title: Corrective osteotomy assisted by computer simulation for a malunited intra-articular fracture of the distal humerus: two case reports.
abstract: Intra-articular malunion after fractures of the distal humerus can cause pain, stiffness and, consequently, osteoarthritis in the long run. Although corrective osteotomy for intra-articular malunion has been reported, it is still technically challenging and needs careful preoperative evaluation and planning. Here, we present two cases of corrective osteotomy assisted by preoperative three-dimensional (3-D) computer simulation.
  
  
  
  We present two cases of malunited intra-articular fracture of the distal humerus, which was treated by corrective osteotomy with the aid of 3-D computer simulation. One case was initially treated with closed reduction and pinning, and the other was initially treated with open reduction and internal fixation. Both of them had pain and severely limited range of motion in the elbow due to intra-articular malunion. 3-D models of the bilateral humeri were created on a computer using computed tomography (CT) data. The deformity was analyzed by superimposing the model of the affected humerus on the mirrored model of the contralateral normal humerus. Osteotomy, reduction and fixation were simulated preoperatively on the computer. The actual surgery was performed exactly according to the preoperative 3-D computer simulation.
  
  
  
  The operative procedures were performed successfully according to the computer simulation. Range-of-motion exercises started 3 days and immediately after the surgery in cases 1 and 2, respectively. Two years after surgery, there were no complaints of pain or instability. The range of elbow motion was 5°-140° and 15°-125° in cases 1 and 2, respectively. Plain radiographs and CT scans showed good reconstruction of the articular surface.
  
  
  
  3-D computer simulations can be useful in preoperative planning for intra-articular corrective osteotomy for complex malunion of the distal humerus.
authors.affiliation: Department of Orthopaedic Surgery, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka City, Osaka, 553-0003, Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Oura
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Oka
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.|Department of Medical Innovation, Osaka University Hospital, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Okada
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. tmurase-osk@umin.ac.jp.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Murase
mesh_terms: D000328:Adult; D003198:Computer Simulation; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017759:Fractures, Malunited / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D021621:Imaging, Three-Dimensional; D057072:Intra-Articular Fractures / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D016059:Range of Motion, Articular; D014057:Tomography, X-Ray Computed
keywords: Computer simulation; Corrective osteotomy; Elbow; Intra-articular malunion