Malunion of the distal radius: 3Dplanning and performance of intra- and extra-articular corrective osteotomy

Abstract

Restoration of the original anatomy with reduction of both current symptoms and risk of posttraumatic osteoarthritis. Symptomatic intra- or extra-articular malunion due to limitation of movement and/or painful function, intra-articular step of > 1 mm, instability of the distal radioulnar joint. Minimal deformity. Pre-existing osteoarthritis Knirk and JupiterII or higher. Simpler surgical alternative, e.g., ulna shortening osteotomy. Smoking or advanced age are not contraindications. Preoperative assessment and performance of abilateral computed tomography (CT). Three-dimensional (3D) malposition analysis and calculation of the correction. Planning of the corrective osteotomy on the 3D model and creation of patient-specific drilling and sawing guides. Performing the 3D-guided osteotomy. Early functional unloaded mobilization with the splint for 8weeks until consolidation control with CT. Significant reduction of the step to < 1 mm (p ≤ 0.05) can be achieved with intra-articular corrections. In extra-articular corrective osteotomies, amean residual rotational malalignment error of2.0° (± 2.2°) and atranslational malalignment error of 0.6 mm (± 0.2 mm) is achieved. Single-cut osteotomies in the shaft region can be performed to within afew degrees for rotation (e.g., pronation/supination4.9°) and for translation (e.g., proximal/distal, 0.8 mm). After surgery, amean residual 3D angle of5.8° (SD3.6°) was measured. Furthermore, surgical time for 3D-assisted surgery is significantly reduced compared to the conventional technique (140 ± 37 vs 108 ± 26 min; p < 0.05). Thus, the progression of osteoarthritis can be reduced in the medium term and improved mobility and grip strength are achieved. The clinical outcome parameters based on patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) scores are roughly comparable.