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In-House 3D Planning for Corrective Osteotomy of the Distal Radius: Prospective Cohort Study With 1-Year Radiological
Charlotte Stor Swinkels1,2,3, Peter Axelsson1,3, Katleen Libberecht1,3
1Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, Göteborg, Västra Götaland, 413 90, Sweden, 46 31-786 00 00.
Background:
Distal radius malunions occur in 5% to 17% of fractures and may lead to pain and functional impairment. While 3D surgical planning with patient-specific guides has demonstrated high accuracy and reduced fluoroscopy use compared with conventional 2D techniques, its routine clinical implementation remains limited, particularly for in-house hospital-based workflows.
Objective:
This study aimed to evaluate the precision of corrective osteotomy for distal radius malunions using in-house-designed 3D patient-specific surgical guides 1 year after surgery. Secondary objectives were to assess clinical and patient-reported outcomes and document intraoperative fluoroscopy use.
Methods:
Corrective osteotomies of extra-articular distal radius malunions were performed in 16 consecutive patients using in-house 3D surgical planning and patient-specific surgical guides. Accuracy was evaluated by comparing preoperative plans with 1-year postoperative computed tomography-based 3D models, assessing ulnar variance, volar tilt, and radial inclination. Acceptable error margins were defined as 5° or less for volar tilt and 2 mm or less for ulnar variance. Clinical outcomes were evaluated using patient-reported outcome measures and range of motion, lift, grip, and torque strength measurements.
Results:
The mean absolute error was 1 (SD 0.8) mm in ulnar variance, 4.9° (SD 2.7°) in volar tilt, and 1.9° (SD 3.6°) in radial inclination. The corrections were within predefined equivalence bounds of the virtual plans in terms of ulnar variance but not volar tilt. Significant improvements were observed in Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores; pain during activity; pain at rest; lift strength; wrist flexion; and ulnar deviation. In total, 12.5% (2/16) of the patients experienced complications following concomitant ulnar shortening procedures and were transferred to standard care. The median intraoperative fluoroscopy duration was 56 (IQR 26-72) seconds.
Conclusions:
In-house 3D planning was feasible and associated with generally favorable radiological and clinical outcomes at 1 year. However, the predefined equivalence criterion was not achieved for volar tilt, and the findings should be interpreted considering the small sample size and observed complications. In-house 3D planning supports continuous surgical refinement and quality improvement.