0
Scientific Articles   |    
Computer-Assisted Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures
Junichi Miyake, MD1; Tsuyoshi Murase, MD, PhD1; Kunihiro Oka, MD, PhD2; Hisao Moritomo, MD, PhD1; Kazuomi Sugamoto, MD, PhD1; Hideki Yoshikawa, MD, PhD1
1 Departments of Orthopaedic Surgery (J.M., T.M., H.M., and H.Y.) and Orthopaedic Biomaterial Science (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Osaka, Japan. E-mail address for T. Murase: tmurase-osk@umin.net
2 Department of Orthopaedic Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai 599-8247, Osaka, Japan
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Investigation performed at Osaka University Graduate School of Medicine, Osaka, Japan



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Oct 17;94(20):e150 1-11. doi: 10.2106/JBJS.K.00829
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: 

Corrective osteotomy for malunited diaphyseal forearm fractures remains a challenging procedure. We developed a computer-assisted system for corrective surgery, including a three-dimensional simulation program and a custom-made osteotomy template, and investigated the results of corrective surgery for malunited diaphyseal forearm fractures with use of this technology.

Methods: 

Twenty patients (fifteen male patients and five female patients) with malunited diaphyseal forearm fractures were managed with three-dimensional corrective osteotomy with a custom-made osteotomy template based on computer simulation. We performed osteotomy of both radius and ulna in fourteen patients and osteotomy of the radius alone in six patients. The median age at the time of surgery was eighteen years (range, eleven to forty-three years). The median duration between the time of injury and the time of surgery was thirty-three months (range, five to 384 months). The minimum duration of follow-up was twenty-four months (median, twenty-nine months; range, twenty-four to forty-eight months). To evaluate the results, we compared preoperative and postoperative data from radiographs, forearm motion, grip strength, and pain.

Results: 

The average radiographic deformity angle preoperatively was 21° (range, 12° to 35°) compared with the normal arm; the radiographic deformity angle was improved to 1° (range, 0° to 4°) postoperatively. The distal radioulnar joints of both sides were symmetric on postoperative radiographs regarding the relative lengths of the radius and ulna. In eighteen patients who had a restricted range of forearm motion preoperatively, the mean arc of forearm motion improved from 76° (range, 25° to 160°) preoperatively to 152° (range, 80° to 180°) postoperatively (p < 0.01). However, forearm supination was still restricted by ≥70° in three patients who had been younger than ten years old at the time of the initial injury and who had long-standing malunion for ninety-six months or longer. Painful recurrent dislocation of the distal ulna or radial head resolved or decreased in five patients. Average grip strength improved from 82% to 94% compared with that of the contralateral, normal side.

Conclusions: 

Computer-assisted osteotomy can provide excellent radiographic and clinical outcome for the treatment of malunited diaphyseal forearm fractures. Satisfactory restoration of forearm motion can be achieved even in relatively long-standing cases in adults.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    12/31/2013
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    12/04/2013
    New York - Icahn School of Medicine at Mount Sinai
    04/02/2014
    W. Virginia - Charleston Area Medical Center
    02/28/2014
    District of Columbia (DC) - Children's National Medical Center