Treatment of Distal Radial Malunions Using a Minimally Invasive Technique versus Plating: A Comparative Study

Treatment of Distal Radial Malunions Using a Minimally Invasive Technique versus Plating: A Comparative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Treatment of Distal Radial Malunions Using a Minimally Invasive Technique versus Plating: A Comparative Study Hao Yao, Jingqiao Li, Xu Zhang, Bing Wang, Xuewu Zhou, Xiaoliang Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7436374/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to compare the efficiency of a minimally invasive technique versus conventional plating fixation for the treatment of distal radial malunions in patients with diabetes. Methods From January 2015 to January 2023, 68 diabetes patients with distal radial malunions were treated. Among them, 33 patients were treated with minimally invasive technique through a 5-mm incision, and 35 patients were treated with conventional a volar locking plate and screw system. Intraoperative assessments included blood loss. Postoperative assessments included infection and bone healing. Assessments at the final follow-up included aesthetics, satisfaction, and Mayo Wrist Score. Results Of the minimally invasive technique group, the blood loss was 33 ± 5 ml. The time of bone healing was 6.5 ± 1.6 weeks. No wound infection occurred. Pin site infection occurred in 2 patients, which was cured with pin care. The follow-up period was 28.3 ± 4.4 months. The patient aesthetics and satisfaction scores were 10 ± 1 and 9 ± 1, respectively. The Mayo Wrist Score was 94 ± 5, including 29 excellent and 4 good results. Of the plating group, the blood loss was 66 ± 11 ml. Deep abscess occurred in 3 patients, and wound cellulitis occurred in 2 patients. The infection was treated with wound care. One infection developed osteomyelitis. There were significant differences between the groups in complication rates (6% vs 45%, P < 0.05). Bone healing was achieved in all patients after 6.4 ± 1.7 weeks. The follow-up period was 29 ± 4.6 months. The Mayo Wrist Score was 86 ± 4, including 18 excellent, 10 good, 6 fair, and 1 poor result. The patient aesthetics and satisfaction scores were 9 ± 1 and 10 ± 1, respectively. There were significant differences in wrist pain, infection, wrist function, aesthetics score, and satisfaction score (P < 0.05). Conclusions Distal radial malunions can be treated with the minimally invasive technique through a small incision. As an alternative technique of conventional volar plating, the minimally invasive technique may be associated less infection and total complications. Wrist immobilization may produce equal function, compared to open surgery with injuries to the wrist ligaments and capsule. Level of Evidence Therapeutic study, Level IVa. minimally invasive technique distal radial malunion plating K-wire bone healing Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 INTRODUCTION Distal radius fractures account for up to 17% of all extremity fractures 1 . Distal radial malunion (DRM) is the major complication, reported in 33% of cases, especially those treated conservatively 2 . DRMs affect wrist biomechanics and can result in pain, limited motion, and functional limitations 3 . Surgical correction of DRM is a challenging problem with unpredictable clinical outcomes due to more complications. A standard definition of DRM has not been established 4 . Usually, DRMs are defined separately. Ali et al 5 defined DRMs as radial inclination of ≤ 15°, dorsal tilt of ≥ 10°, or ulnar variance of ≥ 3 mm. They found that patients who sustain DRMs at age 18 to 65 years are more likely to have adverse activity limitations and pain. DRMs with dorsal tilt > 10°, radial shortening > 3 mm, or intra-articular displacement > 2 mm indicate the need for a discussion regarding the benefits of surgical correction 6 . Currently, there are no absolute surgical indications for DRMs 7 . Consideration should include patient age, wrist pain, grip weakness, loss of mobility, possibility of infection, etc. The conventional surgery is performed though a 5- to 10- cm volar approach 8 . After osteotomy, the fixation was achieved with a volar plate and screw system. The approach allows good visual approximation of the volar cortex, allowing the lift maneuver to aid in reduction. However, struct bone grafting is often needed to decrease the risk of nonunion and possible supporting failure 9 . Owing to the increased ulnar variance after osteotomy, the procedure may be coupled with an ulnar head resection. Moreover, bone grafts are often needed for reshaping properly. Graft loosening, migration, and absorption, as well as poor bone quality may lead to supporting failure, redisplacement, and unpredictable outcomes 10 . Future implant removal may be required in some patients. This prospective study aimed to compare the efficiency of minimally invasive technique (MIT) and conventional volar plating for the treatment of DRMs. We hypothesized that MIT showed better radiographic outcomes with less complications than plating. MATERIALS AND METHODS This study was performed in accordance with the Declaration of Helsinki. The institutional review boards of the Yichang Central People’s Hospital of the First Clinical Medical College of the Three Gorges University reviewed the study and approved the protocol. Informed consent was obtained from each patient. Clinical trial number: pending. From January 2019 to June 2022, 76 patients (76 wrists) with DRMs were selected based on the eligibility criteria as follows: (1) age ≥ 18 or < 50 years; (2) original AO/OTA (AO Foundation and Orthopaedic Trauma Association) Classification types A2 and A3 fractures; and (3) types C2 and C3 fractures without displacement of articular surface. Patients younger than 18 years were excluded because the malunion could be corrected with growth. We excluded types C1 and C2 fractures with displacement of articular surface because reduction through a small incision was difficult (n = 4). We excluded type A1 fractures because they did not involve the distal radius (n = 2). We excluded types B2, B3, and C3 fractures due to a complex procedure for a minimally invasive technique (n = 2). Patients who declined to undergo the surgery were excluded. Other exclusion criteria included combined triangular fibrocartilage complex injuries, pathologic fractures, uncooperative adults, infection, diabetes, rheumatoid arthritis, or gout. Osteotomy plane was confirmed based on preoperative X-rays and CT images (Fig. 1 A, B, C, D). Finally, 68 patients were randomly allocated to the DEF group (n = 33) and plate fixation group (n = 35). MIT The operation was performed under general or brachial plexus anesthesia with tourniquet control. We marked the osteotomy level using fluoroscopy. We made a 5-mm incision between the extensor pollicis longus and extensor digitorum communis, 1 cm distal to the osteotomy level (avoid late skin laceration during distraction) (Fig. 2 A). Through this small incision, we created multiple holes in different directions using a 1.0 to 1.2 mm K-wire in an osteotomy plane (Fig. 2 B). We performed osteotomy by hammering a small seating chisel. During this procedure, care was taken to support the chisel with the hand and forearm, avoiding deep insertion to injure the tendons and nerves (Fig. 3 C). Then, we rotated the chisel to fracture the radius. A 2.5-mm pin was inserted manually, 1 mm distal to the fracture site (avoid skin laceration during distraction), and slid into the fracture site. The pin was continuously passed through the fracture site and exserted the dorsal skin incision. By pulling both ends of the pin distally, we distracted the distal bone fragment to restore radial height, and meanwhile to restore volar tilt and radial inclination. To maintain the reduction, one or two 3.0-mm Steinmann pin was provisionally introduced, obliquely from distally to proximally (Fig. 3 A, B). Satisfactory reduction was confirmed using fluoroscopy. Then, we introduced one or two 3.0-mm transverse bicortical pins into the proximal fragment. Keep two to three 3.0-mm pins in the distal fragment. satisfactory reduction and pin position were confirmed using fluoroscopy. The pins were bent toward the fracture site about 2 cm away from the skin. We mixed Monomer (liquid) and polymer (powder) of bone cement (Single dose 40 g; PALACOS®, Hanau, Germany). When the bone cement viscosity changed over time from a runny liquid into a dough-like state, we applied it to the bent pin ends and waited for it to harden into a solid material. Thus, we created a frame to prevent pin migration. Satisfactory reduction and pin position were confirmed using fluoroscopy. The void at the fracture site was filled with iliac crest autografts through a 4.5-mm drill guide at the small incision. The wrist was immobilized with a joint-spanning external fixator (four 3.5 Schanz pins; Shuangyang Medical Instrument Co., Ltd. Zhangjiagang City, China.) to reinforce maintenance of radial height (Fig. 3 C, D). After surgery. X-rays were taken every 2 weeks until bone healing occurred (Fig. 4 A, B, C). The cement pin frame was protected using a dorsal short-arm splint or