Bilgin S Sinan, Armangil Mehmet
Department of Orthopedics and Traumatology, Division of Hand Surgery, Faculty of Medicine, Ankara University, Turkey.
Acta Orthop Traumatol Turc. 2012;46(1):30-4. doi: 10.3944/aott.2012.2603.
Early correction of malunion of distal radius fractures may be necessary in young, active patients. The aim of this study was to report the advantages and disadvantages of early correction of distal radius malunion.
Eleven patients (10 male, 1 female; average age 36 years, range: 20 to 54 years) with nascent malunion of distal radius fractures were included in this study. The malunions occurred after initial conservative treatment of unstable distal radius fractures. Mean interval between injury and corrective surgery was 12 (range: 8 to 15) weeks. Two patients had intra- and extra-articular malunion and 9 had an extra-articular malunion. Volar correction was made in seven patients and dorsal correction in four. Results were evaluated radiologically and functionally using the Mayo wrist score.
Bony healing was established after correctional osteotomies at an average of 8 (range: 5 to 16) weeks. The average preoperative dorsal deformity was 28° and was corrected to 4° of volar tilt postoperatively. Patients had a positive ulnar variance with an average of 5 mm initially and less than 1 mm postoperatively. Radial inclination was corrected from an average of 9° preoperatively to an average of 20° and the average postoperative Mayo wrist score was 82.5. Tenotomy of brachioradialis was useful for the correction of radial inclination, especially in old cases. Structural (corticocancellous) grafting was used in one patient. All patients returned to their previous functional level.
Advantages of early corrective osteotomy include anatomic restoration at the original fracture line, a shortened healing period and a decreased need for structural bone grafting. Disadvantages are that the recreation of the original fracture line is technically demanding and patients must be cooperative to achieve a successful outcome.
对于年轻、活跃的患者，可能有必要早期纠正桡骨远端骨折畸形愈合。本研究的目的是报告早期纠正桡骨远端畸形愈合的优缺点。
本研究纳入了11例桡骨远端骨折初期畸形愈合的患者（10例男性，1例女性；平均年龄36岁，范围：20至54岁）。这些畸形愈合发生在不稳定桡骨远端骨折的初始保守治疗之后。受伤至矫正手术的平均间隔时间为12周（范围：8至15周）。2例患者存在关节内和关节外畸形愈合，9例患者存在关节外畸形愈合。7例患者进行了掌侧矫正，4例患者进行了背侧矫正。使用梅奥腕关节评分对结果进行放射学和功能评估。
截骨矫正术后平均8周（范围：5至16周）实现了骨愈合。术前平均背侧畸形为28°，术后矫正至掌侧倾斜4°。患者最初平均尺骨正向变异为5mm，术后小于1mm。桡骨倾斜度从术前平均9°矫正至平均20°，术后梅奥腕关节评分平均为82.5。桡侧腕长伸肌切断术对矫正桡骨倾斜度有用，尤其是在陈旧病例中。1例患者使用了结构性（皮质松质）植骨。所有患者均恢复到先前的功能水平。
早期矫正截骨术的优点包括在原骨折线处实现解剖复位、缩短愈合期以及减少结构性骨移植的需求。缺点是重建原骨折线技术要求高，并且患者必须配合才能取得成功的结果。
