gms | German Medical Science

Objectives/Interrogation: Three-dimensional computer modeling and generation of drilling and cutting guides can enhance precision by adding the ability to precisely correct deformity following malunion of the distal radius. The cost of this added technology ($2,500) may be offset by decreasing the operative time required for "free hand" surgical correction.

Methods: A cohort of 35 patients undergoing distal radius osteotomy were managed by "free hand" tri-planer osteotomy to correct rotation, angular, and length deformity. Healing rates, restoration of alignment, and tourniquet times were recorded for all cases.

A prospective series of 14 patients with complex deformity of the distal radius were managed using three-dimensional CT guided computer generated modeling and templating utilizing the contralateral wrist in mirror image as a reference to correct deformity, using preoperatively fabricated drilling, osteotomy and bone removal guides. Postoperative imaging was used to compare outcomes with the contralateral wrist. Operative time was recorded.

Results and Conclusions: Of the 35 patients in the 1st group, 5 had delayed or nonunion requiring re-operation; radial osteotomy surgical time averaged 173 minutes, average, radial&ulnar osteotomies, 271 minutes. There was a mean inability to correct length of 2.5 mm. Angle of inclination was restored to 7 degrees and volar tilt corrected to neutral. In group utilizing 3D templating length was restored to within 1 mm of the contralateral wrist. Angle of inclination was restored to 10 degrees. Volar tilt to 8 degrees. All but one patient healed primarily. Average time for radial osteotomy was 109 minutes, and for radial and ulnar osteotomy was 150 minutes. With "free hand" osteotomies, three patients developed infection. In the templating group there were no infections.

Cost effectiveness of precision templating is evidenced by an average decrease of 64 minutes OR time for radial osteotomy and 81 minutes for radius and ulnar osteotomy showed a significant reduction in OR costs ($4,153 and $5,256 and respectively in our institution). The potential for limiting infection by reduced operating time also adds to patient safety, while precision restoration of anatomy offers a greater potential for long-term successful outcomes.