THE ROLE OF BONE GRAFTING IN CORRECTIVE OSTEOTOMY OF DORSALLY ANGULATED DISTAL RADIUS FRACTURE MALUNIONS: A SYSTEMATIC REVIEW

Symptomatic distal radius fracture malunions often require corrective osteotomy to restore alignment. It remains unclear whether the use of bone grafting during corrective osteotomy affects post-operative outcomes. This systematic review compares the outcomes of extra-articular corrective osteotomy, with or without use of bone grafting, for dorsally malunited distal radius fractures treated with volar plating. Relevant studies were gathered using three electronic databases (EMBASE, MEDLINE, and CINAHL) from database inception to September 2nd, 2022. Inclusion criteria consisted of randomized controlled trials and observational studies reporting outcomes of extra-articular corrective osteotomy for dorsally angulated distal radius malunions treated with volar plating. Studies involving volar deformities, intra-articular osteotomies, dorsal plating, pediatric patients, open fractures, animal and cadaveric models were excluded. From an initial 1504 titles and abstracts that were eligible for screening, a total of 13 studies, with 14 intervention arms were included. These interventions consisted of corrective osteotomies in 236 patients with malunions using either: autograft (6 studies), synthetic bone grafts (2 studies), allograft (1 study) or no grafting (5 studies). The overall union rate after corrective osteotomy was 97% and the mean time-to-union was 12 weeks. Larger corrections of dorsal tilt and ulnar variance were seen in the autograft and allograft groups. Complication and revision rates were highest in the synthetic group, 45% and 26.3% respectively. Grafting in extra-articular corrective osteotomy for dorsally angulated distal radius malunions treated with volar plating is not associated with an improved union rate in the literature. However, larger corrections of dorsal angulation and ulnar variance were performed in the autograft and allograft bone grafting groups and resulted in similar union rates. Synthetic bone grafting was associated with the highest complication and revision rates. Future comparative prospective trials are required to assess whether bone grafting warrants consideration in more advanced deformities.