gms | German Medical Science

Objectives/Interrogation: Corrective osteotomy of the radius frequently requires significant soft tissue releases to achieve correction. We propose a technique that utilises the releases to create a dorsal curtain of vascularised periosteum over the osteotomy site.

Methods: Surgery is performed through the usual volar approach to the distal radius. Following the usual release of brachioradialis, the periosteum is elevated over the dorsal radius for approximately 2 cm proximal to the osteotomy site. The osteotomy is performed taking care not to damage the dorsal soft tissue envelope. The proximal radius shaft is then pronated to allow further exposure and elevation of the dorsal periosteum which is then separated from the extensor tendons and divided 2cm proximal to the osteotomy and left attached to the distal radial fragment. When the correction is made the distally based periosteal flap hangs down proximally over the osteotomy site, separating the bone graft from the extensors and providing vascularity for the graft.

Results and Conclusions: We have utilised this technique for many years without any significant complication. The correction of the radial deformity is usually straightforward because the technique ensures a thorough dorsal release. The cancellous graft appears to unite and remodel extremely rapidly and patients can usually return to activity at 6 weeks post osteotomy when union is seen.

We recommend the use of this technique for all distal radius osteotomies. It facilitates the requisite soft tissue releases, protects the extensor tendons from the bone graft, and encloses the bone graft with a vascularised layer of periosteum to expedite union and graft incorporation/remodelling.