New perspectives on treatment of both bone forearm malunions

Abstract

Diaphyseal fractures of the forearm can present challenges not encountered with other fractures in the body. This is due to the complex relationship between the radius and ulna. The complexity increases when both the radius and ulna are fractured. Restoration of the length, radial bow, rotational alignment, and relationship of the two bones are essential for optimizing forearm rotation, strength, and pain-free function of the entire upper extremity. Often, unsatisfactory results are obtained after fixation of forearm fractures. This is because of malunion of either bone in the forearm in any plane or heterotopic ossification. As the severity of the malunion increases, the risk of distal radioulnar joint subluxation or radial head dislocation becomes a concern. Traditional approaches to reconstruction of forearm malunions have used radiographs or CT scans, with attempts intraoperatively to recreate normal anatomy. While previous studies have demonstrated improvement in motion after traditional osteotomies, recent advances in three dimensional (3-D) imaging, and additive manufacturing (also known as 3-D printing) have shown promise in simplifying reconstructions of these deformities. A review of recent articles on 3-D modeling is included in this paper as well as a case example from the author and instructions on how to use this new technology.