Department of Trauma and Orthopaedic Surgery, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park, Huntingdon, Cambridgeshire, United Kingdom.
Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedic Surgery Diana, Princes of Wales Hospital Scartho Road, Grimsby, Lincolnshire United Kingdom.
Acta Orthop Traumatol Turc. 2021 Aug;55(4):355-361. doi: 10.5152/j.aott.2021.20203.
The aim of this study was to present a novel pre-planned distal radius sliding rotational osteotomy that can address all deformities in dorsally angulated distal radius malunion through a volar approach using a locking plate. Four consecutive adult women with symptomatic dorsally angulated distal radius malunion were surgically treated with sliding rotational osteotomy. All the patients underwent preoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores, a series of radiography, and a course of physiotherapy. The osteotomy was planned on 2 orthogonal radiographs, and the surgery was performed through a volar approach. A back slab was applied post-operatively for two weeks and changed to a removable splint for further four weeks. Gentle active movements out of splint were permitted at two weeks, and formal physiotherapy at six weeks post-operatively. Radiographs were taken immediately post-operatively, at three months, and with DASH scores at a mean final follow-up of 18 months. On radiographic evaluation, all the deformities were corrected within an acceptable range. The mean increase in radial inclination was 6.5 degrees. The mean gain in radial height was 2.95 mm. The mean improvement in ulnar variance was 4.25 mm. The mean change from dorsal to volar angulation was 23 degrees, and the mean improvement in the DASH score was 45.25 at a mean final follow-up of 16 months. All osteotomies achieved bony union within 3 months postoperatively. None of the patients required metalwork removal, and no complications were observed. Sliding rotational osteotomy appears to be a safe technique to correct deformity and improve function in patients with dorsally angulated, shortened, and radially deviated distal radius malunion.
本研究旨在提出一种新的桡骨远端滑动旋转截骨术，通过掌侧入路使用锁定板可解决所有背侧成角的桡骨远端愈合不良的畸形。4 例连续的成年女性，有症状的背侧成角的桡骨远端愈合不良，采用滑动旋转截骨术进行手术治疗。所有患者均进行术前腕关节功能障碍（DASH）评分、一系列影像学检查和物理治疗。截骨术在 2 个正交 X 线片上进行规划，通过掌侧入路进行手术。术后应用背侧夹板固定 2 周，然后更换可移动夹板固定 4 周。术后 2 周即可在夹板外进行温和的主动活动，术后 6 周开始正式的物理治疗。术后立即拍摄 X 线片，术后 3 个月和平均最终随访 18 个月时进行 DASH 评分。影像学评估显示，所有畸形均在可接受范围内得到矫正。桡骨倾斜度平均增加 6.5 度。桡骨高度平均增加 2.95mm。尺侧骨间距离平均增加 4.25mm。背侧至掌侧成角平均改善 23 度，DASH 评分平均改善 45.25 分，平均最终随访 16 个月。所有截骨术后均在 3 个月内达到骨性愈合。无患者需要取出内固定，无并发症发生。滑动旋转截骨术似乎是一种安全的技术，可以矫正畸形并改善背侧成角、缩短和桡侧偏斜的桡骨远端愈合不良患者的功能。
