Corrective osteotomy for isolated malunion of the palmar lunate facet in distal radius fractures

• Published in: The Journal of hand surgery (American ed.) Vol. 35; no. 11; p. 1779
• Main Authors: Ruch, David S, Wray, 3rd, Walter H, Papadonikolakis, Anastasios, Richard, Marc J, Leversedge, Fraser J, Goldner, Richard D
• Format: Journal Article
• Language: English
• Published: United States 01.11.2010
• Subjects: Adult; Cohort Studies; Female; Follow-Up Studies; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fractures, Malunited - diagnostic imaging; Fractures, Malunited - surgery; Hand Strength - physiology; Humans; Injury Severity Score; Intra-Articular Fractures - diagnostic imaging; Intra-Articular Fractures - surgery; Lunate Bone - injuries; Lunate Bone - surgery; Male; Middle Aged; Osteotomy - adverse effects; Osteotomy - methods; Pain Measurement; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Range of Motion, Articular - physiology; Recovery of Function; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Tomography, X-Ray Computed - methods; Wrist Injuries - diagnostic imaging; Wrist Injuries - surgery; Young Adult
• ISSN: 1531-6564
• DOI: 10.1016/j.jhsa.2010.07.036

Malunion of the palmar lunate facet fragment of distal radius fractures is associated with both early functional impairment and late degenerative changes. The goal of this study was to describe the clinical and radiographic outcomes after corrective osteotomy for isolated malunion of the palmar lunate facet. Between 1995 and 2000, a retrospective review identified 13 patients with an average age of 44 years who had undergone corrective intra-articular osteotomy for isolated malunion of the palmar lunate facet. The average interval from the initial injury to the osteotomy was 5.4 months. Final evaluation was performed at 1 year. We performed statistical analysis using the Wilcoxon signed rank test. Wrist extension improved from an average of 53° to 84° (p = .002), flexion from 46° to 61° (p < .002), supination from 38° to 87° (p = .002), and pronation from 79° to 87° (p < .001). Grip strength improved from 30% to 73% of the contralateral side (p < .002). Disabilities of the Arm, Shoulder, and Hand scores improved from an average of 50.7 to 9.7 (p < .002). Palmar tilt improved from an average of 23° to 11° (p < .002). Radial inclination improved from an average of 29° to 22° (p < .002), ulnar variance decreased from +3.9 to -0.9 mm (p = .004), and intra-articular gap decreased from 3.6 to 0.9 mm (p < .002). All patients had excellent or good results according to both the Gartland and Werley and the Fernandez scoring systems. Early intra-articular osteotomy significantly improved wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand scores, and radiographic parameters. Patients reported mostly positive outcomes. Therapeutic IV.