Corrective osteotomy for malunited both bones fractures of the forearm with radial head dislocations using a custom-made surgical guide: two case reports

Abstract

Dislocation of the radial head associated with malunited fracture of the ulna is commonly identified as a chronic Monteggia lesion; however, chronic radial head dislocation with malunited both bone fractures is rare. The pathomechanism of this dislocation is unclear, and treatment is difficult owing to the lack of reliable surgical techniques available to correct bone deformities and reduce the radial head. Recent progress in computed tomography (CT) imaging and computer technology has enabled us to evaluate the 3-dimensional (3D) kinematics of joint motion and to simulate accurate 3D corrective osteotomy using CT bone models. Furthermore, the development of an intraoperative guidance system makes it possible to perform an osteotomy as simulated before surgery. Here we report 2 patients with chronic radial head dislocation with malunited fractures of both bones of the forearm that were successfully treated using a simulation guidance system consisting of an original 3D computer program and a custom-made surgical guide, which was designed to reproduce the preoperative simulation during the surgery.