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Three-Dimensional Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures Using Custom-Made Surgical Guides Based on Computer Simulation
Junichi Miyake, MD1; Tsuyoshi Murase, MD, PhD1; Kunihiro Oka, MD, PhD2; Hisao Moritomo, MD, PhD1; Kazuomi Sugamoto, MD, PhD1; Hideki Yoshikawa, MD, PhD1
1 Departments of Orthopaedic Surgery (J.M., T.M., H.M., and H.Y.) and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Osaka, Japan. E-mail address for J. Miyake: miyake-osk@umin.ac.jp. E-mail address for T. Murase: tmurase-osk@umin.ac.jp. E-mail address for H. Moritomo: moritomo@ort.med.osaka-u.ac.jp. E-mail address for H. Yoshikawa: yhideki@ort.med.osaka-u.ac.jp. E-mail address for K. Sugamoto: sugamoto@ort.med.osaka-u.ac.jp
2 Department of Orthopaedic Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai 599-8247, Osaka, Japan. E-mail address: oka-kunihiro@umin.ac.jp
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Based on an original article: J Bone Joint Surg Am. 2012 Oct;94(20):e150.

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Dec 26;2(4):e24 1-11. doi: 10.2106/JBJS.ST.L.00022
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Three-dimensional corrective osteotomy with use of custom-made surgical guides based on computer simulation can provide a good outcome for patients with a malunited diaphyseal forearm fracture.

Step 1: Create Computer Bone Models from CT Data

Obtain CT data of both forearms, and create computer models of the bones from CT data.

Step 2: Evaluate 3D Deformity

Evaluate the 3D deformity by comparing the affected bone with the mirror image of the contralateral, normal bone.

Step 3: Plan 3D Corrective Osteotomy

Simulate the 3D corrective osteotomy on the basis of information obtained from the deformity evaluation.

Step 4: Design Custom-Made Surgical Guides

Design custom-made surgical guides to reproduce the preoperative simulation during the actual surgery.

Step 5: Operative Setup

Manufacture custom-made surgical guides to reproduce the preoperative simulation during the actual surgery.

Step 6: Perform 3D Osteotomy Using Custom-Made Osteotomy Guides

Perform the osteotomy using the custom-made osteotomy guides and achieve anatomical correction using the reduction guides.


In our series of twenty patients, the average radiographic deformity angle preoperatively was 21° (range, 12° to 35°) compared with that of the normal arm; this improved to 1° (range, 0° to 4°) postoperatively

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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