Three-Dimensional Assessment of Bilateral Symmetry of the Radius and Ulna for Planning Corrective Surgeries

Vroemen, Joy C.; Dobbe, Johannes G. G.; Jonges, R.; Strackee, Simon D.; Streekstra, Geert J.

doi:10.1016/j.jhsa.2011.12.035

Cited by 49 publications

(56 citation statements)

References 29 publications

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“…axis compared to the Z-and X-axis, i.e., a rotation angle of 6.48 6 4.78 (configuration 1) and 6.88 6 5.38 (configuration 2) was measured in longitudinal torsion. These measurements are larger to that reported for other long bones, such as the radius, where torsional differences between the sides along the longitudinal, medio-lateral and antero-posterior axes (0.13861.008, 0.60861.358, and 0.53865.008, respectively) were reported (Vroemen et al, 2012). This suggests that if a mal-united clavicle is assessed, one must be aware that an average torsional variation between the sides of 78 is considered to be normal.…”

Section: Discussioncontrasting

confidence: 78%

Three‐dimensional corrective osteotomies of mal‐united clavicles—is the contralateral anatomy a reliable template for reconstruction?

et al. 2015

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In computer-assisted preoperative planning of corrective osteotomies, the unaffected contralateral bone often serves as three-dimensional template for the reconstruction of mal-united bones. Before applying this approach to new anatomy such as the clavicle bone, it is important to study asymmetry between the sides. The purpose of this study was to investigate bilateral symmetry of the clavicle in healthy cadavers using three-dimensional measurement techniques. Bilateral symmetry of 102 clavicles (51 cadavers, mean age: 52.19 years, 37 male) was measured based on three-dimensional models reconstructed from computed tomography. Besides length, volume, and surface, the side-differences were evaluated by considering the mirrored left clavicle as the reconstruction template and the right clavicle as the one that will be realigned by osteotomy. The relative transformation between the aligned segments was measured to express the difference with to three-dimensional translation and rotation. The same procedure was repeated using mean-sized clavicles, one for each gender, as the template. The contralateral side was a significant more accurate reconstruction template compared to a mean-sized clavicle (P < 0.001). Nevertheless, an average side-differences with respect to rotation and translation of 8.79° ± 5.2° and 3.5 mm ± 2.7 mm, respectively. The left clavicles were significant (P = 0.001) longer with 154 mm compared to the right ones (151 mm). Three-dimensional differences between the left and right clavicles exist, but can be considered as small. Therefore, the contralateral side appears to be a reliable reconstruction template, in particular compared to a mean-sized clavicle.

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Section: Discussioncontrasting

confidence: 78%

Three‐dimensional corrective osteotomies of mal‐united clavicles—is the contralateral anatomy a reliable template for reconstruction?

et al. 2015

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“…Preoperatively defining the reduction target (i.e., the goal model) correctly is a major contributor to a successful planning. So far, the contralateral bone has been proved to be the best reconstruction template available [12,18] although considerable bilateral asymmetry may exist [39][40][41]. Even in case of perfect symmetry, soft tissues may have a considerable influence on the joint function.…”

Section: Resultsmentioning

confidence: 99%

“…During this planning stage, potential side-to-side differences between the bones must also be identified and compensated because several studies showed that asymmetry between the left and the right limbs exist for long bones [39][40][41] such as in length and torsion. Asymmetry in size can be compensated easier for anatomy where the joint is formed by two bones (forearm: radius and ulna; lower leg: tibia and fibula).…”

Section: Template-based Approachmentioning

confidence: 99%

Surgical Treatment of Long-Bone Deformities: 3D Preoperative Planning and Patient-Specific Instrumentation

