title: Three-dimensional correction of distal radius intra-articular malunions using patient-specific drill guides.
abstract: OBJECTIVE
  To analyze the feasibility of combining computer-assisted 3-dimensional planning with patient-specific drill guides and to evaluate this technology's surgical outcomes for distal radius intra-articular malunions.
  
  
  METHODS
  Six symptomatic patients with intra-articular malunions of the distal radius with a stepoff of more than 2 mm were treated with an outside-in corrective osteotomy. The described cases consist of 2 malunited volar Barton fractures, 2 radial styloid fractures, 1 AO-type C1 fracture, and 1 die-punch fracture. The osteotomies were guided by 3-dimensionally generated aiming guides that allowed precise cutting and the reduction of up to 2 fragments. All 6 patients were examined clinically and radiologically after 1 year. The surgical outcomes were quantitatively analyzed by comparing the preoperative and postoperative computed tomographic data.
  
  
  RESULTS
  In all 6 cases, the osteotomies were consolidated 8 weeks postoperatively. After 1 year, 4 patients were pain-free, 1 had mild pain, and 1 experienced moderate pain during heavy work. Wrist motion and grip strength were improved in all patients. The postoperative radiographs showed no articular stepoff or degenerative changes.
  
  
  CONCLUSIONS
  Patient-specific aiming guides provided a reliable method to correct intra-articular malunions of the distal radius. This technique allows the surgeon to safely perform difficult intra-articular osteotomies and may help limit the need for salvage procedures such as partial or complete wrist arthrodesis.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, University of Zurich, Uniklinik Balgrist, Zurich, Switzerland. Electronic address: andreas.schweizer@balgrist.ch.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schweizer
authors.forename: Philipp
authors.initials: P
authors.lastname: Fürnstahl
authors.forename: Ladislav
authors.initials: L
authors.lastname: Nagy
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D057285:Precision Medicine / Q000379:methods; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014955:Wrist Joint / Q000601:surgery
keywords: Computer-assisted 3-dimensional planning; contralateral side; intra-articular radius osteotomy; patient-specific guides; rapid prototyping