Patient-specific distal radius locking plate for fixation and accurate 3D positioning in corrective osteotomy

Abstract

Preoperative three-dimensional planning methods have been described extensively. However, transferring the virtual plan to the patient is often challenging. In this report, we describe the management of a severely malunited distal radius fracture using a patient-specific plate for accurate spatial positioning and fixation. Twenty months postoperatively the patient shows almost painless reconstruction and a nearly normal range of motion.

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.…”

“…Five studies used a digitalized model of a standardized fixation plate to plan its exact position intra-operatively. Dobbe et al [30] created a patient-specific plate, which fitted the geometry of the patient’s bone in the realigned position.…”

“…Radiographic evaluation was based on plain radiography (true anteroposterior and lateral views, n  = 29) or on postoperative CAT scan of the radius ( n  = 19). In addition to CAT evaluation, 14 patients were evaluated by comparing the same 3D planning techniques that were used for the planning of the procedure [27, 30, 32, 33]. Improvement on palmar tilt, radial inclination and ulnar variance showed statistical significance ( p  < 0.05).…”

“…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]. Templates are made to match the patients’ anatomy and include drilling guides and one or more osteotomy slits.…”

Computer-assisted oblique single-cut rotation osteotomy to reduce a multidirectional tibia deformity: case report

“…After osteotomy, the pin pairs are inserted into a reduction guide to achieve reduction [10]. Other techniques use drilling and cutting guides to predrill holes for subsequent fixation using standard osteosynthesis material [11], or by using patient-specific fixation plates that provide accurate alignment of the bone segments [4, 12, 13]. All these approaches may reduce the surgical error but do not allow any deviation from the preoperative plan in cases where the planned rotation angle appears unfeasible during surgery.…”