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Three-Dimensional Surgical Planning and Patient-Specific Osteotomy Guide in the Management of Chronic Monteggia
Abhishet Varama1, Chittawee Jiamton2, Natthaphat Viriya3
1Department of Orthopedic Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Introduction:
Chronic Monteggia fracture-dislocations, characterized by persistent radial head dislocation and ulnar malunion, pose significant reconstructive challenges. While three-dimensional (3D) printing has shown promise in upper extremity deformity correction, its application in chronic Monteggia lesions remains limited.
Case Report:
We report the case of a 24-year-old male presenting with a 1-year history of forearm pain following failed surgical management of a Monteggia fracture. Radiographs revealed a Bado type I chronic Monteggia fracture-dislocation. A personalized 3D-printed osteotomy guide was designed from pre-operative computed tomography data to assist in corrective ulnar osteotomy. The surgical plan included implant removal, corrective osteotomy using a customized surgical guide, bone grafting, and annular ligament reconstruction if unstable radiocapitellar joint after correction. Postoperatively, the patient initially regained functional elbow motion but later developed oligotrophic non-union. Revision surgery with repeat bone grafting resulted in solid union and complete functional recovery.
Conclusion:
This case highlights the potential of 3D-assisted pre-operative planning and patient-specific guides in managing chronic Monteggia deformities. It contributes to the growing evidence supporting personalized surgical technologies in complex upper-limb reconstruction.
