gms | German Medical Science

Objectives/Interrogation: One of the most common complication following distal radial fractures is malunion, especially when treated with close reduction and cast immobilization. The aim of this study is to review the current literature regarding corrective osteotomies to provide the best evidence of the rule of bone grafting.

Methods: Our MEDLINE literature search included 280 studies using the following key words "Malunited distal radius fracture" and 150 studies using key words "Corrective osteotomy of the distal radius". Inclusion criteria were: Malunited distal radial, extra articular fracture, volar locking plate, use of iliac bone graft (cancellous or corticocancellous), non-use of bone graft. Twelve studies met the inclusion criteria.

Results and Conclusions: Seven of the 12 studies considered, described the use of a graft; the remaining five studies didn't use any graft. Type of malunion was dorsal in most of the studies. The healing time was comparable using the graft or not (mean 12.5 weeks), ranging from 7.5 to 16 weeks. The mean disabilities of the arm, shoulder and hand score improvement was 23 points both in the studies that used the graft and in those not using the graft.

This review demonstrated that corrective osteotomy of extra-articular malunited fractures of the distal radius treated by volar locking plate does not necessarily require bone graft. Maintaining a volar cortical contact following corrective osteotomy is important to ensure the physiological transmission of the force vector through the synthesis, and, in this case, the use of bone graft is not necessarily required. Bone grafts however, remain a valuable support, especially to fill gaps when a large defect is created.