Computer-Assisted Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures

Departments of Orthopaedic Surgery (J.M., T.M., H.M., and H.Y.) and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Osaka, Japan. E-mail address for T. Murase: .
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 10/2012; 94(20):e1501-11. DOI: 10.2106/JBJS.K.00829
Source: PubMed


Corrective osteotomy for malunited diaphyseal forearm fractures remains a challenging procedure. We developed a computer-assisted system for corrective surgery, including a three-dimensional simulation program and a custom-made osteotomy template, and investigated the results of corrective surgery for malunited diaphyseal forearm fractures with use of this technology.
Twenty patients (fifteen male patients and five female patients) with malunited diaphyseal forearm fractures were managed with three-dimensional corrective osteotomy with a custom-made osteotomy template based on computer simulation. We performed osteotomy of both radius and ulna in fourteen patients and osteotomy of the radius alone in six patients. The median age at the time of surgery was eighteen years (range, eleven to forty-three years). The median duration between the time of injury and the time of surgery was thirty-three months (range, five to 384 months). The minimum duration of follow-up was twenty-four months (median, twenty-nine months; range, twenty-four to forty-eight months). To evaluate the results, we compared preoperative and postoperative data from radiographs, forearm motion, grip strength, and pain.
The average radiographic deformity angle preoperatively was 21° (range, 12° to 35°) compared with the normal arm; the radiographic deformity angle was improved to 1° (range, 0° to 4°) postoperatively. The distal radioulnar joints of both sides were symmetric on postoperative radiographs regarding the relative lengths of the radius and ulna. In eighteen patients who had a restricted range of forearm motion preoperatively, the mean arc of forearm motion improved from 76° (range, 25° to 160°) preoperatively to 152° (range, 80° to 180°) postoperatively (p < 0.01). However, forearm supination was still restricted by ≥70° in three patients who had been younger than ten years old at the time of the initial injury and who had long-standing malunion for ninety-six months or longer. Painful recurrent dislocation of the distal ulna or radial head resolved or decreased in five patients. Average grip strength improved from 82% to 94% compared with that of the contralateral, normal side.
Computer-assisted osteotomy can provide excellent radiographic and clinical outcome for the treatment of malunited diaphyseal forearm fractures. Satisfactory restoration of forearm motion can be achieved even in relatively long-standing cases in adults.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    • "In upper extremity surgery, the opposite healthy bone can be used to plan and guide reconstruction of complex fractures [16] [17]. However, the presence of bilateral asymmetry in bone shape could hamper using the opposite bone as a reference for planning. "
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    ABSTRACT: Preoperative 3D CT imaging techniques provide displacement analysis of the distal scaphoid fragment in 3D space, using the matched opposite scaphoid as reference. Its accuracy depends on the presence of anatomical bilateral symmetry, which has not been investigated yet using similar techniques. Our purpose was to investigate symmetry by comparing the relative positions of distal and proximal poles between sides. We used bilateral CT scans of 19 adult healthy volunteers to obtain 3D scaphoid models. Left proximal and distal poles were matched to corresponding mirrored right sides. The left-to-right positional differences between poles were quantified in terms of three translational and three rotational parameters. The mean (SD) of ulnar, dorsal, and distal translational differences of distal poles relative to proximal poles was 0.1 (0.6); 0.4 (1.2); 0.2 (0.6) mm and that of palmar rotation, ulnar deviation, and pronation differences was -1.1 (4.9); -1.5 (3.3); 1.0 (3.7)°, respectively. These differences did not significantly differ from zero and thus were not biased to left or right side. We proved that, on average, the articular surfaces of scaphoid poles were symmetrically aligned in 3D space. This suggests that the contralateral scaphoid can serve as reference in corrective surgery. No level of evidence is available.
    Full-text · Article · Aug 2015 · BioMed Research International
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    • "This technology has been utilised to manufacture actual-sized plastic bone models that aid planning and intra-operative contouring of the plate, as well as customised patient-specific osteotomy cutting guides [27, 28, 32, 33]. Forearm to forearm variability in the normal population is well documented, and computerised simulations using mathematical models are being developed to avoid imaging the opposite forearm as well as incorporating the biomechanical effects of the IOM [11-13, 53]. "
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    ABSTRACT: The forearm is a complex anatomical and functional unit with unique osseous, soft tissue and articular relationships. Disruption of these important relations can have a significant impact, leading to pain, instability of the radio-ulnar articulation and reduced range of motion. The gold standard for treating forearm fractures in adults remains anatomic reduction, stable plate fixation and preservation of the surrounding blood supply. Failure to achieve these goals may lead to malunion, requiring reconstructive surgery, which can be technically challenging. In this review, we discuss the essential aspects of anatomy and pathomechanics, clinical and radiological assessment and the state of the art in pre-operative planning and deformity correction surgery.
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