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Nov 28, 2022, 9:32:45 PM11/28/22

Dear Friends

Kindly give your suggestions especially with regards to what implant to use


45 yr old man, h/o fall and # R distal radius-1 yr ago

[Previously 10 yrs ago # L distal radius]

Treated by POP cast   

Malunion with severe dorsal tilt and pain on lifting weights

Range of motion: -Dorsiflexion=40 Palmar flexion=40 Ulnar and radial deviation =20

             Supination full    Pronation restriction last 20 deg

My plan- dorsal opening wedge osteotomy and bone graft- my question is what implant to  use?

Attaching requisite x-rays






Inj AP4-10-21.jpg
iNJ 1-11-21lat.jpg
latest 20-11-22AP.jpg
latest 20-11-22LAT.jpg

DavidLincoln Nelson

Nov 28, 2022, 11:25:49 PM11/28/22
The implant is not the key feature; it is your surgical judgement and surgical technique. I say this as the inventor of one of the plates that is sold internationally. I like my plate, but any good surgeon can get a good result with any good plate. 

The key is where you make the osteomyelitis: proximal enough to get a good purchase on the distal fragment, proximal enough to restore proper anatomy. 

David Nelson
San Francisco

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On Nov 28, 2022, at 6:32 PM, CHERRY KOVOOR <> wrote:

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<Inj AP4-10-21.jpg>
<iNJ 1-11-21lat.jpg>
<latest 20-11-22AP.jpg>
<latest 20-11-22LAT.jpg>

Minoo Patel

Nov 29, 2022, 8:00:52 AM11/29/22

Hi Cherry

I agree with David Nelson

I have my distal radius plate (one that I developed)  but will often use another for say peri-articular applications.


I would be wary of 10 yr old malunions especially with respect to the DRUJ. Expect some loss of supination.


Also, there will be an adaptive DISI which may not fully correct.


Is there an ulna plus? If so avoid losing volar bone contact. You can always shorten the ulna, now or later.


I do a CT scan and then use the Ilizarov oblique plane planning to determine the exact position of the opening wedge.


Any locking plate will do. The simpler the better. Use an anatomic plate as a volar buttress / template against which to reduce. Accept 0-5 deg volar tilt; patients are happier.


Good luck.





Prof. Minoo Patel MBBS, MS, FRACS, Ph.D.

Orthopaedic Surgeon

Adjunct Professor, RMIT University ǀ Senior Lecturer Monash University ǀ Research Fellow Melbourne University

Past Chair, Australian Orthopaedic Association Research Foundation


Suite 5.7. The Epworth Centre, 32 Erin St, Richmond. VIC  3121

Ph: 03 9429 8084    Fax: 03 94294045       Mobile: 0418 418 728


DavidLincoln Nelson

Nov 29, 2022, 4:40:13 PM11/29/22
Osteotomy, not osteomyelitis

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On Nov 29, 2022, at 5:01 AM, Minoo Patel <> wrote:

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