Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures Using Preoperative 3-Dimensional Planning and Patient-Specific Surgical Guides and Implants

Purpose Three-dimensional planning based on computed tomography images of the malunited and the mirrored contralateral forearm allows preoperative simulations of corrective osteotomies, the fabrication of patient-specific osteotomy guides, and custom-made 3-dimensional printed titanium plates. This study aims to assess the precision and clinical outcome of this technique. Methods This was a prospective pilot study with 5 consecutive patients. The mean age at initial injury was 11 years (range, 4-16 years), and themean interval from the time of injury to the time of corrective surgery was 32 months (range, 7-107 months). Patient-specific osteotomy guides and custom-made plates were used for multiplanar corrective osteotomies of both forearm bones at the distal level in 1 patient and at the middle-third level in 4 patients. Patients were assessed before and after surgery after a mean follow-up of 42 months (range, 29-51 months). Results The mean planned angular corrections of the ulna and radius before surgery were 9.9 degrees and 10.0 degrees, respectively. The mean postoperative corrections obtained were 10.1 degrees and 10.8 degrees with corresponding mean errors in correction of 1.8 degrees (range, 0.3 degrees-5.2 degrees) for the ulna and 1.4 degrees (range, 0.2 degrees-3.3 degrees) for the radius. Forearm supination improved significantly from 47 degrees (range, 25 degrees-75 degrees) before surgery to 89 degrees (range, 85 degrees-90 degrees) at final review. Forearm pronation improved from 68 degrees (range, 45 degrees-84 degrees) to 87 degrees (range, 82 degrees-90 degrees). In addition, there was a statistically significant improvement in pain and grip strength. Conclusions This study demonstrates that 3-dimensional planned patient-specific guides and implants allow the surgeon to perform precise corrective osteotomies of complex multiplanar forearm deformities with satisfactory preliminary results. (Copyright (C) 2017 by the American Society for Surgery of the Hand. All rights reserved.)