Introduction: The most frequent distal radius malunion is secondary to a Colles’ fracture with distal radius shortening, loss of radial inclination and dorsal angulation. This deformity generates alterations in the transmission of forces in the wrist with adaptive carpal instability, osteoarthritis in the radiocarpal, midcarpal and distal radioulnar joints with ulnocarpal impaction syndrome, which requires surgical treatment. There are multiple techniques for distal radius osteotomies. The aim of this study is to present a surgical technique, the L-shaped osteotomy for distal radius malunion .
Methods: Surgical technique: The distal radius deformity is studied and the inverted L-shaped osteotomy is marked on the distal radius. It is carved the long branch of the “L” parallel to the articular surface at a distance of between 5 and 20 mm from the joint, and the short branch is carved vertically, following a groove that is formed after the radius malunion, between the metaphysis and base of the radial styloid, tangential to the healthy cortical bone of the radial diaphysis.
Discussion: This procedure is a modification to the usual technique that allows preserving bone stock in the radial column of the radius metaphysis, reducing the size of the gap, improving the contact points between both fragments of the osteotomy, by a simple distraction of the focus of the osteotomy, but also a sliding of the external cortical of the radius on the metaphysis.
Conclusion: The modification of the technique with an L-shaped osteotomy is a simple and reproducible technique, it is more anatomical and preserves more bone stock than in the conventional technique. It allows correction in all planes, reduces the requirements for structural bone grafting, allowing surgery to be performed under a regional anesthetic block and on an ambulatory procedure.
Distal radius fracture, Distal radius osteotomy, Distal radius malunion, Bone graft