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Updated: Jun 7, 2026
Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy
Published on: February 17, 2023
Image-based quantitative osteotomy planning for congenital proximal radioulnar synostosis: plan-execution discrepancy
Yi-Chih Chen1, Hua-Ju Shih2, Chia-Hsieh Chang3
1Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Department of Orthopedics, Cathay General Hospital, Taipei, Taiwan.
Background:
Proximal radioulnar synostosis is a rare congenital anomaly that restricts forearm rotation and significantly impairs daily function. Surgical correction typically involves radial osteotomy with shortening and derotation; however, planning of osteotomy level, bone shortening, and rotational correction remains largely subjective and relies heavily on surgeon experience. This study retrospectively evaluated an image-based quantitative planning framework designed to provide objective geometric parameters for osteotomy in congenital proximal radioulnar synostosis.
Methods:
Preoperative anteroposterior and lateral radiographs from 8 unilateral cases were reconstructed to derive patient-specific deformity geometry, central bone axes, cut points, predicted cutting angles, and model-estimated radial shortening. The planning algorithm uses polynomial fitting and calculus-based minimization to identify osteotomy points. These predictions were compared with intraoperative measurements and postoperative radiographic and functional outcomes.
Results:
All procedures were complication-free, and 7 of 8 forearms showed improved rotational range. At final follow-up, 2 forearms had concentric radial head alignment, whereas 6 showed mild subluxation or dislocation. Observationally, larger discrepancies between model-estimated and surgeon-applied shortening were associated with suboptimal postoperative radial head alignment. In one representative case, a substantial discrepancy corresponded with progressive radial head dislocation despite preserved clinical motion.
Conclusion:
This study highlights the potential value of quantitative, image-based modeling to support osteotomy planning by providing transparent, reproducible parameters that may reduce variability in surgical decision-making. Although limited by its small sample size, retrospective design, and reliance on radiographs, this work establishes a foundation for future prospective validation of computational decision-support tools in pediatric orthopedic deformity correction.