Junichi Miyake1, Tsuyoshi Murase1, Kunihiro Oka2, Hisao Moritomo1, Kazuomi Sugamoto1, Hideki Yoshikawa1. 1. 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 J. Miyake: miyake-osk@umin.ac.jp. E-mail address for T. Murase: tmurase-osk@umin.ac.jp. E-mail address for H. Moritomo: moritomo@ort.med.osaka-u.ac.jp. E-mail address for H. Yoshikawa: yhideki@ort.med.osaka-u.ac.jp. E-mail address for K. Sugamoto: sugamoto@ort.med.osaka-u.ac.jp. 2. Department of Orthopaedic Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai 599-8247, Osaka, Japan. E-mail address: oka-kunihiro@umin.ac.jp.
Abstract
INTRODUCTION: Three-dimensional corrective osteotomy with use of custom-made surgical guides based on computer simulation can provide a good outcome for patients with a malunited diaphyseal forearm fracture. STEP 1 CREATE COMPUTER BONE MODELS FROM CT DATA: Obtain CT data of both forearms, and create computer models of the bones from CT data. STEP 2 EVALUATE 3D DEFORMITY: Evaluate the 3D deformity by comparing the affected bone with the mirror image of the contralateral, normal bone. STEP 3 PLAN 3D CORRECTIVE OSTEOTOMY: Simulate the 3D corrective osteotomy on the basis of information obtained from the deformity evaluation. STEP 4 DESIGN CUSTOM-MADE SURGICAL GUIDES: Design custom-made surgical guides to reproduce the preoperative simulation during the actual surgery. STEP 5 OPERATIVE SETUP: Manufacture custom-made surgical guides to reproduce the preoperative simulation during the actual surgery. STEP 6 PERFORM 3D OSTEOTOMY USING CUSTOM-MADE OSTEOTOMY GUIDES: Perform the osteotomy using the custom-made osteotomy guides and achieve anatomical correction using the reduction guides. RESULTS: In our series of twenty patients, the average radiographic deformity angle preoperatively was 21° (range, 12° to 35°) compared with that of the normal arm; this improved to 1° (range, 0° to 4°) postoperatively. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Three-dimensional corrective osteotomy with use of custom-made surgical guides based on computer simulation can provide a good outcome for patients with a malunited diaphyseal forearm fracture. STEP 1 CREATE COMPUTER BONE MODELS FROM CT DATA: Obtain CT data of both forearms, and create computer models of the bones from CT data. STEP 2 EVALUATE 3D DEFORMITY: Evaluate the 3D deformity by comparing the affected bone with the mirror image of the contralateral, normal bone. STEP 3 PLAN 3D CORRECTIVE OSTEOTOMY: Simulate the 3D corrective osteotomy on the basis of information obtained from the deformity evaluation. STEP 4 DESIGN CUSTOM-MADE SURGICAL GUIDES: Design custom-made surgical guides to reproduce the preoperative simulation during the actual surgery. STEP 5 OPERATIVE SETUP: Manufacture custom-made surgical guides to reproduce the preoperative simulation during the actual surgery. STEP 6 PERFORM 3D OSTEOTOMY USING CUSTOM-MADE OSTEOTOMY GUIDES: Perform the osteotomy using the custom-made osteotomy guides and achieve anatomical correction using the reduction guides. RESULTS: In our series of twenty patients, the average radiographic deformity angle preoperatively was 21° (range, 12° to 35°) compared with that of the normal arm; this improved to 1° (range, 0° to 4°) postoperatively. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.