PURPOSE:To report outcomes of patients with distal radius fracture malunions treated with corrective osteotomy and orthogonal volar and radial "90-90" plate fixation. METHODS:We performed a retrospective review of all patients who underwent distal radius corrective osteotomy and 90-90 fixation from January 2008 through December 2014. Demographic data, injury history, prior treatments, and clinical examination values were recorded. Preoperative radiographic measurements were used to classify the type and severity of deformity. The outcomes were patient-reported pain levels, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) functional scores, and radiographic outcomes. Secondary outcomes, including complications and the need for additional surgeries, were also noted. RESULTS:Thirty-nine cases (31 extra-articular, 8 combined intra- and extra-articular) were included. At mean postoperative follow-up interval of 4 years, significant improvements were observed clinically in wrist flexion-extension arc, grip strength, pain, and Quick Disabilities of the Arm, Shoulder, and Hand scores. Radiographically, significant postoperative improvements were noted in ulnar variance, radial inclination, intra-articular stepoff, and radial tilt, with volarly and dorsally angulated malunions corrected to 9° and 7° of volar tilt, respectively. Twelve patients (31%) underwent additional surgery, the most common being plate removal in 7 patients, 3 of which involved removal of the radial plate. CONCLUSIONS:For patients with symptomatic malunion of the distal radius, corrective osteotomy with 90-90 plate fixation is an effective treatment option for improving pain and restoring function for both volarly and dorsally angulated malunions, including malunions with an intra-articular component. TYPE OF STUDY/LEVEL OF EVIDENCE:Therapeutic IV.

译文

目的:报告采用矫正截骨术和正交掌和and骨“ 90-90”钢板固定治疗的distal骨远端骨折畸形畸形患者的预后。
方法:我们对从2008年1月至2014年12月进行了distal骨远端远端截骨术和90-90固定的所有患者进行了回顾性研究。记录了人口统计学数据,损伤史,既往治疗和临床检查值。术前影像学检查用于对畸形的类型和严重程度进行分类。结果是患者报告的疼痛程度,手臂,肩膀和手的快速残疾(QuickDASH)功能评分以及影像学结果。还注意到次要结果,包括并发症和需要额外手术的情况。
结果:共纳入39例(关节外31例,关节内外8例)。术后平均随访间隔为4年,临床上观察到腕部屈伸弧度,握力,疼痛以及手臂,肩部和手部快速残疾的得分有明显改善。影像学检查发现,尺侧方差,radial骨倾斜,关节内脱位和radial骨倾斜有明显的术后改善,手掌和背角畸形畸形分别矫正为掌侧倾斜9°和7°。 12例患者(占31%)接受了额外的手术,其中最常见的是7例患者中的钢板切除,其中3例涉及了radial骨钢板的切除。
结论:对于有症状的远端radius骨畸形患者,采用90-90钢板固定矫正截骨术是一种有效的治疗选择,可改善掌侧和背角畸形畸形,包括关节内畸形畸形的疼痛并恢复其功能。
研究类型/证据级别:治疗IV。

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