Z-Corrective Osteotomy in Malunited Extra-Articular Fractures of Distal Radius

The Role of Bone Grafting in Corrective Osteotomy of Distal Radius Malunions

Background  It remains unclear whether bone grafting is required during corrective osteotomy of the distal radius. The goal of this systematic review is to determine the union, revision, and complication rates of bone grafting techniques associated with extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating. Questions  Is bone grafting in distal radius corrective osteotomy associated with increased rates of bone union and reduced rates of revision surgery and complications? Materials and Methods  A comprehensive search of the MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases was completed for studies reporting clinical outcomes of extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating. Results  A total of 13 studies, with 14 intervention arms and 236 patients, were included. Bone grafting techniques consisted of autograft (6 studies, n  = 93), synthetic bone grafts (2 studies, n  = 38), allograft (1 study, n  = 14), or no grafting (5 studies, n  = 91). The overall union rate was 97%, and the mean time-to-union was 12.0 weeks. Larger corrections of dorsal tilt and ulnar variance were performed in the autograft and allograft groups. Complication and revision rates were highest in the synthetic group, 45 and 26.3% respectively. Conclusion  Grafting in extra-articular corrective osteotomy for dorsally angulated distal radius malunions treated with volar plating is not associated with an improved union rate in the literature. However, larger corrections were achieved in both the autograft and allograft groups compared to the no-graft and synthetic groups, resulting in similar union rates. Synthetic bone grafting was associated with the highest complication and revision rates. Future comparative prospective trials and proper documentation of whether cortical contact was present or absent are required to assess whether bone grafting warrants consideration in more advanced deformities. Level of Evidence  IV.

Functional outcome of 2-D- and 3-D-guided corrective forearm osteotomies: a systematic review

We performed a systematic review to compare conventional (2-D) versus 3-D-guided corrective osteotomies regarding intraoperative results, patient-reported outcome measures, range of motion, incidence of complications and pain score. PubMed (MEDLINE), Embase and Cochrane CENTRAL were searched, and 53 articles were included, reporting 1257 patients undergoing forearm corrective osteotomies between 2010 and 2022. 3-D-guided surgery resulted in a greater improvement in median Disabilities of the Arm, Shoulder and Hand (DASH) score (28, SD 7 vs. 35, SD 5) and fewer complications (12% vs. 6%). Pain scores and range of motion were similar between 3-D-guided and conventional surgery. 3-D-guided corrective osteotomy surgery appears to improve patient-reported outcomes and reduce complications compared to conventional methods. However, due to the limited number of comparative studies and the heterogeneity of the studies, a large randomized controlled trial is needed to draw definitive conclusions.Level of evidence: III.