Sagittal Rotational Malunions of the Distal Radius: The Role of Pure Derotational Osteotomy

Abstract

Sagittal rotational malunion after distal radius fractures was identified in eight patients by the presence of a “hinge” point on the volar cortex on the lateral radiograph, and the ulnar head being shorter than the anterior lip of the radius on the posterior–anterior radiograph. The surgical correction consisted of preplating the distal fragment with a volar locking plate before an osteotomy through the “hinge” point, and correcting the dorsal tilt of the distal fragment. Any dorsal defect was filled with cancellous bone graft from the olecranon. Pain, range of motion and grip all improved. Disabilities of arm, shoulder and hand score changed from 54 to six. Dorsal sagittal tilt improved by 26°, from −23°to +3°. Ulnar variance improved by 3 mm, from +1.5 to −1.5 mm, becoming identical to the opposite side. A pure derotational osteotomy corrected the apparent shortening of the radius and restored the volar tilt.