gms | German Medical Science

Objectives/Interrogation: Sometimes corrective osteotomies may be challenging. Three dimensional osteotomies are difficult, especially if intraarticular cuts are necessary. Advanced computer based analysis and planning offers new possibilities. We planned to use this technique in selected cases and started our collaboration with "CARD - The Balgrist" end of 2016. This institute offers 3D analysis and patient specific guides, produced by "Medacta".

The question was, if this technique results in clinical and economic satisfaction for the patient and the hospital.

Methods: In our clinic we collected 17 patients with complex, mostly posttraumatic deformities from wrist to elbow joint. In these cases bilateral 3D analysis were performed. In 11 out of 17 cases we did corrective osteotomies with patient specific 3D guides, planned by "CARD" and produced by "Medacta". The following pathologies were treated: intraarticular distal humerus malunion, radial neck malunion and deformity, proximal radius malunion with radial head subluxation, forearm shaft malunion, distal radius nonunion with severe deformity and DRU-joint dislocation, intrarticular distal radius malunion, congenital ulna minus-deformity, double metacarpal malunion, olecranon malunion.

Results and Conclusions: Bilateral 3D Analysis offers new possibilities, a specific insight in malunion and deformity. In combination with patient specific guides, osteotomies get easier, sometimes render possible and much more accurate as without guides. But it may be difficult to transfer the preop planning into the "in vivo" situation, due to soft tissue, scar tissue, unstable nonunion and the fitting of the guide to the bone. In our patients we received good results in all, the patient satisfaction was high. All osteomies healed.

The technique is very expensive and not covered by the german health system. But it makes sense to use this modern technique in selected complex cases, despite the high costs. In the german system osteotomies at hand level are not cost-effective, double osteotomies at forearm level cover the costs adequate.