title: 3-Dimensional prebent plate fixation in corrective osteotomy of malunited upper extremity fractures using a real-sized plastic bone model prepared by preoperative computer simulation.
abstract: OBJECTIVE
  To assess the clinical outcome and accuracy of prebent plate fixation in corrective osteotomy for malunited upper extremity fractures using a plastic bone model manufactured by preoperative computer simulation.
  
  
  METHODS
  Nine consecutive patients underwent computed tomography (CT)-based 3-dimensional corrective osteotomy for malunited upper extremity fractures. There were 4 cubitus varus deformities, 1 cubitus valgus deformity, and 4 forearm diaphyseal malunions. We constructed a computer model of the affected bones using the CT data and simulated the 3-dimensional deformity correction on a computer. A real-sized plastic model of the corrected bone was manufactured by rapid prototyping. We used a metal plate, prebent to fit the plastic bone model, in the actual surgery. Patients were evaluated after an average follow-up of 22 months (range, 14-36 mo). We retrospectively collected radiographic and clinical data at the most recent follow-up and compared them with preoperative data. We also performed CT after surgery and evaluated the error in corrective osteotomy as the difference between preoperative simulation and postoperative bone model.
  
  
  RESULTS
  The range of forearm rotation and grip strength in patients with forearm malunions improved after corrective osteotomies of the radius and ulna. Wrist pain, which 2 patients with forearm malunion had experienced before surgery, disappeared or decreased substantially after surgery. Radiographic examination indicated that preoperative angular deformities were nearly nonexistent after all corrective osteotomies. Three-dimensional errors in the corrective osteotomy using a prebent plate, as evaluated by CT data, were less than 3 mm and 2°.
  
  
  CONCLUSIONS
  Prebent plate fixation in corrective osteotomy for malunited upper extremity fractures using a 3-dimensionally corrected, real-sized plastic bone model prepared by preoperative computer simulation is a precise and relatively easily performed technique that results in satisfactory clinical outcome.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. kataoka@qk9.so-net.ne.jp
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kataoka
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Oka
authors.forename: Junichi
authors.initials: J
authors.lastname: Miyake
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Omori
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Murase
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001133:Bones of Upper Extremity / Q000293:injuries*; D002648:Child; D003198:Computer Simulation; D004867:Equipment Design; D005260:Female; D005542:Forearm / Q000503:physiopathology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D017759:Fractures, Malunited / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000293:injuries; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult