Comparison of an oblique single cut rotation osteotomy with a novel 3D computer-assisted oblique double cut alignment approach

Abstract

An oblique double-cut rotation osteotomy (ODCRO) enables correcting a complex bone deformation by aligning, in 3D, the distal, middle and proximal bone segments with a target bone, without intersegmental gaps. We propose virtual preoperative planning of an ODCRO. To minimize a residual translation error, we use an optimization algorithm and optimize towards bone length, alignment in the transverse direction, or a balanced reconstruction. We compare the residual alignment error with an oblique single-cut rotation osteotomy using 15 complex bone deformations. The single-cut approach was not feasible in 5 cases, whereas the ODCRO procedure was feasible in all cases. The residual alignment error was smaller for the ODCRO than for the single-cut approach except for one case. In a subset for length reconstruction, the length error of 7.3–21.3 mm was restored to 0.0 mm in 4 of 5 cases, although at the cost of an increased transverse translation. The proposed method renders planning an ODCRO feasible and helps restoring bone alignment and lengthening better than an oblique single-cut rotation osteotomy. Awareness of the challenges and possibilities in preoperative planning of an ODCRO will be of value for future alignment surgery and for patients.

The Flipping-Wedge Osteotomy: How 3D Virtual Surgical Planning (VSP) Suggested a Simple and Promising Type of Osteotomy in Pediatric Post-Traumatic Forearm Deformity

“…Despite VSP and 3D-printed PSIs having improved this approach in forearm surgery, the plane of an oblique single-cut rotational osteotomy (OSCRO) calculated by algorithms may be too steep to be clinically achievable [ 31 ]. Dobbe et al in 2021 proposed an oblique double-cut rotational osteotomy (ODCRO) calculated with software to obtain the smoothest alignment of the corrected bone when a single oblique cut is too steep [ 3 ]. The flipping-wedge osteotomy is a lengthening-preserving approach that may avoid a shortening osteotomy if one of the bones is straight.…”

“…Currently, acute correction of post-traumatic forearm deformities in children is generally achieved with a closing-wedge osteotomy, an opening-wedge osteotomy, or an oblique osteotomy of one or both bones [ 1 , 2 ]. The precision of these techniques has significantly improved since the introduction of virtual surgical planning (VSP) and the spread of 3D-printed patient-specific instruments (PSIs) in orthopedic surgery [ 1 , 2 , 3 , 4 ]. Many authors have published methods and algorithms to precisely align a malunited bone to the shape of the uninjured contralateral with a single oblique cut [ 5 , 6 , 7 , 8 , 9 ].…”

“…Many authors have published methods and algorithms to precisely align a malunited bone to the shape of the uninjured contralateral with a single oblique cut [ 5 , 6 , 7 , 8 , 9 ]. However, this method still has some issues: (1) VSP is still technically demanding; (2) it heavily relies on PSI-guided cuts that are difficult to achieve freehand, even by the most expert surgeons; (3) rotational correction must be preoperatively calculated to set the cutting plane; and (4) if the rotational deformity to correct approaches zero, a very steep oblique cut is needed, which may not be clinically feasible [ 3 ].…”

Cold ablation robot‐guided laser osteotomy in hand, wrist and forearm surgery—A feasibility study

“…26,27 Computer assisted analysis and planning of the osteotomy has been established as the gold standard and to facilitate the surgical procedure, additive manufactured guides are frequently used. [28][29][30][31][32][33] The planning process of the osteotomy using CARLO ® requires also a digital workflow with the assessment of the malunion and planning of the surgical intervention. In contrast to the conventional method, no intraoperative patient specific instrumentation is required.…”

“…A frequently performed procedure is therefore the corrective osteotomy of the distal radius due to symptomatic malunion of a distal radius fracture 26,27 . Computer assisted analysis and planning of the osteotomy has been established as the gold standard and to facilitate the surgical procedure, additive manufactured guides are frequently used 28–33 …”