Dorsal and Palmar Osteotomy for Malunion of Distal Radius with Iliac Crest Bone Graft

8 Dorsal and Palmar Osteotomy for Malunion of Distal Radius with Iliac Crest Bone Graft

Indications

Wrist pain, limited wrist motion (especially flexion), and limited forearm rotation
Deformity of radius
Dorsal tilt of articular surface
Loss of radial length due to shortening from both dorsal tilt of the radius and shortening of the palmar cortex

Preoperative Evaluation

Template: must decide whether to correct dorsal tilt alone or correct dorsal tilt and lengthen dorsal and palmar cortex

Discuss the possibility that the radius cannot be restored to its anatomical length. This may create the need to perform a resection of the distal ulna to restore forearm rotation.

Technique

Dorsal approach between third and fourth extensor compartment internal via Z-lplasty of retinaculum (Fig. 8-1)
Place spinal needle into radiocarpal joint to show plane of the articular surface.
Drill K-wire into dorsal aspect of radius at expected level of osteotomy parallel to spinal needle. Check position with fluoroscopy.