Three-Dimensional Correction of Distal Radius Intra-Articular Malunions Using Patient-Specific Drill Guides

Abstract

PURPOSE: To analyze the feasibility of combining computer-assisted 3-dimensional planning with patient-specific drill guides and to evaluate this technology's surgical outcomes for distal radius intra-articular malunions. METHODS: Six symptomatic patients with intra-articular malunions of the distal radius with a stepoff of more than 2 mm were treated with an outside-in corrective osteotomy. The described cases consist of 2 malunited volar Barton fractures, 2 radial styloid fractures, 1 AOtype C1 fracture, and 1 die-punch fracture. The osteotomies were guided by 3-dimensionally generated aiming guides that allowed precise cutting and the reduction of up to 2 fragments. All 6 patients were examined clinically and radiologically after 1 year. The surgical outcomes were quantitatively analyzed by comparing the preoperative and postoperative computed tomographic data. RESULTS: In all 6 cases, the osteotomies were consolidated 8 weeks postoperatively. After 1 year, 4 patients were pain-free, 1 had mild pain, and 1 experienced moderate pain during heavy work. Wrist motion and grip strength were improved in all patients. The postoperative radiographs showed no articular stepoff or degenerative changes. CONCLUSIONS: Patient-specific aiming guides provided a reliable method to correct intraarticular malunions of the distal radius. This technique allows the surgeon to safely perform difficult intra-articular osteotomies and may help limit the need for salvage procedures such as partial or complete wrist arthrodesis. To analyze the feasibility of combining computer-assisted 3-dimensional planning with patient-7 specific drill guides and to evaluate its surgical outcomes for distal radius intra-articular malunions. 8 9 Methods: 10Six symptomatic patients with intra-articular malunions of the distal radius with a step-off of more 11 than 2 mm were treated with an outside-in corrective osteotomy. The described cases consist of 2 12 malunited volar Barton fractures, 2 radial styloid fractures, one AO-type C1 fracture, and 1 die-punch 13 fracture. The osteotomies were guided by 3-dimensionally generated aiming guides that allowed 14 precise cutting and the reduction of up to 2 fragments. All 6 patients were examined clinically and 15 radiologically after 1 year. The surgical outcomes were quantitatively analyzed by comparing the pre-16 and postoperative computed tomographic data. 17 18 Results: 19In all 6 cases, the osteotomies were consolidated 8 weeks postoperatively. After 1 year, 4 patients 20 were pain-free, one had mild pain, and one experienced moderate pain during heavy work. Wrist 21 motion and grip strength were improved in all patients. The postoperative radiographs showed no 22 articular step-off or degenerative changes. 23 24 Discussion: 25Patient-specific aiming guides provided a reliable method to correct intra-articular malunions of the 26 distal radius. This technique allows the surgeon to safely perform difficult intra-articular osteotomies 27 and may help limit the need for salvage procedures such a...

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

“…However, such a technique requires extensive preoperative planning and, moreover, the surgeon must be guided intraoperatively because he has no direct view into the joint. We have developed a preoperative planning methodology combined with a closely-linked surgical technique [11], enabling the surgeon to perform an outside-in approach in a controlled way. We will describe the approach based on one of the most complex cases treated at our institution so far.…”

“…Particularly in young adults, a corrective osteotomy is indicated to avoid salvage procedures such as arthroplasty or fusion [10,11]. In a corrective osteotomy, the pathological bone is cut and the resulting bone parts are correctly realigned (i.e., anatomical reduction), followed by stable fixation with an osteosynthesis implant to secure their position during bone healing.…”

“…Originating from dental surgery [26] and thanks to recent advances in additive manufacturing, the production of patient-specific instruments has instead become a cost-effective and promising alternative to navigation systems [27]. Although the use of patient-specific guides for corrective osteotomies of long bones was described [11,18,[28][29][30][31][32][33][34], the main application of patient-specific guides in orthopedic surgery is currently arthroplasty [35]. The key idea behind patient-specific guides is to design targeting devices specific to the anatomy and pathology of the patient for guiding the surgeon intra-operatively.…”

Internal Derangements of Joints—Past, Present, and Future

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

“…Accordingly, 3D preoperative planning has become popular because it permits exact quantification and correction of a deformity in all six degrees of freedom (Daruwalla et al, 2010;Guitton and Ring, 2010;Oka et al, 2010). In these approaches, bilateral symmetry of the bones is assumed, permitting the use of the unaffected contralateral bone as 3D reconstruction template for the pathological side (Schweizer et al, 2010;Miyake et al, 2011;Schweizer et al, 2013Schweizer et al, , 2014. As a consequence, asymmetry between the sides (if present) may introduce a bias in the exact quantification of the deformity and the planned correction.…”