Three-Dimensional Planning and Patient-Specific Instrumentation for the Fixation of Distal Radius Fractures

Abstract

Background and Objectives: Three-dimensional planning and guided osteotomy utilizing patient-specific instrumentation (PSI) with the contralateral side used as a reference have been proven as effective in the treatment of malunions following complex fractures of the distal radius. However, this approach has not yet been described in relation to fracture reduction of the distal radius. The aim of this study was to assess the technical and logistical feasibility of computer-assisted surgery in a clinical setting using PSI for fracture reduction and fixation. Materials and Methods: Five patients with varied fracture patterns of the distal radius underwent operative treatment with using PSI. The first applied PSI guide allowed specific and accurate placement of Kirschner wires inside the multiple fragments, with subsequent concurrent reduction using a second guide. Results: Planning, printing of the guides, and operations were performed within 5.6 days on average (range of 1–10 days). All patients could be treated within a reasonable period of time, demonstrating good outcomes, and were able to return to work after a follow-up of three months. Mean wrist movements (°) were 58 (standard deviation (SD) 21) in flexion, 62 (SD 15) in extension, 73 (SD 4) in pronation and 74 (SD 10) in supination at a minimum follow-up of 6 months. Conclusions: Three-dimensional planned osteosynthesis using PSI for treatment of distal radius fractures is feasible and facilitates reduction of multiple fracture fragments. However, higher costs must be taken into consideration for this treatment.

Is augmented femoral lateral plating with helically shaped medial plates biomechanically advantageous over straight medial plates?

“…New techniques such as the application of three-dimensional patientspecific surgical guides might further improve fracture reduction and optimal plate positioning and design. 36 This study has some limitations one should be aware of when interpreting the findings. First, only a small number of 10 paired human cadaveric femora were assessed, limiting an unrestricted generalizability of the results.…”

“…The downside of using 90°‐helical plates is the lack of prebent implants provided by the industry and the theoretically possible weakening of the helical plate due to the bending process. New techniques such as the application of three‐dimensional patient‐specific surgical guides might further improve fracture reduction and optimal plate positioning and design 36 …”

The Possibilities of Personalized 3D Printed Implants—A Case Series Study

“…Following the most recent software and 3D printing developments, the use of personalized orthopedic implants for treatment of complex surgical cases has gained more popularity. The modern 3D printing technology has contributed to (1) better understanding of complex bone fracture patterns, (2) standardization of the surgical procedures, and (3) proper implant positioning in preclinical studies [ 1 , 2 , 3 ].…”

Computer-Aided Assessment of Three-Dimensional Standard Bone Morphology of the Distal Radius

“…3D quantitative evaluation methods for the amount of dislocation and analyses of stress distribution with the finite element method have contributed to a more detailed understanding of the pathophysiology of distal radius fractures. Furthermore, advances have been achieved in computer-assisted surgery for distal radius fractures [ 6 , 7 , 8 ]. Some 3D-printed models, preoperative simulations, and navigation for osteosynthesis have been reported.…”