Complex forearm deformities: operative strategy in posttraumatic pathology

Abstract

Complex posttraumatic forearm deformities have a significant impact on the integrity of the upper extremity leading to pain, instability in both the proximal and/or distal radioulnar articulation, and reduced range of forearm motion. Corrective osteotomy or more advanced procedures for malunited fractures or other posttraumatic deformities of the upper extremity, especially in the forearm are challenging procedures. In this review we will discuss the essential aspects of anatomy and pathomechanics, clinical and radiological assessment and the pathway from preoperative planning to the actual deformity correction surgery, either with one-stage correction or using gradual lengthening with external fixation (“callotasis techniques”) and finally the functional outcome we can expect for our patients. In addition we will analyze the modern computer-assisted techniques available to date.

Powerpoint as a Useful Tool in Corrective Osteotomies Calculation—Case Report and Presentation of the Method

“…Many different approaches to this matter have been done, from the trigonometric method of Paley to the more modern 3D printing and maquetting. 3,6 However, in a globalized world, not every surgeon has access to this modern way of planning, and some even prefer the old methods.…”

“…Although the osteotomies calculations have been primarily developed in the lower extremity, 1,2 occasionally, one of these procedures must be performed in the upper extremity. The deformities may be secondary to a malunion or congenital disorders 3 and may get worse during the growing period by altering the biomechanical relationship of the long bones in the forearm. In the presence of abnormal hand pronation and supination, it is vital to correct it with a surgical procedure, keeping in mind that the preoperative planning is the most important part.…”

“…Moreover, great importance is given to the mechanical axis, which is secondary in the upper extremity's corrections. 3,5 Presently, with the advance of new technology, alternative ways to perform this calculation are underway: tridimensional models based on CT scans 1,2,6,7 or using calculus software tools. 4 Although useful and very precise about establishing the cut points, the spread of these technologies is still difficult, since they remain high in cost (3D printers), or because special knowledge of the software (Autocad) is required for their use.…”

Radius- und Ulnaschaftfrakturen

“…Weitaus komplexer sind Fehlstellungen des Unterarms beispielsweise nach kindlichen Frakturen, bei denen der radiale und ulnare Bogen verändert sind. Diese Fehlstellungen können allerdings mit dreidimensionaler präoperativer Planung und kommerziell erhältlichen, patientenspezifischen Instrumentarien ebenfalls erfolgreich behandelt werden (Miyake et al 2012;Murase et al 2008;Mader et al 2015).…”

Corrective Osteotomy of Upper Extremity Malunions Using Three-Dimensional Planning and Patient-Specific Surgical Guides: Recent Advances and Perspectives

“…The forearm is a complex anatomical and functional unit, including the radius, the ulna, the interosseous membrane (IOM), the triangular fibrocartilage complex (TFCC), the proximal (PRUJ) and the distal (DRUJ) radioulnar joint. Forearm malunions represent a disruption of this functional system, which could lead to limited forearm range of motion, loss of power, visible cosmetic changes, painful forearm rotations due to bony impingement of the IOM, and instability of the DRUJ ( 1 , 2 ). Further, the malunion can increase the risk for osteoarthritis, especially if intra-articular structures are involved ( 3 , 4 ).…”