Image-guided distal radius osteotomy using patient-specific instrument guides.

In this article, we describe a method for computer-assisted distal radius osteotomies in which computer-generated, patient-specific plastic guides are used for intraoperative guidance. Before surgery, the correction and plate location are planned using computed tomography scans for both radii and ulnae, and the planned locations of the distal and proximal drill holes for the plate are saved. A plastic, patient-specific instrument guide is created using a rapid prototyping machine into which a mirror image of intraoperative, accessible bone structure of the distal radius is integrated. This allows for unique positioning of the guide during surgery. For each planned drill location, a guidance hole is incorporated into the guide. During surgery, a conventional incision is made, and the guide is positioned on the radius. The surgeon drills the holes for the plate screws into the intact radius and performs the osteotomy using the conventional technique. Using the predrilled holes, the surgeon affixes the plate to the radius fragments. The guides are easy to integrate into the surgical workflow and minimize the need for intraoperative fluoroscopy for guidance of the procedure.