Repair of Distal Radial Malunion with Volar Plating

Osteotomy of a malunited distal radius fracture is indicated for a healed fracture, which has already produced an unfavorable outcome, or one that is likely lead to a poor clinical or radio- graphic result. Historically, osteotomies of the distal radius have been performed for extra-articular fracture malunions using a dorsal buttress plate and iliac crest bone grafting (1). Dorsal plating has been associated with tendon adhesions (2) and iliac crest bone grafting has donor site morbidity (3). A less invasive osteotomy technique is now possible that offers improvements over the established technique. Advances with the new osteotomy technique are attributable to improved implants, new surgical techniques, and the recent availability of synthetic bone graft substitutes. This chapter will focus on use of a volar surgical approach and volar plate fixation when performing osteotomy for malunion of the distal radius. Both extra-and intra-articular malunion will be considered in this chapter.