Arch Hand Microsurg.  2025 Mar;30(1):29-35. 10.12790/ahm.24.0053.

Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius fracture: a preliminary report with a case series

• Kim S
• Park H
• Whang J

• KMID: 2565465
• DOI: http://doi.org/10.12790/ahm.24.0053

Abstract

Purpose
Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement.
Methods
This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively.
Results
The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved.
Conclusion
Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Keyword

Malunited fractures; Wrist Fractures; Corrective osteotomy; Surgical method

Figure

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  Fig. 1. The two orange triangles represent the correction angle. The desired correction angle can be achieved if one triangle rotates at 180°. Asterisks indicate rotational wedge bones.

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  Fig. 2. (A) Dorsal angulated malunion an anteroposterior (AP) radiograph showing severe positive ulnar variance. (B) Preoperative lateral radiograph showing dorsal tilt angulation. (C) Half osteotomy C-arm photograph. (D) Gross half-wedge bone gross photograph. (E) 180° reversed repositioning wedge bone. (F) Repositioning the wedge bone and plating. (G) Postoperative 6-month AP radiograph showing improved ulna variance. (H) Postoperative 6-month lateral radiograph showing improved distal radius dorsal tilt.

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  Fig. 3. Wrist motion at a 6-month postoperative follow-up.

Reference

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