Corrective osteotomy for distal radius malunion using 3D-printed patient-specific guides and spacers: a retrospective...

This study aims to evaluate the effectiveness of 3D-printed personalized osteotomy guide plates in orthopedic surgery for the malunion of old fractures of the distal radius, thereby facilitating the development of more precise individualized treatment plans for clinical practice.

A retrospective analysis was performed on 12 patients with malunion of old distal radius fractures at Foshan Hospital of Traditional Chinese Medicine from January 2022 to December 2023. The patients were categorized into two groups based on surgical methods: the 3D printing group (n = 6), which underwent preoperative CT reconstruction and personalized guide-assisted osteotomy, and the control group (n = 6), which received traditional empirical osteotomy. In the 3D printing group, there was 1 male and 5 females, with an average age of 60.33 ± 10.60 years and a fracture duration of 6.5 ± 1.2 months. The control group comprised 2 males and 4 females, with an average age of 59.83 ± 12.57 years and a fracture duration of 5.9 ± 1.5 months. The operation time, intraoperative fluoroscopy frequency, postoperative imaging indicators (palmar inclination angle, ulnar deviation angle), visual analogue scale (VAS) for pain, and Cooney wrist joint function score were compared between the two groups.

The operation time for the 3D printing group was 64.67 ± 4.46 min, significantly shorter than that of the control group, which was 84.50 ± 4.59 min (P < 0.001). The number of intraoperative fluoroscopy instances was 2.50 ± 0.55 times, compared to 4.33 ± 1.03 times in the control group (P < 0.01). Postoperatively, the ulnar deviation angle in the 3D printing group measured 23.11 ± 0.71°, which was significantly better than the control group's angle of 19.89 ± 1.59° (P < 0.01). However, there was no statistically significant difference in the palmar inclination angle between the two groups (P > 0.05). At the last follow-up, conducted 12 months postoperatively, the Cooney score for the 3D printing group was 85.50 ± 5.68 points, higher than the control group's score of 77.33 ± 7.89 points (P = 0.067). The excellent and good rate at the last follow-up was 83.3% for the 3D printing group, exceeding the control group's rate of 50%. The VAS score for the 3D printing group was 1.83 ± 0.75 points, significantly lower than the control group's score of 2.50 ± 1.05 points (P = 0.235). No complications, including incision infection, loosening of internal fixation, or nonunion, were reported in either group.

The 3D-printed personalized osteotomy guide plate appears to reduce operation time, minimize radiation exposure, enhance the precision of ulnar deviation angle reduction, and improve wrist joint function recovery, with a favorable safety profile. However, these findings are based on a small retrospective study and require validation in larger prospective trials before broader clinical implementation.