|Beitragstitel||Arthroscopy guided corrective osteotomy for intra-articular distal radius malunion. A case report|
Malunion is the most common complication of distal radius fracture (Prommersberger et al. 2006). A malunion with a step-off of 1 mm or more after an intra-articular distal radius fracture may cause pain and arthritic changes at midterm follow-up (del Piñal et al. 2008).
A 28-years-old man was involved in a bicycle accident against a car (30 km/h), with reception on his right wrist. Plain radiographs did not show any fracture. Two months later, the patient was still suffering of pain by flexion-extension of the wrist. CT-scan and MRI showed an intra-articular partially healed fracture of the palmar lip of the intermediary column of the radius, with a step off of 1 mm in the fossa lunata. Wrist arthroscopy allowed identifying the step-off of the fossa lunata easily. Osteotomy at the appropriate location and later reduction were performed through a modified Henry approach under arthroscopic control to achieve perfect congruity of the articular surface. The fragment was stabilized with 1.5 mm LCP plate (Aptus Hand System).
The JAMAR gripping force at 6 weeks postoperative was at 32 kg (64% of contra lateral side) respectively 44 kg (90% of contra lateral side) at 3 months postoperatively. Range of motion at 3 months postoperative was: flexion-extension 90-0-75° and pro-supination 80-0-90°. The preoperative Patient-Rated Wrist Evaluation (PRWE) score was 40/160 and 3 months postoperative was 13/160.
A 1 mm step-off in intra-articular malunion of the distal radius may be symptomatic and should be corrected. Therefore arthroscopically assisted correction is a valuable technique to control the exact site of the articular osteotomy as well as the reduction of the articular surface in such cases.