CT virtual reality in the preoperative workup of malunited distal radius fractures: preliminary results

Abstract

Our objective was to evaluate the usefulness of CT virtual preoperative planning in the surgical repositioning of malunited distal radius fracture. Eleven patients with malunited distal radius fracture underwent multislice CT of both wrists. A preoperative workup was performed in a virtual reality environment created from the CT data sets. Virtual planning comprised three main procedures, carrying out the virtual osteotomy of the radius, prediction of the final position of the distal radius after osteotomy and computer-assisted manufacturing of a repositioning device, which was later placed at the surgical osteotomy site to reposition objectively the distal radius fragment before fixation with the osteosynthesis. All patients tolerated the surgical procedure well. During surgery, the orthopedic surgeons were not required in any of the cases to alter the position of the distal radius that was determined by the repositioning device. At postoperative follow-up, the anatomic relationship of the distal radius was restored (radial inclination, 21.4 degrees ; volar tilt, 10.3 degrees ; ulnar variance, 0.5 mm). Clinically, a significant improvement of pronation (P=0.012), supination (P=0.01), flexion (P=0.001) and extension (P=0.006) was achieved. Pain decreased from 54 to 7 points. CT virtual reality is a valuable adjunct for the preoperative workup and surgical reposition of malunited distal radius fractures.

Three-Dimensional Assessment of Bilateral Symmetry of the Radius and Ulna for Planning Corrective Surgeries

“…[15][16][17][18][19][20][21] In these new techniques, the unaffected contralateral radius serves as 3-dimensional reference for restoring the affected side. A recent report has shown a high intrinsic accuracy of such a computerassisted method.…”

“…[15][16][17][18][19][20][21] Bilateral symmetry is clinically relevant in the preoperative planning of corrective surgery where the contralateral healthy bone is used as a reference for correcting the affected bone. The clinical relevance lies also in providing a method for improved evaluation, which can be used in future studies to evaluate surgical results or compare the malposition of a malunited radius with standard difference parameters as observed in healthy individuals.…”

Three-dimensional virtual planning of corrective osteotomies of distal radius malunions: a systematic review and meta-analysis

“…All participants suffered from a symptomatic, malunited fracture of the distal radius. For 25 participants, the initial fracture type was not specified [16, 23, 28, 30]; the remaining fractures were extra-articular ( n  = 28) or combined extra- and intra-articular ( n  = 15) in nature. Initial treatment comprised plaster cast immobilization with or without closed reduction in 34 patients and open reduction and internal fixation in 7 patients.…”

“…Initial treatment comprised plaster cast immobilization with or without closed reduction in 34 patients and open reduction and internal fixation in 7 patients. Four studies did not report the initial treatment ( n  = 27) [16, 22, 23, 28]. The mean time between injury and the corrective osteotomy was specified for 38 patients and was 30 months (SD 80, range 2–360).…”

“…Additionally, there is the possibility to guide the reposition with optical tracking devices [19, 28]. Another option is the use of synthetic templates that can be placed in the osteotomy gap, thereby restoring the original position of the distal radius [23, 29]. Ultimately, 3D-planning techniques provide the possibility to create patient-specific surgical cutting guides and fixation plates [21, 22, 26, 27, 30–34].…”