Salvage of intraarticular malunions of the hand and wrist. The role of realignment osteotomy.

Malunited intraarticular fractures of the hand and wrist may be repaired months following injury by osteotomy through the healed fracture site. If a congruent joint can be reestablished, pain may be relieved while skeletal alignment and motion are improved. Successful reconstruction depends on careful preoperative evaluation and patient selection. Extensile surgical exposure, accurate reduction, and firm skeletal fixation are essential for this technique. Early supervised joint mobilization allows maximal motion. Eight of nine operated joints have regained substantial motion. One procedure failed to establish firm fixation in osteoporotic bone and required arthrodesis. Secondary tenolysis was required on one occasion. An additional patient gained substantial pain relief and motion from limited articular surface resection.