EXPLORING THE LATEST TRENDS IN BONE GRAFT UTILIZATION FOR EXTRA-ARTICULAR CORRECTIVE OSTEOTOMY IN DORSALLY ANGULATED DISTAL RADIUS MALUNION: INSIGHTS FROM A CANADIAN SURVEY

To examine the trends of bone graft utilization in extra-articular corrective osteotomies for dorsally angulated distal radius (DR) malunions amongst Canadian surgeons. Data for the survey were collected using REDCap electronic data capture tools and distributed among members of the Canadian Orthopaedic Association's and the Wrist Evaluators of Canada group. The survey included 15 questions evaluating: surgeon experience, indications for corrective osteotomy surgery, types of bone grafts used, factors influencing graft selection, and interest in future studies. All data were summarized using descriptive statistics. All analysis was performed in Stata software. A total of 34 responses were received, with 33 from orthopedic surgeons and one from a plastic surgeon. Fifty-six percent of respondents had over a decade of experience, performing 3 to 5 osteotomies annually. Common indications for corrective osteotomy were pain (97%), ulnar abutment (76%), distal radioulnar joint instability (64%), adaptive carpal instability (53%), limited range of motion (38%), and cosmesis (17%). The predominant fixation method reported was a volar fixed-angle locking plate (94%). Use of autograft/allograft cancellous (23% each) and autograft corticoancellous (24%) was similar, followed by synthetic grafts (15%) and allograft corticocancellous (6%). Nine percent of surgeons did not use any grafts. Key factors influencing graft selection were the size of correction and lack of cortical contact. This survey reveals significant variation in bone graft selection preferences and rationales among Canadian surgeons for DR osteotomies. The findings highlight a lack of evidence-based guidance and underscore the need for future studies to determine the impact of gap size and cortical contact on union rates and time to union.