cast. The external fixator was removed 6 weeks after surgery, which allowed wrist movement. After bone healing, the pines were cut off and the frame and pins were removed. Plating The operation was performed under general or brachial plexus anesthesia with tourniquet control. Osteotomy and fixation were done through the 7-cm volar approach as described by Opel et al 12 . Outcome Evaluation We assessed the palmar tilt of the radius on lateral X-rays, and radial inclination, heigh, and ulnar variance on posteroanterior X-rays 13 (Fig. 4 D). We assessed pin site infection based on the clinical symptoms 14 . We assessed wrist pain intensity using the visual analog scale (VAS) 15 . Active range of motion of the wrist was measured using a goniometer 16 . All measurements were compared to those on the opposite side. Grip strength of the hand was assessed using a Baseline hydraulic hand dynamometer (Fabrication Enterprises Inc., White Plains, NY) 17 . We assessed pronation torque using the McConkey method at 5 positions of rotation (90° of supination, 45° of supination, neutral, 45° of pronation, and 80° of pronation) 18 . To exclude any discrepancy between dominant and nondominant hand strength, we based the scores for analysis on the premise that the grip strength was 15% higher at the dominant side compared to the nondominant side; and no correction was required for left-handed patients 19 . Patients rated wrist pain and hand numbness using the 10-cm visual analogue scale 20 . We used the Mayo Wrist Score to assess wrist function (90–100, excellent; 80–89, good; 60–79, satisfactory; < 60, poor) 21 . Aesthetics and patient satisfaction were assessed using the 10-cm visual analog scale 22 . Statistical Analysis Quantitative variables were described as mean and standard deviation for symmetric distribution or median and interquartile range for asymmetric distribution. We used Pearson’s chi-square test to compare categorical variables and Mann-Whitney U test to symmetric and asymmetric distribution. A P < 0.05 was considered statistical significance. The collected data were analyzed with the Statistical Package for Social Sciences 20.0 (SPSS, Inc., Chicago, Ill). RESULTS The MIT group included 33 patients (33 upper limbs). There were 14 male patients and 19 female patients. The age of DEF patients was 53.1 ± 13.6 years (range, 39–66 years) (Table 1 ). The time interval between injury and surgery was 8.75 ± 4.76 months. The preoperative glucose level was 6.5 ± 1.8 mmol/L. There were types A2 (n = 18), A3 (n = 9), C1 (n = 4), and C2 (n = 2) original distal radius fractures. The intraoperative blood loss was 33 ± 5 ml. Preoperatively, the radial height, palmar tilt, radial inclination, and ulnar variance were 12 ± 1 mm, 15°±5°, 23 ± 4°, and 0.6 ± 0.7 mm, respectively. The data after bone healing were 12 ± 1 mm, 15°±5°, 22°±4°, and 0.6 ± 0.7 mm, respectively. There were no significant differences between the data measured immediately after surgery and at bone healing (P = 0.06; 0.05;0.06; and 0.07, respectively). The time of bone healing was 6.5 ± 1.6 weeks. We compared the X-rays taken immediately after surgery and after bone healing. The results showed the fragments remained in place without significant redisplacement (P > 0.05; Table 2 ). Mild pin site infection occurred in 2 patients, which healed by pin site care. Neither wire loosening nor fixation failure was found. No osteomyelitis was found. Bone healing was achieved in all patients after 6.5 ± 1.6 weeks. The follow-up period was 28.3 ± 4.4 months. Active wrist movement and hand grip strength were similar to those on the opposite side. The Mayo Wrist Score was 94 ± 5, including 46 excellent and 7 good results (Table 3). The patient aesthetics and satisfaction scores were 10 ± 1 and 9 ± 1, respectively. Table 1 Preoperative demographics for 68 patients with distal radial malunion. MIT Plating (n = 33) (n = 35) t P Age (year, range) 53.1 ± 13.6 (39–66) 52.3 ± 14.2 (38–65) 1.83 0.07 Sex (m:f) 14 : 19 13 : 22 0.5 0.71 Body mass index 31.3 ± 4.33 30.9 ± 4.24 -1.87 0.13 Smoking (n) 7 6 0.88 0.09 Side (l: r) 25 : 28 27 : 24 0.33 0.8 Dominant hand (n) 17 19 0.17 0.9 Cause (n) Fall 19 15 0.24 0.82 Road traffic accident 6 11 Sports 4 5 Machinery 3 2 Others 1 2 Duration from injury to surgery (month) 8.75 ± 4.76 8.17 ± 4.15 0.25 0.09 Preoperative X-ray parameter Intraarticular fracture (n) 4 8 0.33 0.8 Extra-articular fracture (n) 29 27 Loss of radial heigh (mm) 6 ± 2 6 ± 2 -0.49 0.63 Palmar tilt (°) 27 ± 5 26 ± 5 1.26 0.21 Radial inclination (°) 15 ± 4 16 ± 6 -0.62 0.54 Ulnar variance (mm) 4 ± 1 4 ± 1 -0.76 0.45 Original AO/OTA (n) A2 18 17 0.89 0.43 A3 9 11 C1 4 6 C2 2 1 Operative time (minute) 44 ± 7 65 ± 13 -2.74 < 0.01 Blood loss (ml) 33 ± 5 66 ± 11 -1.62 < 0.01 Infection (n) Deep abscess 0 3 1.33 < 0.01 Cellulitis 0 2 Pin site 2 0 Donor site 0 0 Bone healing (week) 6.5 ± 1.6 6.4 ± 1.7 0.22 0.83 Implant removal surgery (n) 0 18 Final follow-up (month) 28.3 ± 4.4 29 ± 4.6 -1.543 0.13 Data are shown as mean ± standard deviation; MIT, minimally invasive technique; AO/OTA, AO Foundation and Orthopaedic Trauma Association. Table 2 Radiological parameters of 68 distal radial malunions. MIT Plating (n = 33) (n = 35) t P Radial height (mm) IAF 12 ± 1 11 ± 2 2.16 0.05 Bone healing 12 ± 1 11 ± 2 5.21 < 0.01 t 1.938 5.07 P 0.06 < 0.01 Palmar tilt (°) IAF 15 ± 5 14 ± 5 1.95 0.06 Bone healing 15 ± 5 13 ± 5 2.13 0.04 t 1.95 6.26 P 0.05 < 0.01 Radial inclination (°) IAF 23 ± 4 21 ± 3 0.68 0.5 Bone healing 22 ± 4 21 ± 4 2.05 0.04 t 1.94 2.3 P 0.06 < 0.01 Ulnar variance (mm) IAF 0.6 ± 0.7 0.7 ± 0.6 -0.02 0.99 Bone healing 0.6 ± 0.7 1 ± 1.2 -5.32 < 0.01 t -1.85 -2.37 P 0.07 0.02 Data are shown as mean ± standard deviation; MIT, minimally invasive technique; IAF, immediately after surgery. Table 3. Outcomes at the final follow-up. MIT Plating (n = 33) (n = 35) t P Active ROM (°) Flexion 72 ± 4 70 ± 6 0.75 0.13 Extension 62 ± 5 58 ± 8 1.22 0.22 Radial deviation 24 ± 8 26 ± 7 0.23 0.89 Ulnar deviation 17 ± 7 15 ± 6 -1.52 0.07 Pronation 74 ± 15 78 ± 18 5.22 0.12 Supination 81 ± 10 84 ± 12 0.67 0.82 Grip strength (%) * 95 ± 3 96 ± 4 4.22 0.19 Supination torque (%) † 90° of supination 89 ± 7 91 ± 6 -1.26 0.08 45° of supination 93 ± 7 94 ± 5 2.33 0.18 Neutral 92 ± 3 93 ± 4 0.15 0.36 45° of pronation 93 ± 5 95 ± 6 0.56 0.47 80° of pronation 95 ± 5 97 ± 3 -0.28 0.09 Complication Wrist pain (MWS) 0 ± 0 1 ± 1 2.33 < 0.01 Hand numbness (VAS, cm) 0 ± 0 0 ± 0 1.59 0.25 Tendon rupture (n) 0 2 -1.23 < 0.01 Carpal tunnel syndrome (n) 0 3 2.56 < 0.01 Mayo Wrist Score 94 ± 5 86 ± 4 2.15 < 0.01 Excellent (n) 29 18 -0.22 < 0.01 Good (n) 4 10 2.15 < 0.01 Fair 0 6 -0.22 0.68 1.07 < 0.01 < 0.01 < 0.01 Poor 0 1 Aesthetics (VAS, cm) 9 ± 1 8 ± 2 Satisfaction (VAS, cm) 10 ± 1 8 ± 2 Active ROM (°) Flexion 72 ± 4 70 ± 6 0.75 0.13 Data are shown as mean ± standard deviation; MIT, dual external fixation; IAF, immediately after surgery; ROM, range of motion; VAS, visual analogue scale; *, 15% higher at dominant sides compared to the nondominant sides discrepancy, in which percentages show involved limb compared with opposite normal side; †, supination torque based on McConkey method, compared to opposite side as percentages. The plating group included 35 patients (35 upper limbs). There were 13 male patients and 22 female patients. The age of the patients was 52.3 ± 14.2 years (range, 38–65 years) (Table 1 ). The preoperative glucose level was 6.3 ± 1.6 (mmol/L). The time interval between injury and surgery was 8.17 ± 4.15 months. There were types A2 (n = 17), A3 (n = 11), C1 (n = 6), and C2 (n = 1) original distal radius fractures. The blood loss was 66 ± 11 ml. Preoperatively, the radial height, palmar tilt, radial inclination, and ulnar variance were 11 ± 2 mm, 14°±5°, 21 ± 3°, and 0.7 ± 0.6 mm, respectively. The data after bone healing were 11 ± 2 mm, 13°±5°, 21°±4°, and 1 ± 1.2 mm, respectively. There were significant differences between the data measured immediately after surgery and at bone healing (P < 0.01; <0.01; <0.01; and P = 0.02, respectively). The time of bone healing was 6.4 ± 1.7 weeks. We compared the X-rays taken immediately after surgery and after bone healing. The results showed the fragments remained in place with significant redisplacement (P < 0.01; <0.01;<0.01; and = 0.02; Table 2 ). Deep abscess occurred in 3 patients, and wound cellulitis occurred in 2 patients. The infection was treated with wound care. One infection developed osteomyelitis. Bone healing was achieved in all patients after 6.4 ± 1.7 weeks (range, 4–10 weeks). The follow-up period was 29 ± 4.6 months. Active wrist movement and hand grip strength were similar to those on the opposite side. The Mayo Wrist Score was 96 ± 4, including 18 excellent, 10 good, 6 fair, and 1 poor result (Table 3). The patient aesthetics and satisfaction scores were 8 ± 2. A secondary surgery to remove the implant was performed in 18 patients due to tendon irritation or pain, among them, tendon rupture occurred in 2 patients. We found significant differences between the groups in complication rates (6% vs 45%, P < 0.01), operative time (P < 0.01), blood loss (P < 0.01), ulnar variance (P < 0.01) wrist pain (P < 0.01), and aesthetics (P < 0.01). Case 2, 3, and 4 are shown in Figs. 5 and 6 , Fig. 7 , and Fig. 8 , respectively. DISCUSSION We find that DRMs can be treated with MIT especially for original AO/OTA Classification types A2 and A3 fractures and types C1 and C2 fractures without the need for correcting intraarticular malunions. As an alternative technique of conventional volar plating, the minimally invasive technique MIT may be associated with less infection and total complications. It is also associated with less operative time, blood loss, wrist pain, and other complications. Wrist immobilization may produce equal function, compared to open surgery with injuries to the wrist ligaments and capsule. Distraction with a pin directly engaging on the distal bony fragment plays a key role in restoring the normal length of the radius. MIT may be effective in maintaining the reduction until bone healing occurs with good functional outcomes and patient satisfaction. MIT did not require secondary surgery to remove implants. MIT can be an option for selected cases but cannot replace conventional plate fixation in most cases. Usually, percutaneous fixation is overall less expensive in direct costs than open reduction and plate fixation. Constantine et al 23 reviewed 87, 169 undergoing surgical fixation of distal radius fractures and found a significant difference in the rates of postoperative infection between open reduction and internal fixation and percutaneous pinning. Moreover, there was 4-fold increase in cost of care as a result of these infections. Malige et al 24 compared 124 diabetic and 371 nondiabetic distal radius fractures and found a statistically higher rate of total complications (21% vs. 14%, P = 0.045), which is not affected by surgical timing. However, there is not a specific study on DRMs. There are 3 types of DRMs extra-articular, intra-articular, and mixed. Evans et al 25 found DRMs result in a fundamental change in the biomechanics of the wrist. Untreated DRMs may lead to arthritis, pain, limited mobility, or dysfunction. Decreased radial inclination results in a change in the direction of the flexor tendons, a decreased mechanical advantage, grip weakness. Loss of palmar tilt may lead to incongruity of the distal radioulnar joint, decreasing forearm rotation and wrist instability. Palmer et al 26 suggested radial shortening may lead to a shift of force transfer from the radiocarpal to the ulnocarpal joint, as much as a 42% increase. The optimal timing for surgery is still debated. Jupiter et al 27 suggested early (< 14 weeks after injury) or late (≥ 14 weeks after injury) surgery are comparable. Sato et al 28 presented a series of 28 patients who underwent an osteotomy for treatment of a volar DRMs. In all patients, an iliac crest structural graft was used, followed by volar plating. All wrists united at the osteotomy site at an average of over 7 weeks, and supination improved to 80° from an average 16° preoperatively. McQueen et al 29 treated 23 DRMs by distal radial osteotomy using non-bridging external fixation and bone grafting. The mean preoperative dorsal angle of 20° was corrected to over 5° of volar tilt, and the mean preoperative positive ulnar variance of 3.9 mm was corrected to 2.5 mm. Brown et al 30 treated 11 DRMs with functional disability in the wrist due to limited wrist motion. Surgery consisted of opening wedge osteotomies to correct radial tilt and radial angle. Postoperatively, combined dorsal and volar flexion improved from a mean of 34° to 72°. Combined pronation and supination improved from a mean of 68° to 106°. Ma et al 31 reviewed 68 patients with extra-articular DRMs. They performed distal radius lengthening osteotomy in 32 patients and ulnar shortening osteotomy in 36 patients. They found distal radius lengthening osteotomy achieved better reduction of pain and improvement of function. Ulnar shortening osteotomy is a simpler procedure but increases potential to cause subsequent osteoarthritis of the distal radioulnar joint. In the treatment of DRMs, percutaneous distraction is a commonly used maneuver to restore the normal length of radius 32 . However, the distraction is compromised due to soft tissue contracture and elasticity of ligament and capsule. Our maneuver is bony distraction, which is more effective due to avoiding those drawbacks. In this important procedure, the surgeon should palpate the radial artery and insert the pin 0.5 cm ulnarly away from the artery to avoid injuries to the artery and median nerve. DRMs are often associated with poor bone quality, such as osteoporosis. Bridging-external fixation can reduce axial load onto the distal fragments 33 . The advantages of our technique are a minimally invasive procedure with minimal wound complications. Fixation is reliable to maintain the reduction until bone healing occurs. The procedure is simple because structure bone grafts are not required, avoiding graft loosening, migration, and absorption. The disadvantage is pin site infection, but the incidence is low. Moreover, immobilization of the wrist may produce joint stiffness but no scar formation due to intact of the capsule and surrounding ligaments may impact minor morbidity to the wrist. The indications for our technique are extra-articular DRMs, such as original AO/OTA Classification types A2 and A3 fractures and types C1 and C2 fractures, and even C3 fractures without the need to correct intraarticular malunions. In type B2 and B3 fractures, volar plating can provide rigid volar support, which is a contraindication of our technique. This study has limitations. The kinematics of fixation should require further study. Confirming precise duration of diabetes is difficult, which may affect the outcomes. Surgeon preference, experience, and abilities may influence wire configuration and placement. A retrospective, unblinded study may affect the actual outcomes. Surgeons’ experience improved over time, which may influence determination of the technical effects. CONCLUSIONS Distal radial malunions can be treated with MIT through a small incision. As an alternative technique of conventional volar plating, MIT may be associated less infection and total complications. Wrist immobilization may produce equal function, compared to open surgery with injuries to the wrist ligaments and capsule. Declarations Availability of data and materials Xiaoliang Yang, MD, Prof. Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang , Hebei , 050051 , China [email protected] ；Phone Number: +86-18533112726 Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki for the ethical standards of the institutional review boards of the hospital involved. Ethical approvals were obtained from the Ethical Review Board of the participating hospitals. The institutional review boards of the Yichang Central People's Hospital of the First Clinical Medical College of the Three Gorges University reviewed the study and approved the protocol. Informed consent was obtained from each patient. Consent for publication The author confirms that the work described has not been published before. Competing interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors received no financial support for the research, authorship, and/or publication of this article. No authors have a financial interest in any of the products, devices, or drugs mentioned in this study. Authors' contributions Conceptualization Hao Yao, MD., Xiaoliang Yang, Data curation, formal analysis, Software Xu Zhang, MD. Investigation Bing Wang, MD., Xuewu Zhou, MD. Methodology Hao Yao, Xiaoliang Yang,, MD. Project administration Xiaoliang Yang, MD. Resources Jingqiao Li, MD. Validation, Supervision Jingqiao Li, MD. Visualization Bing Wang, MD. Writing – original draft Hao Yao, MD. Writing – review & editing Bing Wang, MD., Xiaoliang Yang,, MD. Acknowledgements Not applicable References Rundgren J, Bojan A, Mellstrand Navarro C, Enocson A. 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McQueen MM, Wakefield A. Distal radial osteotomy for malunion using non-bridging external fixation: good results in 23 patients. Acta Orthop . 2008;79:390–395. Brown JN, Bell MJ. Distal radial osteotomy for malunion of wrist fractures in young patients. J Hand Surg Br . 1994;19:589–593. Ma HH, Chen YC, Huang HK, Huang YC, Chang MC, Wang JP. Comparing radial lengthening osteotomy with ulnar shortening osteotomy to treat ulnar impaction syndrome after distal radius fracture malunion. Arch Orthop Trauma Surg . 2022;142:525–531. Wada T, Tatebe M, Ozasa Y, Sato O, Sonoda T, Hirata H, Yamashita T. Clinical outcomes of corrective osteotomy for distal radial malunion: a review of opening and closing-wedge techniques. J Bone Joint Surg Am . 2011;93:1619–1626. Arslan H, Subasi M, Kesemenli C, Kapukaya A, Necmioglu S. Distraction osteotomy for malunion of the distal end of the radius with radial shortening. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7436374","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":510867357,"identity":"ca8a0953-63cb-4856-93f7-ee97296a8ec8","order_by":0,"name":"Hao Yao","email":"","orcid":"","institution":"Yichang Central People's Hospital of the First Clinical Medical College of the Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Yao","suffix":""},{"id":510867360,"identity":"29c3eff5-e00e-4bd4-b4a7-afb008a055d9","order_by":1,"name":"Jingqiao Li","email":"","orcid":"","institution":"Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jingqiao","middleName":"","lastName":"Li","suffix":""},{"id":510867362,"identity":"ab1fa25e-d90c-45cb-a441-0a5e5bc1c5b3","order_by":2,"name":"Xu Zhang","email":"","orcid":"","institution":"Yichang Central People's Hospital of the First Clinical Medical College of the Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Xu","middleName":"","lastName":"Zhang","suffix":""},{"id":510867364,"identity":"5ac292e0-776b-4756-87b6-ba308a2e0efe","order_by":3,"name":"Bing Wang","email":"","orcid":"","institution":"Yichang Central People's Hospital of the First Clinical Medical College of the Three Gorges University","correspondingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Wang","suffix":""},{"id":510867365,"identity":"9520cb48-a5ce-4dee-a705-0b39044fe998","order_by":4,"name":"Xuewu Zhou","email":"","orcid":"","institution":"Third Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xuewu","middleName":"","lastName":"Zhou","suffix":""},{"id":510867366,"identity":"71f79f42-9f77-4cba-b9bf-bdb18f3d774f","order_by":5,"name":"Xiaoliang Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYBACNv7mww8SDP7J8bM3H3yQUFFDWAufxLE0gw8FB4wle44lGzw4c4ywFjmGHAPJGR8OJBrcyFGTfNjCTITDGM4YGPMY3ElgOHOGrSKxgY2Bv707Ab8W5raCxzwGz/IY23uP3UjcIcMgcebsBgK2HN4AtIW5mJnnXNqNxDNsDAYSuYS0JBhIA7UktknkmBUktjEToyUF6H2Dw4k9QC0MxGkBB7JBmrEEz7FkiYQzx3gI+kW+HxSVf2zk7I83H/z4o6JGjr+9F78WDMBDmvJRMApGwSgYBVgBAOM8TnKmtJrJAAAAAElFTkSuQmCC","orcid":"","institution":"Third Hospital of Hebei Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xiaoliang","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2025-08-22 16:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7436374/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7436374/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90907261,"identity":"8455dc65-c6e6-41a5-9498-4c779d2c25b0","added_by":"auto","created_at":"2025-09-09 13:20:50","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":477870,"visible":true,"origin":"","legend":"\u003cp\u003eA 36-year-old female patient suffered from distal radial malunion due to the fracture occurred 4 months ago. A. Posteroanterior (PA) X-ray. B. Lateral X-ray. C. Radial view of 3-dimensional CT scan. D. Anteroulnar view.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7436374/v1/d3020b2c1645a53fb54a537b.jpeg"},{"id":90911982,"identity":"42565c14-726f-4edc-ad41-1fee36d89b1b","added_by":"auto","created_at":"2025-09-09 13:44:50","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1006425,"visible":true,"origin":"","legend":"\u003cp\u003eA. A 5-mm incision between the extensor pollicis longus and extensor digitorum communis, 5 to10 mm distal to the osteotomy level (avoid skin laceration during late distraction). B. Multiple pin holes are created using a 1.0 to 1.2 mm K-wire in different directions in the osteotomy plane. C. Osteotomy is performed by hammering a small seating chisel. Support the chisel with the hand and forearm (arrow), avoiding deep insertion to injure the tendons and nerves.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7436374/v1/00b87a384f4a37066fc3f23d.jpeg"},{"id":90910265,"identity":"41a7cece-bac7-4fd1-bf6a-cb8d9f26bfc5","added_by":"auto","created_at":"2025-09-09 13:36:50","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":777981,"visible":true,"origin":"","legend":"\u003cp\u003eA. A 2.5-mm pin was inserted manually, 5 to10 mm distal to the fracture site (avoid late skin laceration during distraction), and slid into the fracture site. The pin was continuously passed through the fracture site and exserted the dorsal skin incision. By pulling both ends of the pin distally (arrows), distract the distal bone fragment to restore the normal length of the radius, and meanwhile to restore volar tilt and radial inclination. To maintain the reduction, one or two 3.0-mm pins (*) were provisionally introduced, obliquely from distally to proximally. B. Bony distraction maneuver on X-ray. C. Insert two to three 3.0-mm pins in the distal fragment and two pins in the proximal fragment. The pin ends were bent toward the fracture site about 2 cm away from the skin. Bone cement is mounted on the pin ends. D. A bridging external fixator is applied against axial load.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7436374/v1/a2de103cbbb14c694126b28d.jpeg"},{"id":90909062,"identity":"592c9b5c-bf2b-4f73-b2be-cb3fcadd2018","added_by":"auto","created_at":"2025-09-09 13:28:50","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":474461,"visible":true,"origin":"","legend":"\u003cp\u003eA. PA X-ray immediately after surgery. B. Lateral X-ray. C. Bone healing 1.5 months after surgery on anteroposterior X-ray. D. Lateral X-ray. E. PA X-ray after 2 years.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7436374/v1/7ce64dcf25e67df7b504eaa3.jpeg"},{"id":90907266,"identity":"7d528c58-c3af-451a-b9ec-698d9846976d","added_by":"auto","created_at":"2025-09-09 13:20:50","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":689439,"visible":true,"origin":"","legend":"\u003cp\u003eA 51-year-old male patient suffered distal radius fracture 4 months before admission. A. PA X-ray immediately after surgery. B. Lateral X-ray. C. Multiple pin holes are made for osteotomy. D. Distracting the distal bone fragment with a pin (*) to restore the normal length of the radius.\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7436374/v1/a5d06d580f7115440781bb09.jpeg"},{"id":90910267,"identity":"b387f3b3-f636-43e8-8625-ed8b3c174d62","added_by":"auto","created_at":"2025-09-09 13:36:50","extension":"jpeg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1408411,"visible":true,"origin":"","legend":"\u003cp\u003eImmediately after surgery. A. PA X-ray. B. Lateral X-ray. C. Dorsal appearance of fixation. D. Anterior appearance of fixation. E. Bone healing showing on PA X-ray after 6 weeks. F. Lateral X-ray. G. A PA X-ray showing 2 months after surgery. H. Lateral X-ray.\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7436374/v1/c70014f2bb1613d289f8d72e.jpeg"},{"id":90907262,"identity":"40f34e78-b2ed-447e-a2c7-13797ef69aa9","added_by":"auto","created_at":"2025-09-09 13:20:50","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":1464751,"visible":true,"origin":"","legend":"\u003cp\u003eA 37-year-old female patient suffered from distal radial malunion due to the fracture occurred 6 months ago. A. Preoperative PA X-ray. B. Lateral X-ray. C. PA showing X-ray immediately after correction and bong grafting. D. A photo showing anterior aspect of the injured forearm. E. A photo showing the posterior aspect of the forearm. G. AP X-ray 6 weeks after surgery. H. Lateral X-ray\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7436374/v1/f94d6858964c8aafaa1320fb.jpeg"},{"id":90909068,"identity":"c2464a81-7d36-4c58-8338-6afc804a0c7e","added_by":"auto","created_at":"2025-09-09 13:28:50","extension":"jpeg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":1514763,"visible":true,"origin":"","legend":"\u003cp\u003eA 58-year-old female patient suffered distal radius fracture 2 months before surgery. A. PA X-ray. B. Lateral X-ray. C. PA X-ray immediately after surgery. D. Oblique X-ray. E. A photo showing the dorsal aspect of the forearm. F. PA X-ray taken 2 months after correction.\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7436374/v1/1edb3482d99bb4692fa286d2.jpeg"},{"id":98201837,"identity":"43393495-6301-485f-81c1-f31497bb36e2","added_by":"auto","created_at":"2025-12-15 07:55:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8616289,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7436374/v1/8b900511-85b6-4feb-acff-6243416c9805.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Treatment of Distal Radial Malunions Using a Minimally Invasive Technique versus Plating: A Comparative Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDistal radius fractures account for up to 17% of all extremity fractures \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Distal radial malunion (DRM) is the major complication, reported in 33% of cases, especially those treated conservatively \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. DRMs affect wrist biomechanics and can result in pain, limited motion, and functional limitations \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Surgical correction of DRM is a challenging problem with unpredictable clinical outcomes due to more complications.