Diaphyseal forearm malunions with distal radioulnar joint instability treated by 3D-planned osseous correction
Johan SH Fischer, Eline M van Es, Joost W ColarisIntroduction:
This study evaluates the effect of a three-dimensional (3D)-planned corrective osteotomy using patient-specific drilling and cutting guides in patients with a diaphyseal forearm malunion and distal radioulnar joint (DRUJ) instability following a childhood forearm fracture.
Methods:
Nine patients (mean age at trauma, 12 years) with malunion and preserved forearm rotation but symptomatic DRUJ instability underwent a corrective osteotomy of the radius and/or ulna. Function and pain were assessed using the Patient-Rated Wrist/Hand Evaluation (PRWHE) score, the Numeric Rating Scale (NRS) and the Patient-Specific Functional Scale (PSFS). Furthermore, baseline clinical assessments were compared with findings at 12 months of follow-up.
Results:
At 12 months, all patients demonstrated significant and clinically relevant improvement in function and pain as well as a stable DRUJ without additional soft-tissue repair. Median PRWHE scores improved from 44.5 to 5.5 (
Conclusion:
These findings indicate that precision 3D-guided osteotomy can restore DRUJ stability and improve symptoms in patients with a diaphyseal forearm malunion without the need for (additional) soft-tissue reconstruction.
Level of evidence:
IV