Distal Radius Malunion


Malunion with associated dysfunction is a common complication of distal radius fracture. The deformity may be extra-articular, characterized by loss of radial length and abnormal metaphyseal angulation, or intra-articular, involving either the radiocarpal joint or the distal radioulnar joint, or both. Dysfunction can be loss of mobility, loss of strength, loss of functional use of the hand, or pain. Deformity does not always result in dysfunction, however, particularly in older patients with lower functional demands; therefore, impairment of function rather than radiographic deformity is the reason to treat a distal radius malunion. Careful radiographic evaluation is an essential step in the preoperative workup of patients with distal radius malunion and permits the measurement of key radiographic parameters that form the basis of surgical planning. There are no absolute surgical indications for distal radius malunion; therefore, in deciding treatment, the severity and duration of symptoms and the risk of progression should be weighed against the risks of surgery. Nonsurgical treatment involving physical therapy, splinting, and other modalities may improve function to a level at which the patient may not need surgery. Surgical intervention usually consists of corrective osteotomy, bone grafting, and fixation. This article describes standard opening wedge osteotomies commonly used in correction of radial malalignment.

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