A Survey on the Treatment of Extra-articular Malunions of the Distal Radius

Purpose The purpose of this study is to gain more insight into potential controversial aspects associated with the surgical treatment of extra-articular malunions of the distal radius, leading to an initial step toward establishing guidelines. Materials and Methods We conducted a survey among surgeons experienced in performing corrective osteotomies of the distal radius. The collected data included general information about the respondents, (contra-)indications for surgical treatment, preoperative planning, and technical aspects of the surgical procedures. We performed a subgroup analysis based on surgical experience (operating on <= 5 malunions/year and >5 malunions/year). Results There was a high level of agreement on performing corrective osteotomy based on clinical symptoms and radiographic abnormalities. However, there was no consensus on which specific radiographic abnormalities should be corrected. Moderate consensus was found on the necessity of obtaining an X-ray of the contralateral wrist and a computed tomography (CT) scan of the affected wrist for preoperative planning. Most surgeons prefer using a corticocancellous bone graft from the iliac crest to fill the osteotomy defect. There was no consensus on the duration of postoperative cast immobilization. In our subgroup analysis, we found moderate consensus among the more experienced surgeons that timing was not important for planning of the surgery. Furthermore, the experienced surgeons were more likely to obtain a CT scan of the contralateral side as a template and to use synthetic bone model as replica of the patient's deformity as part of preoperative planning. Conclusion This study gives more insight into the treatment of malunited extra-articular distal radius fractures, but some aspects remain the subject of debate. Future research on these aspects is necessary to optimize the operative treatment of malunited distal radius fractures.