Fürnstahl

Schweizer

Graf

et al. 2015

Lecture Notes in Computational Vision and Biomechanics

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Congenital or posttraumatic bone deformity may lead to reduced range of motion, joint instability, pain, and osteoarthritis. The conventional joint-preserving therapy for such deformities is corrective osteotomy-the anatomical reduction or realignment of bones with fixation. In this procedure, the bone is cut and its fragments are correctly realigned and stabilized with an implant to secure their position during bone healing. Corrective osteotomy is an elective procedure scheduled in advance, providing sufficient time for careful diagnosis and operation planning. Accordingly, computer-based methods have become very popular for its preoperative planning. These methods can improve precision not only by enabling the surgeon to quantify deformities and to simulate the intervention preoperatively in three dimensions, but also by generating a surgical plan of the required correction. However, generation of complex surgical plans is still a major challenge, requiring sophisticated techniques and profound clinical expertise. In addition to preoperative planning, computer-based approaches can also be used to support surgeons during the course of interventions. In particular, since recent advances in additive manufacturing technology have enabled cost-effective production of patient-and intervention-specific osteotomy instruments, customized interventions can thus be planned for and performed using such instruments. In this chapter, state of the art and future perspectives of computer-assisted deformity-correction surgery of the upper and lower extremities are presented. We elaborate on the benefits and pitfalls of different approaches based on our own experience in treating over 150 patients with three-dimensional preoperative planning and patient-specific instrumentation.

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“…In this study we used bilateral CT-scans of intact forearms including the proximal radius obtained from a historical group available from previously conducted experiments [8]. This group included 20 healthy right-handed volunteers (14 women and 6 men; average age 28 years; range 22–56 years).…”

Section: Methodsmentioning

confidence: 99%

“…Dominance is an important aspect in anatomic studies. One study, for example, analyzed bilateral symmetry of the radius, and showed that the dominant right side was generally longer [8]. …”

Section: Introductionmentioning

confidence: 99%

Validation of the contralateral side as reference for selecting radial head implant sizes

et al. 2016

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PurposeIn arthroplasty of comminuted radial head fractures, the contralateral radial head diameter can be used as reference for implant selection. However, potential bilateral asymmetry may result in a mismatch of the implant with the native bone. Therefore, our purpose was to evaluate anatomical right-to-left differences of radial head diameters. We also compared conventional two-dimensional (2D) with three-dimensional (3D) measurements.MethodsWe used bilateral CT-scans from 25 intact proximal radius pairs of right-handed adult subjects to obtain 50 3D radial head models. After contralateral matching, diameters were calculated using a 3D-based method using an automated circle-fit in standardized cross-sections at the widest level midway through the radial head. The 3D-based diameters were compared to orthogonal line measurements in standard axial CT-slices.ResultsThree-dimensional analysis yielded a radial head diameter of 23.0 ± 1.7 mm. The dominant right side was significantly wider, with right-to-left differences of 0.2 ± 0.4 mm, with a maximum of 0.9 mm. The 2D-based diameter was 22.9 ± 1.7 mm, which was 0.1 ± 0.3 mm smaller compared to corresponding 3D-based diameter.ConclusionsIn healthy radial heads, the diameter was biased to the dominant right side, but individual differences were not larger than 1 mm. Compared to implant designs, in which diameter increments are usually 2 mm, this right-bias is not clinically relevant, as it would not affect implant selection. Therefore, the contralateral side can be considered a suitable reference. In clinical practice, the surgeon could estimate this diameter using standard axial CT slices, since its difference with the 3D-based evaluation was also relatively small compared to implant sizing increments.

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Three-Dimensional Assessment of Bilateral Symmetry of the Radius and Ulna for Planning Corrective Surgeries

Cited by 49 publications

References 29 publications

Three‐dimensional corrective osteotomies of mal‐united clavicles—is the contralateral anatomy a reliable template for reconstruction?

Three‐dimensional corrective osteotomies of mal‐united clavicles—is the contralateral anatomy a reliable template for reconstruction?

Surgical Treatment of Long-Bone Deformities: 3D Preoperative Planning and Patient-Specific Instrumentation

Validation of the contralateral side as reference for selecting radial head implant sizes

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