the Arm, Shoulder and Hand Quick form) questionnaire.


RESULTS
Mean follow-up evaluation was made at an average of 20.4 (range: 12 to 38) months. All osteotomies healed radiologically at mean time of 12.2 (range: 12 to 16) weeks. There was a significant improvement in the anatomical and functional parameters (p<0.05). The mean tilt of the radius improved from -27.4° of extension to 3.4° of extension and the mean radial inclination improved from 18.4° to 22.5°. The mean ulnar variance improved from 12.1 mm to <1 mm. Wrist flexion/extension range of motion improved from 100.8° to 144° and forearm range of rotation increased from 118° to 174.6°. Radial and ulnar deviation averaged from 22° to 27.3° postoperatively. According to the criteria of Knirk and Jupiter, 3 patients (17%) had Stage 2 degenerative arthritis. The average Q-DASH score improved from 26.5 to 5.7 and grip strength increased from 59.7% (17.5 kg) to 83.2% (24.4 kg) of the opposite side strength.


CONCLUSION
Fixed-angle volar plates provide a stable fixation after corrective osteotomies of the distal radius and might be a safer alternative to conventional fixation methods.