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Preservation of Distal Radioulnar Joint Function in Distal Radius Malunion Correction
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ABSTRACT
An intact distal radioulnar joint is essential in hand function. Previous techniques used to correct distal radius malunions disrupt the functional integrity of the distal radioulnar joint. The authors adopted a surgical technique to preserve the distal radioulnar joint, in correction of distal radius malunions. The technique includes radius osteotomy and bicorticocancellous bone graft with ulnar diaphyseal shortening.
Medical records of 21 patients were reviewed to compare the pre- and postoperative functional parameters in patients whose distal radioulnar joint was preserved. Grip strength, forearm pronation/supination, wrist flexion/extension, patient reported improvement in pain, radiographic symptoms, and work status were compared.
Of the 21 patients, 2 were restricted to one-handed duty, and 19 (90%) were released without restrictions at follow-up. The increase in grip strength ranged from -5 to 75 lbs, with an average increase of 33 lbs. The range of increase was –20% to 320% with an average increase of 150% of the preoperative value. One patient had reduced grip strength postoperatively.
Pronation improvement ranged from 5º-60º, with an average improvement of 33º. Compared to the preoperative values, the range of improvement was 5%-200% with an average improvement of 83%. Supination improvement ranged from –15º to 70º, with an average improvement of 28º. Compared to the preoperative values, the range of improvement was –42% to 200% with an average improvement of 79%. One patient had decreased supination postoperatively.
Flexion improvement ranged from –20º to 65º, with an average improvement of 20º. Compared to preoperative values, the range of improvement was –30% to 180% with an average improvement of 46%. Two patients had reduced flexion postoperatively.
Extension improvement ranged from –10º to 55º, with an average improvement of 19º. Compared to preoperative values, the range of improvement was –40% to 300% with an average of 70%. Two patients had reduced extension postoperatively.