title: Distal radius osteotomy with volar locking plates based on computer simulation.
abstract: BACKGROUND
  Corrective osteotomy using dorsal plates and structural bone graft usually has been used for treating symptomatic distal radius malunions. However, the procedure is technically demanding and requires an extensive dorsal approach. Residual deformity is a relatively frequent complication of this technique.
  
  
  OBJECTIVE
  We evaluated the clinical applicability of a three-dimensional osteotomy using computer-aided design and manufacturing techniques with volar locking plates for distal radius malunions.
  
  
  METHODS
  Ten patients with metaphyseal radius malunions were treated. Corrective osteotomy was simulated with the help of three-dimensional bone surface models created using CT data. We simulated the most appropriate screw holes in the deformed radius using computer-aided design data of a locking plate. During surgery, using a custom-made surgical template, we predrilled the screw holes as simulated. After osteotomy, plate fixation using predrilled screw holes enabled automatic reduction of the distal radial fragment. Autogenous iliac cancellous bone was grafted after plate fixation.
  
  
  RESULTS
  The median volar tilt, radial inclination, and ulnar variance improved from -20°, 13°, and 6 mm, respectively, before surgery to 12°, 24°, and 1 mm, respectively, after surgery. The median wrist flexion improved from 33° before surgery to 60° after surgery. The median wrist extension was 70° before surgery and 65° after surgery. All patients experienced wrist pain before surgery, which disappeared or decreased after surgery.
  
  
  CONCLUSIONS
  Surgeons can operate precisely and easily using this advanced technique. It is a new treatment option for malunion of distal radius fractures.
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Miyake
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Murase
authors.forename: Hisao
authors.initials: H
authors.lastname: Moritomo
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Sugamoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D003198:Computer Simulation; D005260:Female; D005500:Follow-Up Studies; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome