Strategies in Trauma and Limb Reconstruction

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VOLUME 10 , ISSUE 2 ( August, 2015 ) > List of Articles

Original Article

Computer-assisted 3D planned corrective osteotomies in eight malunited radius fractures

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

Keywords : Malunion, Radius, Corrective osteotomy, 3D

Citation Information : Walenkamp MM, de Muinck Keizer RJ, Dobbe JG, Streekstra GJ, Goslings JC, Kloen P, Strackee SD, Schep NW. Computer-assisted 3D planned corrective osteotomies in eight malunited radius fractures. 2015; 10 (2):109-116.

DOI: 10.1007/s11751-015-0234-2

License: CC BY-NC-SA 4.0

Published Online: 01-12-2013

Copyright Statement:  Copyright © 2015; The Author(s).


Abstract

In corrective osteotomy of the radius, detailed preoperative planning is essential to optimising functional outcome. However, complex malunions are not completely addressed with conventional preoperative planning. Computer-assisted preoperative planning may optimise the results of corrective osteotomy of the radius. We analysed the pre- and postoperative radiological result of computer-assisted 3D planned corrective osteotomy in a series of patients with a malunited radius and assessed postoperative function. We included eight patients aged 13–64 who underwent a computer-assisted 3D planned corrective osteotomy of the radius for the treatment of a symptomatic radius malunion. We evaluated pre- and postoperative residual malpositioning on 3D reconstructions as expressed in six positioning parameters (three displacements along and three rotations about the axes of a 3D anatomical coordinate system) and assessed postoperative wrist range of motion. In this small case series, dorsopalmar tilt was significantly improved (p = 0.05). Ulnoradial shift, however, increased by the correction osteotomy (6 of 8 cases, 75 %). Postoperative 3D evaluation revealed improved positioning parameters for patients in axial rotational alignment (62.5 %), radial inclination (75 %), proximodistal shift (83 %) and volodorsal shift (88 %), although the cohort was not large enough to confirm this by statistical significance. All but one patient experienced improved range of motion (88 %). Computer-assisted 3D planning ameliorates alignment of radial malunions and improves functional results in patients with a symptomatic malunion of the radius. Further development is required to improve transfer of the planned position to the intra-operative bone. Level of evidence IV.


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  1. Cooney W, Dobyns J, Linscheid R (1980) Complications of Colles' fractures. J Bone Joint Surg 62:613-619
  2. McKay SD, MacDermid JC, Roth JH, Richards RS (2001) Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg Am 26:916-922. doi:10.1053/jhsu.2001.26662
  3. Crisco JJ, Moore DC, Marai GE, Laidlaw DH, Akelman E, Weiss AC et al (2007) Effects of distal radius malunion on distal radioulnar joint mechanics—an in vivo study. J Orthop Res. doi:10.1002/jor
  4. Buijze G, Prommersberger K-J, González Del Pino J, Fernandez DL, Jupiter JB (2012) Corrective osteotomy for combined intraand extra-articular distal radius malunion. J Hand Surg Am 37:2041-2049. doi:10.1016/j.jhsa.2012.07.013
  5. Fernandez DL (1982) Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg 64:1164-1178
  6. Prommersberger K-J, van Schoonhoven J, Lanz UB (2002) Outcome after corrective osteotomy for malunited fractures of the distal end of the radius. J Hand Surg Am 27B:55-60
  7. Vroemen JC, Dobbe JGG, Strackee SD, Streekstra GJ (2013) Positioning evaluation of corrective osteotomy for the malunited radius: 3-D CT versus 2-D radiographs. Orthopedics 36:e193- e199. doi:10.3928/01477447-20130122-22
  8. Miyake J, Murase T, Yamanaka Y, Moritomo H, Sugamoto K, Yoshikawa H (2013) Comparison of three dimensional and radiographic measurements in the analysis of distal radius malunion. J Hand Surg Eur 38:133-143. doi:10.1177/1753193412451383
  9. Bilic R, Zdravkovic V, Boljevic Z (1994) Osteotomy for deformity of the radius: computer-assisted three-dimensional modelling. J Bone Joint Surg 76-B:150-154
  10. Cirpar M, Gudemez E, Cetik O, Turker M, Eksioglu F (2010) Rotational deformity affects radiographic measurements in distal radius malunion. Eur J Orthop Surg Traumatol 21:13-20. doi:10.1007/s00590-010-0653-1
  11. Capo JT, Accousti K, Jacob G, Tan V (2009) The effect of rotational malalignment on X-rays of the wrist. J Hand Surg Eur 34:166-172. doi:10.1177/1753193408090393
  12. Pennock A, Phillips C, Matzon J, Daley E (2005) The effects of forearm rotation on three wrist measurements: radial inclination, radial height and palmar tilt. Hand Surg 10:17-22. doi:10.3928/01477447-20130122-22
  13. Leong NL, Buijze G, Fu EC, Stockmans F, Jupiter JB (2010) Computer-assisted versus non-computer-assisted preoperative planning of corrective osteotomy for extra-articular distal radius malunions: a randomized controlled trial. BMC Musculoskelet Disord 11:282. doi:10.1186/1471-2474-11-282
  14. Dobbe J, du Pré K, Kloen P, Blankevoort L, Streekstra G (2011) Computer-assisted and patient-specific 3-D planning and evaluation of a single-cut rotational osteotomy for complex long-bone deformities. Med Biol Eng Comput 49:1363-1370. doi:10.1007/s11517-011-0830-3
  15. Murase T, Oka K, Moritomo H, Goto A, Yoshikawa H, Sugamoto K (2008) Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg Am 90:2375-2389. doi:10.2106/JBJS.G.01299
  16. Stockmans F, Dezillie M, Vanhaecke J (2013) Accuracy of 3D virtual planning of corrective osteotomies of the distal radius. J Wrist Surg 2:306-314
  17. Dobbe JGG, Strackee SD, Schreurs AW, Jonges R, Carelsen B, Vroemen JC et al (2011) Computer-assisted planning and navigation for corrective distal radius osteotomy, based on pre- and intraoperative imaging. IEEE Trans Biomed Eng 58:182-190. doi:10.1109/TBME.2010.2084576
  18. Krishnan S, Dawood A, Richards R, Henckel J, Hart A (2012) A review of rapid prototyped surgical guides for patient-specific total knee replacement. J Bone Joint Surg Br 94:1457-1461
  19. Dobbe J, Vroemen J, Strackee S, Streekstra G (2014) Patientspecific distal radius locking plate for fixation and accurate 3D positioning in corrective osteotomy. Strateg Trauma Limb Reconstr 9:179-183
  20. Schweizer A, Fürnstahl P, Nagy L (2013) Three-dimensional correction of distal radius intra-articular malunions using patientspecific drill guides. J Hand Surg Am 38:2339-2347. doi:10.1016/j.jhsa.2013.09.023
  21. Vroemen JC, Dobbe JGG, Sierevelt IN, Strackee SD, Streekstra GJ (2013) Accuracy of distal radius positioning using an anatomical plate. Orthopedics 36:457-462. doi:10.3928/01477447-20130327-22
  22. Athwal GS, Ellis RE, Small CF, Pichora DR (2003) Computerassisted distal radius osteotomy. J Hand Surg Am 28:951-958. doi:10.1016/S0363-5023(03)00375-7
  23. Miyake J, Murase T, Oka K, Moritomo H, Sugamoto K, Yoshikawa H (2012) Computer-assisted corrective osteotomy for malunited diaphyseal forearm fractures. J Bone Joint Surg 94:1-11
  24. Lozano-Calderón SA, Brouwer KM, Doornberg JN, Goslings JC, Kloen P, Jupiter JB (2010) Long-term outcomes of corrective osteotomy for the treatment of distal radius malunion. J Hand Surg Eur 35:370-380. doi:10.1177/1753193409357373
  25. Miyake J, Murase T, Yamanaka Y, Moritomo H, Sugamoto K, Yoshikawa H (2012) Three-dimensional deformity analysis of malunited distal radius fractures and their influence on wrist and forearm motion. J Hand Surg Eur 37:506-512. doi:10.1177/1753193412443644
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