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

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.