Treatment of the neglected distal radius fracture.

Operative treatment of inadequately or imperfectly treated fractures of the distal radius can improve wrist and hand function substantially, but rarely restores the limb to normal. Patients with malunion of the distal radius present either with poor radiographic alignment before complete healing of the fracture (nascent malunion) or with functional problems that may be related to inadequate alignment of a healed fracture (mature malunion). Corrective osteotomy is offered to patients who have sufficient malalignment that the surgeon thinks problems are inevitable or to patients in whom the functional deficit can be related clearly to the malunion. Ununited fractures are associated with painful instability of the wrist and very poor hand function. Operative treatment has proved successful even when the distal fragment is small. Operative treatment for reconstruction of the distal radius has been facilitated by the introduction of plates with angular stable screws (screws that lock into the plate). Painful arthritis is salvaged with arthrodesis.