7 Extension Osteotomy for the Malunited Distal Radius

• Wrist pain, limited wrist motion (especially flexion), and limited forearm rotation
  
• Deformity of the radius (Fig. 7-1)
  
• Loss of radial length due to dorsal tilt of articular surface

Preoperative Evaluation

• Template: must decide whether to correct dorsal tilt alone or correct dorsal tilt and lengthen dorsal and palmar cortex
  
• Prepare the patient for the possibility of a resection of the distal ulna if a block to forearm rotation persists after restoring the shape of the radius, or if there is arthritis of distal radioulnar joint (DRUJ).

Figure 7-1

Technique

• Use dorsal approach to the radius.
  
• Remove the extensor pollicis longus (EPL) from the third compartment and retract radially.
  
• Z-lengthen the retinaculum of the fourth compartment and retract the extensor digitorum communis (EDC) tendons ulnarly (Fig. 7-2).
  
• 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 (Fig. 7-3).

Figure 7-2

Related posts:

Intra-articular Fractures of the Distal Radius Treated with Dorsal Plate Nonunion of an Ulnar Neck Fracture Percutaneous Screw Fixation of Scaphoid Fractures Flexor Carpi Radialis Tendon Stabilization of the Scapholunate Joint (Brunelli Procedure) Closed Reduction and Internal Fixation of Bennett’s or Rolando’s Fractures Capitate Shortening with Capitohamate Fusion

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