Arthroscopic-Assisted Osteotomy for Intraarticular Malunion of the Distal Radius

Abstract

Classically, the management of the young patient with a step-off in the distal radius has been panarthrodesis. Several pioneer surgeons such as Saffar, Fernández, and others [1, 12, 14, 18–21, 23] opened the door to the possibility of cutting the displaced fragments again and reducing them in an anatomical position. The gold standard for the most common sagittal step-off (anteroposterior) is to carry out the osteotomy through a dorsal route partly under fluoroscopic guidance [1, 14, 19, 20]. For the volar shearing-type malunions, the joint is approached volarly, the external callus removed, and with an osteotome directed toward the joint, the fragment is slowly cut away with the hope that the osteotome follows the original fracture line [19, 20, 23]. All these procedures and others can be grouped under “outside-in osteotomy” techniques, and although good results have been reported, fears of devascularization and inaccurate reduction exist. Fernández [12] considers the technique appropriate only for single line fractures, González del Pino and others [14, 20] used it for the more complex four-part fracture configurations.