Functional evaluation (PRWE) and radiographic alignment in distal radius corrective osteotomy



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Abstract

BACKGROUND: The malunited distal radius fracture is commonly characterized by loss of volar tilt, radial inclination and radial height. This anatomical mismatch profoundly alters the wrist biomechanics. A corrective osteotomy is designed to precisely restore the alignment of the articular surface.

AIM: This study assessed the functional results and radiographic alignment after distal radius corrective osteotomy.

METHODS: Between January 2020 and October 2025, all distal radius corrective osteotomies performed at a single center were included, with functional outcomes assessed using the Patient-Rated Wrist Evaluation (PRWE) score. Further parameters included articular alignment, fracture type, ulnar styloid fracture presence, time to union, bone graft usage and complications.

RESULTS: In our study 23 patients were included  with a median age of 47.5 years (IQR 34–54). The median follow-up time was 3 years. The median PRWE score observed was 22.5 (IQR 0.75–36.5). Bone union was achieved in a median time of 8.5 weeks (IQR 6–10). Radial inclination improved by a mean of 8.0° (SD 6.5). Ulnar variance improved by a mean of 2.87 mm (SD 2.83), and radial length improved by a mean of 3.9 mm (SD 2.63). Dorsal angulated malunions improved from a mean of 24.6° (SD 12.1) to dorsal angulation of 4.1° (SD 9.8). Five complications necessitating further treatment were diagnosed.

CONCLUSIONS: Corrective osteotomy is an effective treatment for symptomatic distal radius malunion, leading to good functional outcomes and improved radiographic alignment. Our analysis suggests that the PRWE score interpretation benefits from age-group stratification. PRWE results, in severe deformities, remain unaffected by the presence of an associated ulnar styloid fracture. If significant dorsal angulation is present, patient satisfaction improves with even a modest postoperative residual dorsal angulation.

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About the authors

Miodrag Nenad Vranjes

University of Novi Sad; Faculty of Medicine

Author for correspondence.
Email: miodrag.vranjes@mf.uns.ac.rs
ORCID iD: 0000-0002-0642-4942

Department of Orthopaedic Surgery

Serbia, ul. Hajduk Veljkova 3, 21000 Novi Sad, Serbia

Milena Božo Mikić

University of Novi Sad; Faculty of Medicine

Email: milena.mikic@mf.uns.ac.rs
ORCID iD: 0000-0001-8146-1308

Department of Orthopaedic Surgery

Serbia, ul. Hajduk Veljkova 3, 21000 Novi Sad, Serbia

Nemanja Miroslav Gvozdenović

University of Novi Sad; Faculty of Medicine

Email: nemanja.gvozdenovic@mf.uns.ac.rs
ORCID iD: 0000-0001-8501-8389
Serbia, ul. Hajduk Veljkova 3, 21000 Novi Sad, Serbia

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