Malunited Colles' fractures: correction with a biplanar closing wedge osteotomy.

A malunited Colles' fracture causes distortion of three anatomic features of the distal radius: length of the bone and the angles of its articular surface in both frontal and sagittal planes. The relative importance of each of these factors was studied in a series of 14 patients with malunited Colles' fractures and severe disabilities. Reversal of the normal palmar tilt of the distal radius in the sagittal plane was the most consistent and serious deformity of the bone, and in five patients it was associated with dorsal subluxation of the entire carpus. Correction of the malunion was achieved with a biplanar closing wedge osteotomy without a bone graft. Resection of the ulna head and decompression of the median nerve within the carpal tunnel were done to reduce the likelihood that additional surgery would be required in the future.