\u003c/p\u003e\u003cp\u003eA standard definition of DRM has not been established \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Usually, DRMs are defined separately. Ali et al \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e defined DRMs as radial inclination of \u0026le;\u0026thinsp;15\u0026deg;, dorsal tilt of \u0026ge;\u0026thinsp;10\u0026deg;, or ulnar variance of \u0026ge;\u0026thinsp;3 mm. They found that patients who sustain DRMs at age 18 to 65 years are more likely to have adverse activity limitations and pain. DRMs with dorsal tilt\u0026thinsp;\u0026gt;\u0026thinsp;10\u0026deg;, radial shortening\u0026thinsp;\u0026gt;\u0026thinsp;3 mm, or intra-articular displacement\u0026thinsp;\u0026gt;\u0026thinsp;2 mm indicate the need for a discussion regarding the benefits of surgical correction \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eCurrently, there are no absolute surgical indications for DRMs \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Consideration should include patient age, wrist pain, grip weakness, loss of mobility, possibility of infection, etc. The conventional surgery is performed though a 5- to 10- cm volar approach \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. After osteotomy, the fixation was achieved with a volar plate and screw system. The approach allows good visual approximation of the volar cortex, allowing the lift maneuver to aid in reduction. However, struct bone grafting is often needed to decrease the risk of nonunion and possible supporting failure \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Owing to the increased ulnar variance after osteotomy, the procedure may be coupled with an ulnar head resection. Moreover, bone grafts are often needed for reshaping properly. Graft loosening, migration, and absorption, as well as poor bone quality may lead to supporting failure, redisplacement, and unpredictable outcomes \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Future implant removal may be required in some patients.\u003c/p\u003e\u003cp\u003eThis prospective study aimed to compare the efficiency of minimally invasive technique (MIT) and conventional volar plating for the treatment of DRMs. We hypothesized that MIT showed better radiographic outcomes with less complications than plating.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e This study was performed in accordance with the Declaration of Helsinki. The institutional review boards of the Yichang Central People\u0026rsquo;s Hospital of the First Clinical Medical College of the Three Gorges University reviewed the study and approved the protocol. Informed consent was obtained from each patient. Clinical trial number: pending.\u003c/p\u003e\u003cp\u003eFrom January 2019 to June 2022, 76 patients (76 wrists) with DRMs were selected based on the eligibility criteria as follows: (1) age\u0026thinsp;\u0026ge;\u0026thinsp;18 or \u0026lt;\u0026thinsp;50 years; (2) original AO/OTA (AO Foundation and Orthopaedic Trauma Association) Classification types A2 and A3 fractures; and (3) types C2 and C3 fractures without displacement of articular surface. Patients younger than 18 years were excluded because the malunion could be corrected with growth. We excluded types C1 and C2 fractures with displacement of articular surface because reduction through a small incision was difficult (n\u0026thinsp;=\u0026thinsp;4). We excluded type A1 fractures because they did not involve the distal radius (n\u0026thinsp;=\u0026thinsp;2). We excluded types B2, B3, and C3 fractures due to a complex procedure for a minimally invasive technique (n\u0026thinsp;=\u0026thinsp;2). Patients who declined to undergo the surgery were excluded. Other exclusion criteria included combined triangular fibrocartilage complex injuries, pathologic fractures, uncooperative adults, infection, diabetes, rheumatoid arthritis, or gout. Osteotomy plane was confirmed based on preoperative X-rays and CT images (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA, B, C, D). Finally, 68 patients were randomly allocated to the DEF group (n\u0026thinsp;=\u0026thinsp;33) and plate fixation group (n\u0026thinsp;=\u0026thinsp;35).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMIT\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe operation was performed under general or brachial plexus anesthesia with tourniquet control. We marked the osteotomy level using fluoroscopy. We made a 5-mm incision between the extensor pollicis longus and extensor digitorum communis, 1 cm distal to the osteotomy level (avoid late skin laceration during distraction) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Through this small incision, we created multiple holes in different directions using a 1.0 to 1.2 mm K-wire in an osteotomy plane (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). We performed osteotomy by hammering a small seating chisel. During this procedure, care was taken to support the chisel with the hand and forearm, avoiding deep insertion to injure the tendons and nerves (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC). Then, we rotated the chisel to fracture the radius. A 2.5-mm pin was inserted manually, 1 mm distal to the fracture site (avoid skin laceration during distraction), and slid into the fracture site. The pin was continuously passed through the fracture site and exserted the dorsal skin incision. By pulling both ends of the pin distally, we distracted the distal bone fragment to restore radial height, and meanwhile to restore volar tilt and radial inclination. To maintain the reduction, one or two 3.0-mm Steinmann pin was provisionally introduced, obliquely from distally to proximally (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA, B). Satisfactory reduction was confirmed using fluoroscopy. Then, we introduced one or two 3.0-mm transverse bicortical pins into the proximal fragment. Keep two to three 3.0-mm pins in the distal fragment. satisfactory reduction and pin position were confirmed using fluoroscopy. The pins were bent toward the fracture site about 2 cm away from the skin. We mixed Monomer (liquid) and polymer (powder) of bone cement (Single dose 40 g; PALACOS\u0026reg;, Hanau, Germany). When the bone cement viscosity changed over time from a runny liquid into a dough-like state, we applied it to the bent pin ends and waited for it to harden into a solid material. Thus, we created a frame to prevent pin migration. Satisfactory reduction and pin position were confirmed using fluoroscopy. The void at the fracture site was filled with iliac crest autografts through a 4.5-mm drill guide at the small incision. The wrist was immobilized with a joint-spanning external fixator (four 3.5 Schanz pins; Shuangyang Medical Instrument Co., Ltd. Zhangjiagang City, China.) to reinforce maintenance of radial height (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC, D).\u003c/p\u003e\u003cp\u003eAfter surgery. X-rays were taken every 2 weeks until bone healing occurred (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA, B, C). The cement pin frame was protected using a dorsal short-arm splint or cast. The external fixator was removed 6 weeks after surgery, which allowed wrist movement. After bone healing, the pines were cut off and the frame and pins were removed.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePlating\u003c/h2\u003e\u003cp\u003eThe operation was performed under general or brachial plexus anesthesia with tourniquet control. Osteotomy and fixation were done through the 7-cm volar approach as described by Opel et al \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOutcome Evaluation\u003c/h3\u003e\n\u003cp\u003eWe assessed the palmar tilt of the radius on lateral X-rays, and radial inclination, heigh, and ulnar variance on posteroanterior X-rays \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eD). We assessed pin site infection based on the clinical symptoms \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. We assessed wrist pain intensity using the visual analog scale (VAS) \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Active range of motion of the wrist was measured using a goniometer \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. All measurements were compared to those on the opposite side. Grip strength of the hand was assessed using a Baseline hydraulic hand dynamometer (Fabrication Enterprises Inc., White Plains, NY) \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. We assessed pronation torque using the McConkey method at 5 positions of rotation (90\u0026deg; of supination, 45\u0026deg; of supination, neutral, 45\u0026deg; of pronation, and 80\u0026deg; of pronation) \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. To exclude any discrepancy between dominant and nondominant hand strength, we based the scores for analysis on the premise that the grip strength was 15% higher at the dominant side compared to the nondominant side; and no correction was required for left-handed patients \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Patients rated wrist pain and hand numbness using the 10-cm visual analogue scale \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. We used the Mayo Wrist Score to assess wrist function (90\u0026ndash;100, excellent; 80\u0026ndash;89, good; 60\u0026ndash;79, satisfactory; \u0026lt; 60, poor) \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Aesthetics and patient satisfaction were assessed using the 10-cm visual analog scale \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eQuantitative variables were described as mean and standard deviation for symmetric distribution or median and interquartile range for asymmetric distribution. We used Pearson\u0026rsquo;s chi-square test to compare categorical variables and Mann-Whitney U test to symmetric and asymmetric distribution. A P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistical significance. The collected data were analyzed with the Statistical Package for Social Sciences 20.0 (SPSS, Inc., Chicago, Ill).