Temporary fixation with the Agee-Wristjack during correctional osteotomies for malunions and nonunions of the distal radius.

Upper extremity surgeons are often responsible for managing complex malunions and nonunions of distal radius fractures. Studies have demonstrated that corrective osteotomies of the malunited distal radius with placement of sculpted bone grafts produce the best functional and cosmetic results in patients. We describe a technique for providing provisional stabilization of the osteotomy site for treatment of distal radius malunions and nonunions using the Agee-Wristjack external fixator device. The Agee-Wristjack has several features that make it superior to other available small external fixators. Its gear mechanisms confer stable distraction of the distal radius following osteotomy and greatly facilitate appropriate positioning of the distal fragment. Iliac crest bone graft may be harvested and shaped precisely to fit the osteotomy defect. Placement of the Agee-Wristjack's distal fixator pins into the index metacarpal instead of the distal radius fragment facilitates application of a plate, with minimal interference from the distal pins. Finally, the Agee-Wristjack may be maintained following surgery to supplement the internal fixation.