Three-Dimensional Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures Using Custom-Made Surgical Guides Based on Computer Simulation

Introduction Three-dimensional corrective osteotomy with use of custom-made surgical guides based on computer simulation can provide a good outcome for patients with a malunited diaphyseal forearm fracture. Step 1 Create Computer Bone Models from CT Data Obtain CT data of both forearms, and create computer models of the bones from CT data. Step 2 Evaluate 3D Deformity Evaluate the 3D deformity by comparing the affected bone with the mirror image of the contralateral, normal bone. Step 3 Plan 3D Corrective Osteotomy Simulate the 3D corrective osteotomy on the basis of information obtained from the deformity evaluation. Step 4 Design Custom-Made Surgical Guides Design custom-made surgical guides to reproduce the preoperative simulation during the actual surgery. Step 5 Operative Setup Manufacture custom-made surgical guides to reproduce the preoperative simulation during the actual surgery. Step 6 Perform 3D Osteotomy Using Custom-Made Osteotomy Guides Perform the osteotomy using the custom-made osteotomy guides and achieve anatomical correction using the reduction guides. Results In our series of twenty patients, the average radiographic deformity angle preoperatively was 21° (range, 12° to 35°) compared with that of the normal arm; this improved to 1° (range, 0° to 4°) postoperatively. What to Watch For IndicationsContraindicationsPitfalls & Challenges.