Essential Surgical Techniques
Three-Dimensional Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures Using Custom-Made Surgical Guides Based on Computer Simulation
Junichi Miyake, MD; Tsuyoshi Murase, MD, PhD; Kunihiro Oka, MD, PhD; Hisao Moritomo, MD, PhD; Kazuomi Sugamoto, MD, PhD; Hideki Yoshikawa, MD, PhD

Overview

Introduction 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.

Results 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

What to Watch For Indications

Contraindications

Pitfalls & Challenges

Introduction

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.

Clinical studies have demonstrated that corrective osteotomy for malunited diaphyseal forearm fractures remains a challenging procedure. Anatomical correction of angular deformity, achievement of axial alignment, and restoration of the normal lengths of both bones are necessary to achieve a good outcome, but complex three-dimensional (3D) deformities of both forearm bones are difficult to assess accurately with use of radiography or cross-sectional imaging.

We developed a system incorporating a 3D computer simulation program using …


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