Clinical efficacy and wrist joint function evaluation of radial opening osteotomy with bone grafting and closed osteotomy in treating distal radial malunion

CHEN Hu; HUANG Cheng-xiao

doi:10.3969/j.issn.1009-4237.2017.05.007

Abstract：Objective To explore the clinical efficacy and wrist joint function of radial opening osteotomy with bone grafting and closed osteotomy in treating patients with distal radial malunion. Methods Clinical data of 46 cases of distal radial malunion were retrospectively analyzed, who were treated in Dongfeng Hospital of Hubei University of Medicine from Jul.2008 to May 2014.Patients were divided into open group (25 cases) and closed group (21 cases) according to the operation method.The open group underwent open distal radius osteotomy with bone grafting;and the closed group was given closed osteotomy.The operation time,the healing time and the complication of the two groups were recorded.Palmar tilt,ulnar deviation and ulnar variance degree of two groups before and after surgery were measured, and Mayo wrist score was used to evaluate the patients' wrist joint function. Results The operation time[(129.4±13.2)min vs.(135.2±14.8)min] and bone healing time[(2.1±0.4) month vs.(2.2±0.6)months] of the open group and the closed group had no significant difference (P>0.05).The complication rate of the open group was 16.0% (4/25),and was 14.3% (3/21) in the closed group,without statistically significant difference between the two groups(P>0.05).The postoperative palmar tilt was significantly reduced,the ulnar deviation was increased,and the ulnar variance was significantly shortened,with statistical differences in comparison with before operation (P<0.05).The ulnar deviation of the closed group was significantly less than that of the open group [(19.3±2.5)° vs.(24.6±3.7)°],ulnar variance was significantly lower than that of the open group[(0.4±0.1)mm vs.(2.8±0.4)mm, P<0.05].The flexion and extension activities,and the rotational activities of the two groups were significantly improved compared with before surgery (P<0.05).The flexion and extension activity of the closed group was significantly higher than that of the open group [(143.8±17.6)°vs.(114.3±14.7)°, P<0.05], and the rotating activity of the two groups had no statistically significant difference [(157.4±17.1)°vs.(153.7±16.5)°(P>0.05).The excellent and good rate of the open group was 95.2% and was 72.0% in the closed group,and there was no statistically significant difference between the two groups(P>0.05). Conclusion Closed osteotomy can improve distal radial malunion,which is better in ulnar variance,wrist joint activity degree and wrist joint function than the opening osteotomy,and it is worthy of clinical promotion.