When “Acceptable” Isn't Enough: Functional Outcomes After Corrective Osteotomy for Subtle Malunion of the Distal Radius

Abstract Malunion of a distal radius fracture may lead to persistent pain and functional limitation. Traditionally, the indication for corrective osteotomy is based on two-dimensional radiographic criteria. However, a subset of patients with radiographically subtle malunions—defined as cases in which all radiographic parameters fall within the acceptable limits outlined by current guidelines—may still experience significant symptoms that impair activities of daily living or occupational performance. Notably, rotational deformities are typically not evaluated, despite their potential clinical relevance. The objective of this retrospective cohort study was to evaluate the clinical outcomes of corrective osteotomy using a three-dimensional-printed patient-specific implant in patients with a minimal malunion of the distal radius. Surgical outcomes were assessed using patient-reported outcome measures, including the Patient-Rated Wrist/Hand Evaluation (PRWHE), as well as clinical evaluation of distal radioulnar joint (DRUJ) stability. Fourteen patients were included. The PRWHE improved from 72 (interquartile range [IQR]: 56, 81) to 35 (IQR: 8, 57), p = 0.004, after a follow-up of 11 months (IQR: 10, 13). Preoperatively, 12 patients had DRUJ instability. Postoperatively, only one patient exhibited asymptomatic DRUJ instability. No postoperative complications were observed. Patients with subtle malunions of the distal radius may benefit from corrective osteotomy. Standard guideline parameters may not be sufficient to identify all patients who could benefit from surgical intervention. Moreover, DRUJ instability following a distal radius fracture should be considered a manifestation of malunion until proven otherwise. IV.