“…This is consistent with previously reported residual angles for forearm osteotomies using this technique. 7 , 8 , 11 Figure 7 Residual angles comparing 3-dimensional/computer-planned versus postoperative alignments. The lines of best fit were calculated for each bone alinement, both 3-dimensional planned (purple) and postoperative (green) lines of best fit along all 3 (along the 3-dimensional planes) anatomical planes, A coronal, B sagittal, and C axial.…”
Section: Casementioning
confidence: 99%
“…The combination of a neutral ulnar variance, <2° residual deformity in 2-dimensional planes, and 2° absolute rotational deformity after surgery demonstrates the accurate and precise surgical correction using 3-dimensional planning technology. 7 , 8 , 11 …”
Section: Casementioning
confidence: 99%
“… 4 , 5 In such cases, the recent use of computer-guided 3-dimensional planning models and patient-specific cutting guides has allowed surgeons to offer patients more accurate correction of forearm deformities. 4 , 5 , 6 , 7 , 8 …”
mentioning
confidence: 99%
“…Of the limited literature comprising case reports, a case series, and a 40-patient randomized controlled trial, most studies reported radius-only osteotomies or ulnar corrective osteotomy in the context of concurrent radius and ulna fracture malunions. 5 , 6 , 7 , 8 , 9 We present a case using a computer-assisted 3-dimensional planned approach to an ulna-only corrective osteotomy for symptomatic fracture malunion in a patient with a history of a surgically fixed distal radius fracture but malunited conservatively treated distal ulnar fracture, with excellent postoperative outcomes over a 12-month follow-up period. Written informed consent was obtained from the patient for publication of this report and accompanying figures.…”
“…This is consistent with previously reported residual angles for forearm osteotomies using this technique. 7 , 8 , 11 Figure 7 Residual angles comparing 3-dimensional/computer-planned versus postoperative alignments. The lines of best fit were calculated for each bone alinement, both 3-dimensional planned (purple) and postoperative (green) lines of best fit along all 3 (along the 3-dimensional planes) anatomical planes, A coronal, B sagittal, and C axial.…”
Section: Casementioning
confidence: 99%
“…The combination of a neutral ulnar variance, <2° residual deformity in 2-dimensional planes, and 2° absolute rotational deformity after surgery demonstrates the accurate and precise surgical correction using 3-dimensional planning technology. 7 , 8 , 11 …”
Section: Casementioning
confidence: 99%
“… 4 , 5 In such cases, the recent use of computer-guided 3-dimensional planning models and patient-specific cutting guides has allowed surgeons to offer patients more accurate correction of forearm deformities. 4 , 5 , 6 , 7 , 8 …”
mentioning
confidence: 99%
“…Of the limited literature comprising case reports, a case series, and a 40-patient randomized controlled trial, most studies reported radius-only osteotomies or ulnar corrective osteotomy in the context of concurrent radius and ulna fracture malunions. 5 , 6 , 7 , 8 , 9 We present a case using a computer-assisted 3-dimensional planned approach to an ulna-only corrective osteotomy for symptomatic fracture malunion in a patient with a history of a surgically fixed distal radius fracture but malunited conservatively treated distal ulnar fracture, with excellent postoperative outcomes over a 12-month follow-up period. Written informed consent was obtained from the patient for publication of this report and accompanying figures.…”
“…While the benefit of PSI has been demonstrated for malunions at the wrist, and at the extra-articular phalanges [ 4 , 7 , 8 ], the role of PSI for treating intra-articular malunions at the finger joints remains unclear.…”
Background
Intra-articular malunions of the finger can lead to deformity and loss of function and can be treated with intra-articular corrective osteotomies. The aim of this study was to evaluate radiographic joint congruency, feasibility and functional outcome of three-dimensional (3D) printed patient-specific instrumentation (PSI) for corrective osteotomies at the trapeziometacarpal and finger joints.
Methods
Computer-tomography (CT) scans were acquired preoperatively for standard 3D planning, which was followed by calculation of cutting planes and the design of individualized bone surface contact drilling, sawing and reposition guides. Follow-up CT scans and clinical examinations (range of motion, grip strength) were performed. Postoperative complications were documented and patient-reported outcome measurements were assessed (Single Assessment Numeric Evaluation (SANE) score, brief Michigan Hand Questionnaire (MHQ)).
Results
Ten patients (mean age 28.4 ± 12.8,range 13.8–51.3) years) were included with a mean follow-up of 21 ± 18 (3–59) months including seven osteotomies at the trapeziometacarpal or metacarpophalangeal joints and three at the proximal interphalangeal joint (PIP). All radiographic follow-up examinations showed the planned correction with good joint congruency and regular osseous consolidation. At the latest follow-up, the range of motion (ROM) increased and the average grip strength recovered to the level of the contralateral side. No postoperative complication was detected. The mean SANE score improved from 44 ± 23 (0–70) to 82 ± 12 (60–90) after a mean of 72 ± 20 (44–114) months. The mean postoperative brief MHQ was 92 ± 8 (71–98).
Conclusion
The use of 3D PSI in treating intra-articular malunions at the trapeziometacarpal and finger joints restored articular congruency accurately. ROM and grip strength improved postoperatively comparable to the healthy contralateral side and patient-reported outcome measures improved after medium-term follow-up.
Purpose
There is a debate whether corrective osteotomies of the distal radius should be performed using a 3D work-up with pre-contoured conventional implants (i.e., of-the-shelf) or patient-specific implants (i.e., custom-made). This study aims to assess the postoperative accuracy of 3D-assisted correction osteotomy of the distal radius using either implant.
Methods
Twenty corrective osteotomies of the distal radius were planned using 3D technologies and performed on Thiel embalmed human cadavers. Our workflow consisted of virtual surgical planning and 3D printed guides for osteotomy and repositioning. Subsequently, left radii were fixated with patient-specific implants, and right radii were fixated with pre-contoured conventional implants. The accuracy of the corrections was assessed through measurement of rotation, dorsal and radial angulation and translations with postoperative CT scans in comparison to their preoperative virtual plan.
Results
Twenty corrective osteotomies were executed according to their plan. The median differences between the preoperative plan and postoperative results were 2.6° (IQR: 1.6–3.9°) for rotation, 1.4° (IQR: 0.6–2.9°) for dorsal angulation, 4.7° (IQR: 2.9–5.7°) for radial angulation, and 2.4 mm (IQR: 1.3–2.9 mm) for translation of the distal radius, thus sufficient for application in clinical practice. There was no significant difference in accuracy of correction when comparing pre-contoured conventional implants with patient-specific implants.
Conclusion
3D-assisted corrective osteotomy of the distal radius with either pre-contoured conventional implants or patient-specific implants results in accurate corrections. The choice of implant type should not solely depend on accuracy of the correction, but also be based on other considerations like the availability of resources and the preoperative assessment of implant fitting.
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