JMIR Publications

ABSTRACT

Background:

Distal radius malunions occur in 5–17% of fractures and may lead to pain and functional impairment. While three-dimensional (3D) surgical planning with patient-specific guides has demonstrated high accuracy and reduced fluoroscopy use compared with conventional two-dimensional techniques, its routine clinical implementation remains limited, particularly for in-house hospital-based workflows.

Objective:

This study aimed to evaluate the precision of corrective osteotomy for distal radius malunions using in-house designed 3D patient-specific surgical guides one year after surgery. Secondary objectives were to assess clinical and patient-reported outcomes and to document intraoperative fluoroscopy use.

Methods:

Corrective osteotomies of extra-articular distal radius malunions were performed in 16 consecutive patients using in-house 3D surgical planning and patient-specific surgical guides. Accuracy was evaluated by comparing preoperative plans with one-year postoperative computed tomography-based 3D models, assessing ulnar variance, volar tilt and radial inclination. Acceptable error margins were defined as ≤ 5° for volar tilt and ≤ 2 mm for ulnar variance. Clinical outcomes were evaluated using patient-reported outcome measures and range of motion, lift, grip and torque strength measurements.

Results:

The mean error was −0.8 mm (SD 1.0 mm) in ulnar variance, −4.6º (SD 3.2º) in volar tilt and −0.7º (SD 2.4º) in radial inclination. The corrections were within predefined equivalence bounds of the virtual plans in terms of ulnar variance, but not volar tilt. Significant improvements were observed in Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder and Hand (DASH) scores, pain during activity, pain at rest, lift strength, wrist flexion and ulnar deviation.

Conclusions:

3D technology enables accurate planning, execution and evaluation of corrective osteotomies. Despite generally good outcomes, residual alignment errors and two major complications highlight the complexity of these procedures. In-house 3D planning supports continuous surgical refinement and quality improvement.