\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe MIT group included 33 patients (33 upper limbs). There were 14 male patients and 19 female patients. The age of DEF patients was 53.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6 years (range, 39\u0026ndash;66 years) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The time interval between injury and surgery was 8.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76 months. The preoperative glucose level was 6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 mmol/L. There were types A2 (n\u0026thinsp;=\u0026thinsp;18), A3 (n\u0026thinsp;=\u0026thinsp;9), C1 (n\u0026thinsp;=\u0026thinsp;4), and C2 (n\u0026thinsp;=\u0026thinsp;2) original distal radius fractures. The intraoperative blood loss was 33\u0026thinsp;\u0026plusmn;\u0026thinsp;5 ml. Preoperatively, the radial height, palmar tilt, radial inclination, and ulnar variance were 12\u0026thinsp;\u0026plusmn;\u0026thinsp;1 mm, 15\u0026deg;\u0026plusmn;5\u0026deg;, 23\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u0026deg;, and 0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 mm, respectively. The data after bone healing were 12\u0026thinsp;\u0026plusmn;\u0026thinsp;1 mm, 15\u0026deg;\u0026plusmn;5\u0026deg;, 22\u0026deg;\u0026plusmn;4\u0026deg;, and 0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 mm, respectively. There were no significant differences between the data measured immediately after surgery and at bone healing (P\u0026thinsp;=\u0026thinsp;0.06; 0.05;0.06; and 0.07, respectively). The time of bone healing was 6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 weeks. We compared the X-rays taken immediately after surgery and after bone healing. The results showed the fragments remained in place without significant redisplacement (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Mild pin site infection occurred in 2 patients, which healed by pin site care. Neither wire loosening nor fixation failure was found. No osteomyelitis was found. Bone healing was achieved in all patients after 6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 weeks. The follow-up period was 28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 months. Active wrist movement and hand grip strength were similar to those on the opposite side. The Mayo Wrist Score was 94\u0026thinsp;\u0026plusmn;\u0026thinsp;5, including 46 excellent and 7 good results (Table\u0026nbsp;3). The patient aesthetics and satisfaction scores were 10\u0026thinsp;\u0026plusmn;\u0026thinsp;1 and 9\u0026thinsp;\u0026plusmn;\u0026thinsp;1, respectively.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePreoperative demographics for 68 patients with distal radial malunion.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMIT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePlating\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year, range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6 (39\u0026ndash;66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2 (38\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (m:f)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 : 19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 : 22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSide (l: r)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 : 28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 : 24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDominant hand (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCause (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoad\u0026nbsp;traffic\u0026nbsp;accident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSports\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMachinery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration from injury to surgery (month)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative X-ray parameter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntraarticular fracture (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtra-articular fracture (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLoss of radial heigh (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePalmar tilt (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadial inclination (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUlnar variance (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOriginal AO/OTA (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative time (minute)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood loss (ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInfection (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeep abscess\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCellulitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePin site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDonor site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBone healing (week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImplant removal surgery (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinal follow-up (month)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.543\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eData are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; MIT, minimally invasive technique; AO/OTA, AO Foundation and Orthopaedic Trauma Association.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRadiological parameters of 68 distal radial malunions.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMIT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePlating\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadial height (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIAF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBone healing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.938\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePalmar tilt (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIAF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBone healing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadial inclination (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIAF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBone healing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUlnar variance (mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIAF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBone healing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-5.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eData are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; MIT, minimally invasive technique; IAF, immediately after surgery.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eTable\u0026nbsp;3. Outcomes at the final follow-up.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMIT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePlating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActive ROM (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlexion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadial deviation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u0026thinsp;\u0026plusmn;\u0026thinsp;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUlnar deviation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePronation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84\u0026thinsp;\u0026plusmn;\u0026thinsp;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrip strength (%) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupination torque (%) \u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90\u0026deg; of supination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45\u0026deg; of supination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45\u0026deg; of pronation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e80\u0026deg; of pronation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWrist pain (MWS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHand numbness (VAS, cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTendon rupture (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCarpal tunnel syndrome (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMayo Wrist Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExcellent (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e-0.22\u003c/p\u003e\u003cp\u003e0.68\u003c/p\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAesthetics (VAS, cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSatisfaction (VAS, cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActive ROM (\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlexion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eData are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; MIT, dual external fixation; IAF, immediately after surgery; ROM, range of motion; VAS, visual analogue scale; *, 15% higher at dominant sides compared to the nondominant sides discrepancy, in which percentages show involved limb compared with opposite normal side; \u0026dagger;, supination torque based on McConkey method, compared to opposite side as percentages.