Three-Dimensional Corrective Osteotomy for Malunited Fractures of the Upper Extremity Using Patient-Matched Instruments

Abstract

Background: Medical image processing has facilitated simulation of 3-dimensional (3-D) corrective osteotomy, and 3-D rapid prototyping technology has further enabled the manufacturing of patient-matched surgical guides and implants (patient-matched instruments, or PMIs). However, 3-D corrective osteotomy using these technologies has not been the standard procedure. We aimed to prospectively verify the efficacy and safety of PMIs in corrective osteotomy for deformities of the upper extremity. Methods: We enrolled 16 patients with a total of 17 bone deformities in the upper extremity. Eight patients had distal radial malunion; 5, distal humeral malunion; and 3, forearm diaphyseal malunion. All cases underwent 3-D corrective osteotomy with PMIs. The primary end point was the residual maximum deformity angle (MDA), which was calculated from 2 deformity angles—1 on the anteroposterior and 1 on the lateral postoperative radiograph. Secondary end points included the deformity angle on radiographs, 3-D error between the preoperative planning model and the postoperative result, range of motion, grip strength, pain measured with a visual analog scale (VAS), patient satisfaction, and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results: The average MDA significantly improved from 25.5° preoperatively to 3.3° at the final follow-up (p < 0.001). The angular deformity was within 5° in all cases, except for 1 with distal radial malunion who had a higher angle on the anteroposterior radiograph. The error between the correction seen on the postoperative 3-D bone model and the planned correction was <1° and <1 mm. Flexion and extension of the wrist and pronation of the forearm of the patients treated for distal radial malunion improved significantly, and pronation improved for those treated for forearm diaphyseal malunion. The average VAS score, grip strength, and DASH score significantly improved as well. Of the 16 patients, 15 were very satisfied or satisfied with the outcomes. Conclusions: Corrective osteotomy using PMIs achieved accurate correction and good functional recovery in the upper extremity. Although our study was limited to cases without any deformity on the contralateral side, 3-D corrective osteotomy using PMIs resolved treatment challenges for complex deformities in upper extremities. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Using 3D Printing Technology for Corrective Biplanar Chevron Osteotomy with Customized Osteotomy Guide and Patient-Matched Monoblock Crosslink Plate in Treatment of Cubitus Varus Deformity: A Case Report and Technical Note

“…Concerning the development of the patient-matched plate for the CVD, there were only two studies-one by Omori et al [12] in a cadaveric study and the other by Oka et al [13] in a prospective multicenter study. In these studies, both patient-matched plate designs were made from titanium and placed on the lateral side of the distal humerus.…”

“…Recently, three-dimensional (3D) printing technology has been continually developing and become one of the most exciting and fastest growing elds in healthcare due to excellent accuracy that stems from using preoperative computerized tomography (CT) evaluations and advanced computer software; this technology enables personalized treatment and introduces wide-ranging potential uses, including in the clinical application of orthopedic surgery [6]. Regarding the treatment of CVD, previous studies showed that 3D printing technology is bene cial for preoperative planning [7], designing individualized surgical guides [8,9,10], preparing prebent plates with real-sized plastic bone models [11], and printing patientmatched plates [12,13]. However, to the best of our knowledge, the application of 3D printing technology in the treatment of CVD remains limited to designing osteotomy guides for simple techniques, such as lateral closed-wedge osteotomy, and mostly xations with conventional implants.…”

Preoperative psychometric properties of visual analog scale asessments for function, pain, and strength compared with legacy upper extremity outcome measures in glenohumeral osteoarthritis

“… 44 However, as new PROMs continue to be developed (eg, PROMIS), it is increasingly important to administer simple, efficient instruments that are also appropriately discriminative of outcomes. 37 VAS instruments are the existing gold standard in the evaluation of pain, 7 , 23 , 28 , 38 , 58 and instrument-based advantages in efficiency and simplicity have led researchers to examine VAS instruments in functional disability, 1 hand function and grip, 15 , 29 and general health status and monitoring of symptoms. 13 , 26 The current study suggests that in those with GHOA, the VAS Pain measure outperforms the VAS Function and VAS Strength measures relative to legacy instruments.…”

Patient-specific plate for navigation and fixation of the distal radius: a case series

“…The PSP is designed to fit the patient's bone contour optimally; this has the advantage of aligning the bone segments according to the preoperative plan, which may limit tendon ruptures [22], and obviating the need for secondary surgery for plate removal [23] as is common when using standard plates. Preclinical studies [15,20] and initial clinical evaluations [16,24,25] have shown the PSP method to be promising for corrective osteotomy of the distal radius.…”