Abstract
Closed treatment of paediatric diaphyseal forearm fractures carries the risk of re-displacement, which can lead to symptomatic malunions. This is because growth will not correct angulation deformity as it does in metaphyseal fractures. The purpose of this prospective cohort study was to evaluate the outcomes after 3-D-planned corrective osteotomy with patient-specific surgical guides for paediatric malunited forearm fractures causing impaired pro-supination. Our primary outcome measure was the gain in pro-supination at 12 months follow-up. Fifteen patients with a mean age at trauma of 9.6 years and time until osteotomy of 5.9 years were included. Preoperatively, patients displayed a mean pro-supination of 67° corresponding to 44% of the contralateral forearm. At final follow-up, this improved to 128°, achieving 85% of the contralateral side. Multivariate linear regression analysis revealed that predictors of greater functional gain after 3-D corrective osteotomy are severe preoperative impairment in pro-supination, shorter interval until 3-D corrective osteotomy and greater angulation of the radius.Level of evidence: III
Highlights
Diaphyseal forearm fractures account for 15% of paediatric fractures (Cheng et al, 1999)
A corrective osteotomy is challenging due to angular deformities of both radius and ulna in coronal, sagittal. and axial planes (Bauer et al, 2017; Miyake et al, 2012). 3-D planned corrective osteotomy can aid in accurate correction of forearm malunions (Walenkamp et al, 2015)
We reported medians and interquartile range (IQR) for non-parametric variables and means and 95% confidence intervals (CI) for normally distributed variables
Summary
Diaphyseal forearm fractures account for 15% of paediatric fractures (Cheng et al, 1999). Fracture re-displacement occurs in 34% of displaced diaphyseal both-bone forearm fractures in children (Colaris et al, 2013), leading to malunion and decreased forearm rotation (Colaris et al, 2014), which may need a corrective osteotomy (Roth et al, 2017). 3-D planned corrective osteotomy can aid in accurate correction of forearm malunions (Walenkamp et al, 2015). Using this method, patient-specific drilling and cutting guides can be 3D printed to transfer the planned osteotomy plane to the patient’s bones during surgery
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