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe plating group included 35 patients (35 upper limbs). There were 13 male patients and 22 female patients. The age of the patients was 52.3\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2 years (range, 38\u0026ndash;65 years) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The preoperative glucose level was 6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 (mmol/L). The time interval between injury and surgery was 8.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15 months. There were types A2 (n\u0026thinsp;=\u0026thinsp;17), A3 (n\u0026thinsp;=\u0026thinsp;11), C1 (n\u0026thinsp;=\u0026thinsp;6), and C2 (n\u0026thinsp;=\u0026thinsp;1) original distal radius fractures. The blood loss was 66\u0026thinsp;\u0026plusmn;\u0026thinsp;11 ml. Preoperatively, the radial height, palmar tilt, radial inclination, and ulnar variance were 11\u0026thinsp;\u0026plusmn;\u0026thinsp;2 mm, 14\u0026deg;\u0026plusmn;5\u0026deg;, 21\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u0026deg;, and 0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 mm, respectively. The data after bone healing were 11\u0026thinsp;\u0026plusmn;\u0026thinsp;2 mm, 13\u0026deg;\u0026plusmn;5\u0026deg;, 21\u0026deg;\u0026plusmn;4\u0026deg;, and 1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 mm, respectively. There were significant differences between the data measured immediately after surgery and at bone healing (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; \u0026lt;0.01; \u0026lt;0.01; and P\u0026thinsp;=\u0026thinsp;0.02, respectively). The time of bone healing was 6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 weeks. We compared the X-rays taken immediately after surgery and after bone healing. The results showed the fragments remained in place with significant redisplacement (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; \u0026lt;0.01;\u0026lt;0.01; and =\u0026thinsp;0.02; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Deep abscess occurred in 3 patients, and wound cellulitis occurred in 2 patients. The infection was treated with wound care. One infection developed osteomyelitis. Bone healing was achieved in all patients after 6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 weeks (range, 4\u0026ndash;10 weeks). The follow-up period was 29\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6 months. Active wrist movement and hand grip strength were similar to those on the opposite side. The Mayo Wrist Score was 96\u0026thinsp;\u0026plusmn;\u0026thinsp;4, including 18 excellent, 10 good, 6 fair, and 1 poor result (Table\u0026nbsp;3). The patient aesthetics and satisfaction scores were 8\u0026thinsp;\u0026plusmn;\u0026thinsp;2. A secondary surgery to remove the implant was performed in 18 patients due to tendon irritation or pain, among them, tendon rupture occurred in 2 patients.\u003c/p\u003e\u003cp\u003eWe found significant differences between the groups in complication rates (6% vs 45%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), operative time (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), blood loss (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), ulnar variance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) wrist pain (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and aesthetics (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Case 2, 3, and 4 are shown in Figs.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, and Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, respectively.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWe find that DRMs can be treated with MIT especially for original AO/OTA Classification types A2 and A3 fractures and types C1 and C2 fractures without the need for correcting intraarticular malunions. As an alternative technique of conventional volar plating, the minimally invasive technique MIT may be associated with less infection and total complications. It is also associated with less operative time, blood loss, wrist pain, and other complications. Wrist immobilization may produce equal function, compared to open surgery with injuries to the wrist ligaments and capsule. Distraction with a pin directly engaging on the distal bony fragment plays a key role in restoring the normal length of the radius. MIT may be effective in maintaining the reduction until bone healing occurs with good functional outcomes and patient satisfaction. MIT did not require secondary surgery to remove implants. MIT can be an option for selected cases but cannot replace conventional plate fixation in most cases. Usually, percutaneous fixation is overall less expensive in direct costs than open reduction and plate fixation.\u003c/p\u003e\u003cp\u003eConstantine et al \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e reviewed 87, 169 undergoing surgical fixation of distal radius fractures and found a significant difference in the rates of postoperative infection between open reduction and internal fixation and percutaneous pinning. Moreover, there was 4-fold increase in cost of care as a result of these infections. Malige et al \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e compared 124 diabetic and 371 nondiabetic distal radius fractures and found a statistically higher rate of total complications (21% vs. 14%, P\u0026thinsp;=\u0026thinsp;0.045), which is not affected by surgical timing. However, there is not a specific study on DRMs.\u003c/p\u003e\u003cp\u003eThere are 3 types of DRMs extra-articular, intra-articular, and mixed. Evans et al \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e found DRMs result in a fundamental change in the biomechanics of the wrist. Untreated DRMs may lead to arthritis, pain, limited mobility, or dysfunction. Decreased radial inclination results in a change in the direction of the flexor tendons, a decreased mechanical advantage, grip weakness. Loss of palmar tilt may lead to incongruity of the distal radioulnar joint, decreasing forearm rotation and wrist instability. Palmer et al \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e suggested radial shortening may lead to a shift of force transfer from the radiocarpal to the ulnocarpal joint, as much as a 42% increase. The optimal timing for surgery is still debated. Jupiter et al \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e suggested early (\u0026lt;\u0026thinsp;14 weeks after injury) or late (\u0026ge;\u0026thinsp;14 weeks after injury) surgery are comparable.\u003c/p\u003e\u003cp\u003eSato et al \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e presented a series of 28 patients who underwent an osteotomy for treatment of a volar DRMs. In all patients, an iliac crest structural graft was used, followed by volar plating. All wrists united at the osteotomy site at an average of over 7 weeks, and supination improved to 80\u0026deg; from an average 16\u0026deg; preoperatively. McQueen et al \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e treated 23 DRMs by distal radial osteotomy using non-bridging external fixation and bone grafting. The mean preoperative dorsal angle of 20\u0026deg; was corrected to over 5\u0026deg; of volar tilt, and the mean preoperative positive ulnar variance of 3.9 mm was corrected to 2.5 mm. Brown et al \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e treated 11 DRMs with functional disability in the wrist due to limited wrist motion. Surgery consisted of opening wedge osteotomies to correct radial tilt and radial angle. Postoperatively, combined dorsal and volar flexion improved from a mean of 34\u0026deg; to 72\u0026deg;. Combined pronation and supination improved from a mean of 68\u0026deg; to 106\u0026deg;. Ma et al \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e reviewed 68 patients with extra-articular DRMs. They performed distal radius lengthening osteotomy in 32 patients and ulnar shortening osteotomy in 36 patients. They found distal radius lengthening osteotomy achieved better reduction of pain and improvement of function. Ulnar shortening osteotomy is a simpler procedure but increases potential to cause subsequent osteoarthritis of the distal radioulnar joint.\u003c/p\u003e\u003cp\u003eIn the treatment of DRMs, percutaneous distraction is a commonly used maneuver to restore the normal length of radius \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. However, the distraction is compromised due to soft tissue contracture and elasticity of ligament and capsule. Our maneuver is bony distraction, which is more effective due to avoiding those drawbacks. In this important procedure, the surgeon should palpate the radial artery and insert the pin 0.5 cm ulnarly away from the artery to avoid injuries to the artery and median nerve. DRMs are often associated with poor bone quality, such as osteoporosis. Bridging-external fixation can reduce axial load onto the distal fragments \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe advantages of our technique are a minimally invasive procedure with minimal wound complications. Fixation is reliable to maintain the reduction until bone healing occurs. The procedure is simple because structure bone grafts are not required, avoiding graft loosening, migration, and absorption. The disadvantage is pin site infection, but the incidence is low. Moreover, immobilization of the wrist may produce joint stiffness but no scar formation due to intact of the capsule and surrounding ligaments may impact minor morbidity to the wrist. The indications for our technique are extra-articular DRMs, such as original AO/OTA Classification types A2 and A3 fractures and types C1 and C2 fractures, and even C3 fractures without the need to correct intraarticular malunions. In type B2 and B3 fractures, volar plating can provide rigid volar support, which is a contraindication of our technique.