Volar and dorsal approaches show comparable outcomes for distal radius malunion corrective osteotomyDifferent Surgical Approaches Show Similar Results for Wrist Malunion

The journal of hand surgery Asian-Pacific volume Published August 3, 2026 Study authors: Nix Anatolia, Hansjee Shanil, Divall Pip, Chong Han Hong, Kulkarni Kunal PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that volar and dorsal approaches offer comparable outcomes for distal radius malunion corrective osteotomy.

This systematic review and exploratory network meta-analysis synthesized evidence from 20 studies involving 517 wrists to compare volar, dorsal, and dual surgical approaches for correcting distal radius malunion. The analysis indicates that all three techniques successfully improve patient-reported outcome measures (PROMs), functional outcomes, and radiographic alignment. Specifically, the study found no statistically significant differences between dorsal and volar approaches regarding pain scores or range of motion.

Regarding specific malunion types, the authors noted potential benefits for dual approaches in intra-articular malunions involving radial inclination and ulnar variance. Conversely, a volar approach may be more effective for extra-articular malunions specifically affecting ulnar variance. The study also found that graft utilization did not significantly impact union rates across any of the three surgical methods.

Clinical evidence is limited by methodological constraints, which prevent firm comparative conclusions between the primary approaches. While some specific configurations may favor certain techniques, there is no definitive evidence to prefer one approach over another for general cases. Clinicians should consider individualized treatment plans based on specific malunion configuration, patient factors, and surgeon experience.

This study looked at how different surgical methods help people over age 16 who have a malunion of the distal radius. A malunion occurs when a broken wrist bone heals in an incorrect position, causing symptoms like pain or limited movement. Researchers compared three specific techniques: volar, dorsal, and dual approaches.

The results showed that all three surgical methods improved patient-reported outcomes and radiographic alignment. Specifically, patients who had the dorsal or volar procedures reported similar levels of pain relief and range of motion. While the dual approach showed some potential benefits for certain types of internal bone issues, it did not significantly change overall scores compared to the volar method.

Because this was an exploratory study with several limitations, the results do not prove one surgery is better than another. The findings suggest that the best choice may depend on the specific type of bone misalignment and the surgeon's experience. Patients should talk to their doctors to decide which surgical path fits their specific wrist injury.

What this means for you:

Different surgical methods for wrist malunion show similar results for pain and movement, though some have minor benefits.

Common questions

Are all surgical methods equally effective for wrist pain?

The study found that both the dorsal and volar surgical approaches were comparable in their effectiveness for reducing pain and improving range of motion. While different techniques exist, they showed similar results for these primary patient outcomes.

What are the differences between the dual and volar approaches?

The dual approach showed some potential benefits over the volar approach specifically for intra-articular malunions involving radial inclination and ulnar variance. However, for overall functional scores like DASH, both methods performed similarly.

Are there any known risks or complications with these surgeries?

Overall complication rates were low across the studied procedures. However, the study noted that the dorsal approach was associated with a higher rate of hardware removal compared to other methods.

Study Details

Study typeSystematic review

EvidenceLevel 1

Follow-up192.0 mo

PublishedAug 2026

PMID42438292

View Original Abstract ↓

Symptomatic malunion following distal radius fracture can adversely impact wrist function. Corrective osteotomy, utilising volar, dorsal or dual approaches, is a common treatment option. This study aimed to review the literature and compare the outcomes of these different surgical approaches. A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted, including studies comparing volar, dorsal or dual approaches in patients aged ≥16 years. Data on patient-reported outcome measures (PROMs), pain scores, grip strength, range of motion (ROM), radiographic alignment, graft use, union rates and complications were extracted and analysed via an exploratory network meta-analysis. A total of 20 studies encompassing 517 wrists were included. All approaches demonstrated improvements in PROMs, functional outcomes and radiographic alignment. Analysis suggested comparable effectiveness of dorsal and volar approaches in improving ROM and pain. Dual approaches showed similar Disabilities of the Arm, Shoulder and Hand (DASH) scores to volar. No statistically significant differences were observed between approaches in improving radiographic alignment. Subgroup analysis revealed potential benefits of the dual approach over the volar for intra-articular malunions, particularly correction of radial inclination and ulnar variance. Conversely, the volar approach may be more effective than the dorsal in correcting ulnar variance in extra-articular malunions. Graft utilisation did not significantly impact union rates across any approach. Overall complication rates were low, but the dorsal approach exhibited a higher rate of hardware removal. This exploratory analysis found no definitive evidence to favour one surgical approach over another, though methodological limitations preclude firm comparative conclusions. Current evidence supports individualised approach selection based upon malunion configuration, patient factors and surgeon experience. Prospective comparative studies are needed to establish definitive comparative effectiveness. Level III (Therapeutic).

Volar and dorsal approaches show comparable outcomes for distal radius malunion corrective osteotomyDifferent Surgical Approaches Show Similar Results for Wrist Malunion

Common questions

Study Details

Low-intensity pulsed ultrasound shows a 0.79 healing rate in nonunion fractures across observational studies

Trial results show mixed success for ultrasound on nonunion fractures

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Volar and dorsal approaches show comparable outcomes for distal radius malunion corrective osteotomyDifferent Surgical Approaches Show Similar Results for Wrist Malunion

Common questions

Study Details

Low-intensity pulsed ultrasound shows a 0.79 healing rate in nonunion fractures across observational studies

Trial results show mixed success for ultrasound on nonunion fractures

Clinical research that matters. Delivered to your inbox.

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