We describe a technique consisting of simultaneous radial closing-wedge and ulnar shortening osteotomy to treat malunion of distal radial fractures.
Step 1: Preoperative Planning
Plan the radial closing-wedge osteotomy to correct the volar tilt angle to 8.5° to 15.5° and the ulnar shortening osteotomy to restore ulnar variance to −2.5 to 0.5 mm.
Step 2: Radial Closing-Wedge Osteotomy
Remove the wedge of bone from the radius and reduce the distal fragment, keeping the dorsal cortex as a hinge.
Step 3: Distal Ulnar Shortening Osteotomy
Resect the section of the ulna equivalent to the positive ulnar variance with transverse osteotomies.
Step 4: Plate Fixation of the Radial Osteotomy Site
Hold together the two fragments of the radius with a Kirschner wire and fix the osteotomy site with a volar locking plate.
Step 5: Proximal Ulnar Shortening Osteotomy
Evaluate residual ulnar positive variance with fluoroscopy and restore the ulnar variance to within a normal range by removing additional bone from the proximal fragment.
Step 6: Plate Fixation of the Ulnar Osteotomy Site
Use a compression device to close and fix the ulnar osteotomy site.
Step 7: Postoperative Management
Allow early motion immediately after the operation.
We retrospectively evaluated forty-two patients at a minimum of one year after treatment of an extra-articular distal radial malunion with a radial corrective osteotomy.
What to Watch For
Pitfalls & Challenges