\u003c/p\u003e\u003cp\u003eThis study has limitations. The kinematics of fixation should require further study. Confirming precise duration of diabetes is difficult, which may affect the outcomes. Surgeon preference, experience, and abilities may influence wire configuration and placement. A retrospective, unblinded study may affect the actual outcomes. Surgeons\u0026rsquo; experience improved over time, which may influence determination of the technical effects.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eDistal radial malunions can be treated with MIT through a small incision. As an alternative technique of conventional volar plating, MIT may be associated less infection and total complications. Wrist immobilization may produce equal function, compared to open surgery with injuries to the wrist ligaments and capsule.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiaoliang Yang, MD, Prof. Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang , Hebei , 050051 , China\u003c/p\u003e\n\u003cp\[email protected]；Phone Number: +86-18533112726\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki for the ethical standards of the institutional review boards of the hospital involved. Ethical approvals were obtained from the Ethical Review Board of the participating hospitals.\u003c/p\u003e\n\u003cp\u003eThe institutional review boards of the Yichang Central People\u0026apos;s Hospital of the First Clinical Medical College of the Three Gorges University reviewed the study and approved the protocol. Informed consent was obtained from each patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author confirms that the work described has not been published before.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article. No authors have a financial interest in any of the products, devices, or drugs mentioned in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization \u0026nbsp;Hao Yao, MD., Xiaoliang Yang,\u003c/p\u003e\n\u003cp\u003eData curation, formal analysis, Software \u0026nbsp;Xu Zhang, MD.\u003c/p\u003e\n\u003cp\u003eInvestigation \u0026nbsp;Bing Wang, MD., Xuewu Zhou, MD. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethodology \u0026nbsp;Hao Yao, Xiaoliang Yang,, MD.\u003c/p\u003e\n\u003cp\u003eProject administration \u0026nbsp;Xiaoliang Yang, MD.\u003c/p\u003e\n\u003cp\u003eResources \u0026nbsp; Jingqiao Li, MD.\u003c/p\u003e\n\u003cp\u003eValidation, Supervision Jingqiao Li, MD. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVisualization \u0026nbsp;Bing Wang, MD. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; original draft \u0026nbsp;Hao Yao, MD. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; review \u0026amp; editing \u0026nbsp;Bing Wang, MD., Xiaoliang Yang,, MD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRundgren J, Bojan A, Mellstrand Navarro C, Enocson A. 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A comparison of early and late reconstruction of malunited fractures of the distal end of the radius. \u003cem\u003eJ Bone Joint Surg Am\u003c/em\u003e. 1996;78:739e748.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSato K, Nakamura T, Iwamoto T, Toyama Y, Ikegami H,Takayama S. Corrective osteotomy for volarly malunited distal radius fracture. \u003cem\u003eJ Hand Surg Am\u003c/em\u003e. 2009;34:27e33.e1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcQueen MM, Wakefield A. Distal radial osteotomy for malunion using non-bridging external fixation: good results in 23 patients. \u003cem\u003eActa Orthop\u003c/em\u003e. 2008;79:390\u0026ndash;395.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown JN, Bell MJ. Distal radial osteotomy for malunion of wrist fractures in young patients. \u003cem\u003eJ Hand Surg Br\u003c/em\u003e. 1994;19:589\u0026ndash;593.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMa HH, Chen YC, Huang HK, Huang YC, Chang MC, Wang JP. Comparing radial lengthening osteotomy with ulnar shortening osteotomy to treat ulnar impaction syndrome after distal radius fracture malunion. \u003cem\u003eArch Orthop Trauma Surg\u003c/em\u003e. 2022;142:525\u0026ndash;531.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWada T, Tatebe M, Ozasa Y, Sato O, Sonoda T, Hirata H, Yamashita T. Clinical outcomes of corrective osteotomy for distal radial malunion: a review of opening and closing-wedge techniques. \u003cem\u003eJ Bone Joint Surg Am\u003c/em\u003e. 2011;93:1619\u0026ndash;1626.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArslan H, Subasi M, Kesemenli C, Kapukaya A, Necmioglu S. Distraction osteotomy for malunion of the distal end of the radius with radial shortening.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"minimally invasive technique, distal radial malunion, plating, K-wire, bone healing","lastPublishedDoi":"10.21203/rs.3.rs-7436374/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7436374/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to compare the efficiency of a minimally invasive technique \u003cem\u003eversus\u003c/em\u003e conventional plating fixation for the treatment of distal radial malunions in patients with diabetes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eFrom January 2015 to January 2023, 68 diabetes patients with distal radial malunions were treated. Among them, 33 patients were treated with minimally invasive technique through a 5-mm incision, and 35 patients were treated with conventional a volar locking plate and screw system. Intraoperative assessments included blood loss. Postoperative assessments included infection and bone healing. Assessments at the final follow-up included aesthetics, satisfaction, and Mayo Wrist Score.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf the minimally invasive technique group, the blood loss was 33\u0026thinsp;\u0026plusmn;\u0026thinsp;5 ml. The time of bone healing was 6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 weeks. No wound infection occurred. Pin site infection occurred in 2 patients, which was cured with pin care. The follow-up period was 28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 months. The patient aesthetics and satisfaction scores were 10\u0026thinsp;\u0026plusmn;\u0026thinsp;1 and 9\u0026thinsp;\u0026plusmn;\u0026thinsp;1, respectively. The Mayo Wrist Score was 94\u0026thinsp;\u0026plusmn;\u0026thinsp;5, including 29 excellent and 4 good results. Of the plating group, the blood loss was 66\u0026thinsp;\u0026plusmn;\u0026thinsp;11 ml. Deep abscess occurred in 3 patients, and wound cellulitis occurred in 2 patients. The infection was treated with wound care. One infection developed osteomyelitis. There were significant differences between the groups in complication rates (6% vs 45%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Bone healing was achieved in all patients after 6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 weeks. The follow-up period was 29\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6 months. The Mayo Wrist Score was 86\u0026thinsp;\u0026plusmn;\u0026thinsp;4, including 18 excellent, 10 good, 6 fair, and 1 poor result. The patient aesthetics and satisfaction scores were 9\u0026thinsp;\u0026plusmn;\u0026thinsp;1 and 10\u0026thinsp;\u0026plusmn;\u0026thinsp;1, respectively. There were significant differences in wrist pain, infection, wrist function, aesthetics score, and satisfaction score (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eDistal radial malunions can be treated with the minimally invasive technique through a small incision. As an alternative technique of conventional volar plating, the minimally invasive technique may be associated less infection and total complications. Wrist immobilization may produce equal function, compared to open surgery with injuries to the wrist ligaments and capsule.\u003c/p\u003e\u003ch2\u003eLevel of Evidence\u003c/h2\u003e\u003cp\u003eTherapeutic study, Level IVa.\u003c/p\u003e","manuscriptTitle":"Treatment of Distal Radial Malunions Using a Minimally Invasive Technique versus Plating: A Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 13:20:45","doi":"10.21203/rs.3.rs-7436374/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd6cf714-813b-4206-bc5c-75ea5137a09c","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T07:54:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 13:20:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7436374","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7436374","identity":"rs-7436374","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}