Andreas Schweizer1, Philipp Fürnstahl, Ladislav Nagy. 1. Department of Orthopaedic Surgery, University of Zurich, Uniklinik Balgrist, Zurich, Switzerland. Electronic address: andreas.schweizer@balgrist.ch.
Abstract
PURPOSE: To analyze the feasibility of combining computer-assisted 3-dimensional planning with patient-specific drill guides and to evaluate this technology's surgical outcomes for distal radius intra-articular malunions. METHODS: Six symptomatic patients with intra-articular malunions of the distal radius with a stepoff of more than 2 mm were treated with an outside-in corrective osteotomy. The described cases consist of 2 malunited volar Barton fractures, 2 radial styloid fractures, 1 AO-type C1 fracture, and 1 die-punch fracture. The osteotomies were guided by 3-dimensionally generated aiming guides that allowed precise cutting and the reduction of up to 2 fragments. All 6 patients were examined clinically and radiologically after 1 year. The surgical outcomes were quantitatively analyzed by comparing the preoperative and postoperative computed tomographic data. RESULTS: In all 6 cases, the osteotomies were consolidated 8 weeks postoperatively. After 1 year, 4 patients were pain-free, 1 had mild pain, and 1 experienced moderate pain during heavy work. Wrist motion and grip strength were improved in all patients. The postoperative radiographs showed no articular stepoff or degenerative changes. CONCLUSIONS: Patient-specific aiming guides provided a reliable method to correct intra-articular malunions of the distal radius. This technique allows the surgeon to safely perform difficult intra-articular osteotomies and may help limit the need for salvage procedures such as partial or complete wrist arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
PURPOSE: To analyze the feasibility of combining computer-assisted 3-dimensional planning with patient-specific drill guides and to evaluate this technology's surgical outcomes for distal radius intra-articular malunions. METHODS: Six symptomatic patients with intra-articular malunions of the distal radius with a stepoff of more than 2 mm were treated with an outside-in corrective osteotomy. The described cases consist of 2 malunited volar Barton fractures, 2 radial styloid fractures, 1 AO-type C1 fracture, and 1 die-punch fracture. The osteotomies were guided by 3-dimensionally generated aiming guides that allowed precise cutting and the reduction of up to 2 fragments. All 6 patients were examined clinically and radiologically after 1 year. The surgical outcomes were quantitatively analyzed by comparing the preoperative and postoperative computed tomographic data. RESULTS: In all 6 cases, the osteotomies were consolidated 8 weeks postoperatively. After 1 year, 4 patients were pain-free, 1 had mild pain, and 1 experienced moderate pain during heavy work. Wrist motion and grip strength were improved in all patients. The postoperative radiographs showed no articular stepoff or degenerative changes. CONCLUSIONS:Patient-specific aiming guides provided a reliable method to correct intra-articular malunions of the distal radius. This technique allows the surgeon to safely perform difficult intra-articular osteotomies and may help limit the need for salvage procedures such as partial or complete wrist arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Authors: M M J Walenkamp; R J O de Muinck Keizer; J G G Dobbe; G J Streekstra; J C Goslings; P Kloen; S D Strackee; N W L Schep Journal: Strategies Trauma Limb Reconstr Date: 2015-09-09