Fluoroscopic and Magnetic Resonance Cross-Sectional Imaging Assessments of Radial and Ulnar Torsion Profiles in Volunteers

Correction of Forearm Malunion Guided by the Preoperative Complaint

“…However, accuracy of preoperative planning is dependent on correct assessment of the angular and axial components of the deformity. Therefore, the lack of reliable assessments of radius and ulna axial malunions impair accurate planning of osteotomies of complex deformities in the radius and ulna [10,11]. The overall improvement in ROM after osteotomies for patients with a predominant deficit in supination was much better than for patients with a pronation deficit.…”

“…Bone angulations are easily discernible on radiographs, but those involving the radius must be assessed with respect to a plane of reference taking into account the axial rotation of this bone during pronation-supination to make side comparison possible. Axial malunions are difficult to be estimated with two-plane radiographs, and therefore we recommend systematically assessing axial malunions preoperatively with MRI and fluoroscopy coupled with goniometry before planning corrective osteotomy of the forearm [10,11]. However, axial malunions of the radius and the ulna are difficult to quantify because the healthy side is the only available reference, and there are important side differences in the healthy population [4,10,11].…”

“…The exact amount of radial and ulnar torsion was defined on comparative MR images of both forearms in nine patients (Table 3) [4,11]. Side difference in the torsion profile of the radius exceeding 30°o r 20°in the ulna was a reason to correct the axial malunion, because side differences greater than these limits are considered nonphysiologic [10]. The site of the osteotomy determined the type of exposure.…”

“…We obtained full-length conventional radiographs of both forearms, anteroposterior and lateral in neutral rotation and with the elbow flexed at 90°, and any angular residual deformity was measured in the same way as preoperatively. Residual axial malunions were determined systematically at the last followup with fluoroscopy coupled with goniometry [10].…”

Complex Radius Shaft Malunion: Osteotomy with Computer-Assisted Planning

“…Anatomical landmarks, radiographs from the uninvolved opposite side and intraoperative image intensifier are used as a guide for planning, intraoperative orientation and control of the result [14,17,19,25]. However, the rotational component of a malunion is almost undetectable on plain radiographs [5][6][7]23] and requires a more sophisticated side-to-side comparison of bony rotation profiles on computed tomography (CT) images [2,6]. These methods assess rotational malunions based on few anatomical landmarks on 2-dimensional planes (2-d CT slices) in spite of the 3-d nature of the available data.…”