Diagnosing the Malunited Distal Radius

Distal radius fractures (DRFs) are among the most common fractures managed by trauma surgeons, accounting for approximately 17% of all fractures managed in an orthopedic trauma unit. Malunion is fairly common following a DRF, with reported malunion rates of 23.6% and 10.6% after closed reduction with casting and surgical management, respectively. Patients with symptomatic malunion after a DRF demonstrate persistent disability at 1 year, 2 years, and 12-14 years after fracture treatment. Malunited DRFs alter the biomechanics of the distal radioulnar joint (DRUJ) as well as the radiocarpal, ulnocarpal, and midcarpal articulations, which may accelerate degenerative changes and produce pain as well as functional impairment. Carefully planned corrective osteotomies can significantly improve the radiographic and functional outcomes in these patients, and, therefore, it is paramount to recognize and appropriately diagnose this condition.