Patient-specific plate for navigation and fixation of the distal radius: a case series

Abstract

Purpose Corrective osteotomy of a malunited distal radius conventionally relies on 2D imaging techniques for alignment planning and evaluation. However, this approach results in suboptimal bone repositioning, which is associated with poor patient outcomes. In this case series, we evaluate the use of novel patient-specific plates (PSPs), which feature navigation and fixation of bone segments as preoperatively planned in 3D. Methods Ten participants with distal radius malunion underwent CT scans for preoperative alignment planning. Patient-specific guides and plates were designed, 3D-printed, and sterilized for use in corrective surgery of the distal radius. Pre- and postoperative results were compared in regard to clinical, functional, and radiographic outcomes. Results The application of a PSP was successful in 7 of the 10 cases. After treatment, the residual alignment error was reduced by approximately 50% compared with conventional treatment. The use of PSPs reduced pain significantly. Pre- and postoperative results were pooled and demonstrated significant correlations between: (1) pain and malpositioning, (2) the range of pro- and supination motion, the MHOQ score, the EQ-5D-5L score and dorsovolar angulation, and (3) MHOQ score and proximodistal translation. Conclusion The correlation between malalignment and MHOQ score, EQ-5D-5L score, pain, and range of motion shows that alignment should be restored as well as possible. Compared to the conventional approach, which relies on 2D imaging techniques, corrective osteotomy based on 3D preoperative planning and intraoperative fixation with a PSP has been shown to improve bone alignment and reduce pain. Level of evidence IV.

Three-Dimensionally Planned and Printed Patient-Tailored Plates for Corrective Osteotomies of the Distal Radius and Forearm

“…Only 3 case reports have documented the technique of printing titanium plates for stable fixation in corrective osteotomies of the radius and ulna. 10,13,14 These reports included 1, 5, and 7 cases, all of which resulted in satisfactory outcomes. Dobbe et al 10 also compared the 3-dimensional preoperative planning and intraoperative fixation with a patientspecific plate to conventional planning using 2dimensional images and standard plates.…”

“…Alignment is correlated to patient-reported and functional outcomes, which implies that 3dimensional preoperative planning and use of patient-tailored plates could potentially lead to better outcomes over traditional methods. 10,22 A biomechanical study showed that 3-dimensionally printed, volar-locking, titanium plates provided significantly higher stiffness compared with conventional distal radius plates. 23 Further comparative studies investigating the clinical outcomes after both methods are still required.…”

“…23 Further comparative studies investigating the clinical outcomes after both methods are still required. 10 Since more precise bone realignment is directly related to better functional outcomes, we assume that using this 3-dimensional planning technology with patient-specific, titanium plates would lead to superior outcomes than those achieved using traditional planning and standard plates. 1,3 Although the outcomes of 3-dimensional technology on our small case series are encouraging, it is yet to be clarified whether the clinical results are actually better or whether the complication rates are lower when compared with freehand osteotomy.…”

“…1,4e8 The capability to manufacture personalized implants has also seen an increase in popularity, particularly in trauma surgery because, in contrast to conventional plates, patient-tailored implants can be fitted to the patient's exact bone contour. 9,10 In craniomaxillofacial surgery, 3-dimensionally printed implants are very popular and have been proven effective. 11 For the treatment of distal radius and forearm malunions, this 3-dimensional process of tailoring plates for the individual patient is yet to be extensively discussed in the literature.…”

“…12 There are only 3 case reports that investigated patient-tailored plates for the treatment of malunited diaphyseal forearm fractures in children and adults with distal radius malunions. 10,13,14 Therefore, the aim of the current study was to evaluate the 1-year postoperative clinical, radiological, and patient-reported outcomes in patients after a planned 3-dimensional corrective osteotomy for posttraumatic malunions of the distal radius or forearm using patient-tailored plates and to determine the feasibility and effectiveness of this methodology.…”