Scientific article| Volume 42, ISSUE 12, P1031.e1-1031.e8, December 2017

Accuracy and Early Clinical Outcome of 3-Dimensional Planned and Guided Single-Cut Osteotomies of Malunited Forearm Bones

Published:September 06, 2017DOI:


      To investigate the reduction accuracy of 3-dimensional planned single-cut osteotomies (SCOTs) of the forearm that were performed using patient-specific guides.


      A retrospective analysis of SCOTs performed between 2012 and 2014 was performed. Ten patients (age, 15–59 years) with 6 malunions of the ulna and 6 malunions of the radius were identified. The reduction accuracy was assessed by comparing the 3-dimensional preoperative plan of each osteotomy with the superimposed bone model extracted from postoperative computed tomography data. The difference was assessed by 3-dimensional angle and in all 6 degrees of freedom (3 translations, 3 rotations) with respect to an anatomical coordinate system. Wrist range of motion and grip strength was assessed after a mean of 16.7 months and compared with the preoperative measurements.


      On average, the 12 SCOTs demonstrated excellent accuracy of the reduction with respect to rotation (ie, pronation/supination, 4.9°; flexion/extension, 1.7°; ulnar/radial angulation, 2.0°) and translation (ie, proximal/distal, 0.8 mm; radial/ulnar, 0.8 mm; dorsal/palmar, 0.8 mm). A mean residual 3-dimensional angle of 5.8° (SD, 3.6°) was measured after surgery. All 6 patients operated on for reasons of a reduced range of motion demonstrated improved symptoms and increased movement (from 20° to 80°). In the patients with unstable/painful distal radioulnar joint, 3 were totally free of complaints and 1 patient showed residual pain during sports.


      A SCOT combined with patient-specific guides is an accurate and reliable technique to restore normal anatomy in multiplanar deformities of the forearm.

      Type of study/level of evidence

      Therapeutic IV.

      Key words

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        • Trousdale R.T.
        • Linscheid R.L.
        Operative treatment of malunited fractures of the forearm.
        J Bone Joint Surg Am. 1995; 77: 894-902
        • Colaris J.W.
        • Allema J.H.
        • Reijman M.
        • et al.
        Which factors affect limitation of pronation/supination after forearm fractures in children? A prospective multicentre study.
        Injury. 2014; 45: 696-700
        • McQueen M.M.
        • Hajducka C.
        • Court-Brown C.M.
        Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment.
        J Bone Joint Surg Br. 1996; 78: 404-409
        • Miyake J.
        • Oka K.
        • Kataoka T.
        • Moritomo H.
        • Sugamoto K.
        • Murase T.
        3-Dimensional deformity analysis of malunited forearm diaphyseal fractures.
        J Hand Surg Am. 2013; 38: 1356-1365
        • Schweizer A.
        • Fürnstahl P.
        • Harders M.
        • Székely G.
        • Nagy L.
        Complex radius shaft malunion: osteotomy with computer-assisted planning.
        Hand (N Y). 2010; 5: 171-178
        • Dobbe J.G.G.
        • Strackee S.D.
        • Schreurs A.W.
        • et al.
        Computer-assisted planning and navigation for corrective distal radius osteotomy, based on pre- and intraoperative imaging.
        IEEE Trans Biomed Eng. 2011; 58: 182-190
        • Kunz M.
        • Ma B.
        • Rudan J.F.
        • Ellis R.E.
        • Pichora D.R.
        Image-guided distal radius osteotomy using patient-specific instrument guides.
        J Hand Surg Am. 2013; 38: 1618-1624
        • Vlachopoulos L.
        • Schweizer A.
        • Graf M.
        • Nagy L.
        • Fürnstahl P.
        Three-dimensional postoperative accuracy of extra-articular forearm osteotomies using CT-scan based patient-specific surgical guides.
        BMC Musculoskelet Disord. 2015; 16: 336
        • D’Aubigne R.M.
        Plane oblique osteotomy in correction of deformities of the extremities [in French].
        Bull Mem Arch Chir. 1952; 78: 271-276
        • Sangeorzan B.P.
        • Judd R.P.
        • Sangeorzan B.J.
        Mathematical analysis of single-cut osteotomy for complex long bone deformity.
        J Biomech. 1989; 22: 1271-1278
        • Besl P.J.
        • McKay N.D.
        Method for registration of 3-D shapes.
        Robot Tentat. 1992; 14: 239-256
      1. Fürnstahl P, Schweizer A, Graf M, et al. Surgical treatment of long-bone deformities: 3D preoperative planning and patient-specific instrumentation. In: Zheng G, Li S, eds. Computational Radiology for Orthopaedic Interventions. Vol. 23. Cham, Switzerland: Springer International; 2016:123–149.

        • Athwal G.S.
        • Ellis R.E.
        • Small C.F.
        • Pichora D.R.
        Computer-assisted distal radius osteotomy.
        J Hand Surg Am. 2003; 28: 951-958
        • Schneider P.
        • Eberly D.
        Geometric Tools for Computer Graphics. Vol 1. Scribd, San Francisco, CA2002
        • Fernandez D.L.
        Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation.
        J Bone Joint Surg Am. 1982; 64: 1164-1178
        • Prommersberger K.J.
        • Van Schoonhoven J.
        • Lanz U.B.
        Outcome after corrective osteotomy for malunited fractures of the distal end of the radius.
        J Hand Surg Br. 2002; 27: 55-60
        • Vroemen J.C.
        • Dobbe J.G.G.
        • Strackee S.D.
        • Streekstra G.J.
        Positioning evaluation of corrective osteotomy for the malunited radius: 3-D CT versus 2-D radiographs.
        Orthopedics. 2013; 36: e193-e199
        • Schemitsch E.H.
        • Richards R.R.
        The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults.
        J Bone Joint Surg Am. 1992; 74: 1068-1078
        • Ma B.
        • Kunz M.
        • Gammon B.
        • Ellis R.E.
        • Pichora D.R.
        A laboratory comparison of computer navigation and individualized guides for distal radius osteotomy.
        Int J Comput Assist Radiol Surg. 2014; 9: 713-724
        • Murase T.
        • Oka K.
        • Moritomo H.
        • Goto A.
        • Yoshikawa H.
        • Sugamoto K.
        Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system.
        J Bone Joint Surg Am. 2008; 90: 2375-2389
        • Dobbe J.G.G.
        • Du Pré K.J.
        • Kloen P.
        • Blankevoort L.
        • Streekstra G.J.
        Computer-assisted and patient-specific 3-D planning and evaluation of a single-cut rotational osteotomy for complex long-bone deformities.
        Med Biol Eng Comput. 2011; 49: 1363-1370
        • Walenkamp M.M.J.
        • de Muinck Keizer R.J.O.
        • Dobbe J.G.G.
        • et al.
        Computer-assisted 3D planned corrective osteotomies in eight malunited radius fractures.
        Strategies Trauma Limb Reconstr. 2015; 10: 109-116