gms | German Medical Science

Objectives/Interrogation: The goal of the work was to improve treatment of patients having distal radius epyphysis/metaphysis region malunion combined with persistent wrist joint (WJ) contractures.

Methods: Research materials and methods. We performed a retrospective investigation of 67 patients with distal radius ephyshis/metaphysis (DREM) malunion during the period of 2011 to 2017. The patients were 12 men and 55 women, aged 18 to 78. Time period elapsed after injury was 1.5 months or more (the average time was 79±18.7 days).

The admission of patients for surgical treatment revealed: all 67 patients had a significant deterioration in their quality of life due to the weakness of the hand grips, pain when performing hand grips and axial load on the forearm. The post-traumatic deformities of the DREM were accompanied by 100% contracture in wrist joint (WJ). Flexion-extensor movement had 74 degrees limitation (52% of normal state) in average. Before surgery, control radiographs had determined: the fusion of radius was shorter than 3 mm, there also were radius articular surface axis violation with displacement of wrist bones (wrist collapse), subluxation or dislocation of ulna head. 48 (71.6%) cases revealed osteoporosis of distal forearm and wrist bones.

All 67 patients underwent radial bone osteotomy at deformation apex using the distraction method. On 6-7th day after the osteotomy, bone fragments reposition was gradually carried out (1 mm per day) using the distraction device. Distraction regenerate was formed and position of the radius fragments was stabilized after completing the restoration of articular surfaces of radius and ulna. The time of treatment in the device was 7-9 weeks.

Results and Conclusions: Immediate and long-term results (6 months or more after surgery) were studied in all 67 patients according to the DASH system. (Decrease from 88 to 23 points). Fusion of the radius in correct position was achieved in 63 cases out of 67 (94.0%), complete restoration of movement amplitude in wrist joint was achieved in 61 case (91.0%). In 3 cases, satisfactory results were obtained, and one case were bad due to premature removal of the device.Restoration of length and axis of the radius provides the elimination of WJ contractures. Distraction technologies allow simultaneous restoration of radius anatomy and WJ and forearm joint movements. The distraction method is effective in treatment of patients with DREM malunions in combination with DOUH, persistent WJ contractures.