[Malunion of the distal radius: 3D planning and performance of intra- and extra-articular corrective osteotomy]. / Malunion der distalen Radiusfraktur: 3-D-Planung und Durchführung von intra- und extraartikulären Korrekturosteotomien.
Oper Orthop Traumatol
; 35(5): 258-269, 2023 Oct.
Article
in De
| MEDLINE
| ID: mdl-37129610
ABSTRACT
OBJECTIVE:
Restoration of the original anatomy with reduction of both current symptoms and risk of posttraumatic osteoarthritis. INDICATIONS Symptomatic intra- or extra-articular malunion due to limitation of movement and/or painful function, intra-articular step of >â¯1â¯mm, instability of the distal radioulnar joint. CONTRAINDICATIONS Minimal deformity. Pre-existing osteoarthritis Knirk and Jupiter II or higher. Simpler surgical alternative, e.g., ulna shortening osteotomy. Smoking or advanced age are not contraindications. SURGICAL TECHNIQUE Preoperative assessment and performance of a bilateral computed tomography (CT). Three-dimensional (3D) malposition analysis and calculation of the correction. Planning of the corrective osteotomy on the 3D model and creation of patient-specific drilling and sawing guides. Performing the 3D-guided osteotomy. POSTOPERATIVE MANAGEMENT Early functional unloaded mobilization with the splint for 8 weeks until consolidation control with CT.RESULTS:
Significant reduction of the step to <â¯1â¯mm (pâ¯≤ 0.05) can be achieved with intra-articular corrections. In extra-articular corrective osteotomies, a mean residual rotational malalignment error of 2.0° (±â¯2.2°) and a translational malalignment error of 0.6â¯mm (±â¯0.2â¯mm) is achieved. Single-cut osteotomies in the shaft region can be performed to within a few degrees for rotation (e.g., pronation/supination 4.9°) and for translation (e.g., proximal/distal, 0.8â¯mm). After surgery, a mean residual 3D angle of 5.8° (SD 3.6°) was measured. Furthermore, surgical time for 3D-assisted surgery is significantly reduced compared to the conventional technique (140⯱ 37 vs 108⯱ 26â¯min; pâ¯< 0.05). Thus, the progression of osteoarthritis can be reduced in the medium term and improved mobility and grip strength are achieved. The clinical outcome parameters based on patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) scores are roughly comparable.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Osteoarthritis
/
Radius Fractures
/
Fractures, Malunited
Type of study:
Prognostic_studies
Limits:
Humans
Language:
De
Journal:
Oper Orthop Traumatol
Journal subject:
ORTOPEDIA
/
TRAUMATOLOGIA
Year:
2023
Document type:
Article