Patient-Specific Guided Osteotomy to Correct a Symptomatic Malunion of the Left Forearm.
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ABSTRACT:
SUBMITTER: Schroder FF
PROVIDER: S-EPMC8394506 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionTraditional bone surgery using saws and chisels is associated with direct contact of instruments with the bone causing friction, heat and pressure and hence, damaging the bone and the surrounding soft tissues.MethodCold ablation laser osteotomy offers new possibilities to perform corrective osteotomies in the field of bone surgery. We introduce the technology of navigated cold ablation robot-guided laser osteotomy, present potential applications, and preliminary pre-clinical cadaver test results in the field of hand-, wrist- and forearm surgery.ResultsThe cadaver tests showed first promising results for corrections in all planes and axes using different cutting patterns.ConclusionCold ablation laser osteotomy seems to be a feasible new method to perform osteotomies in the field of hand-, wrist- and forearm surgery. Primary osseous stability could be achieved using various cutting patterns which could lead to reduction of the amount of hardware required for osteosynthesis. Further tests are required to proof the latter and precision.
| S-EPMC9541476 | biostudies-literature
Project description:Achievement of appropriate mechanical knee alignment is crucial to ensure optimal clinical outcomes following osteotomy procedures about the knee. The use of patient-specific instrumentation (PSI) to assist in preoperative planning and intraoperative realignment has gained increasing popularity. The purpose of this article is to describe a surgical technique involving a medial closing wedge high tibial osteotomy performed using three-dimensional (3D) PSI and cutting guide to revise residual valgus deformity following failed distal femoral osteotomy. The correction angle, 3D position of the hinge and wedge, as well as final plate and screw position are planned preoperatively using virtual software and computed tomography imaging to allow precise surgical execution.
| S-EPMC8807722 | biostudies-literature
Project description:BackgroundTo provide surgical support for corrective osteotomy, we developed an image fusion system for three-dimensional (3D) preoperative planning and fluoroscopy. To assess the utility of this image fusion system, we evaluated the reproducibility of preoperative planning for corrective osteotomy of dorsally angulated distal radius malunion using the system and compared reproducibility without using the system.MethodsTen wrists from 10 distal radius malunion patients who underwent corrective osteotomy were evaluated. 3D preoperative planning and the image fusion system were used for the image fusion group (n = 5). Only 3D preoperative planning was used for the control group (n = 5). 3D preoperative planning was performed for both groups in order to assess reduction, placement, and the choice of implants. In the image fusion group, the outline of the planned image was displayed on a monitor and overlapped with fluoroscopy images during surgery. Reproducibility was evaluated using preoperative plan and postoperative 3D images. Images were compared with the 3D coordinates of the radial styloid process (1), the volar and dorsal edges of the sigmoid notch (2) (3), and the barycentric coordinates of the three reference points. The reproducibility of the preoperative plan was evaluated by the distance of the coordinates between the plan and postoperative images for the reference points.ResultsThe distances between preoperative planning and postoperative reduction in the image fusion group were 2.1 ± 1.1 mm, 1.8 ± 0.7 mm, 1.9 ± 0.9 mm, and 1.4 ± 0.7 mm for reference points (1), (2), (3), and the barycenter, respectively. The distances between preoperative planning and postoperative reduction in the control group were 3.7 ± 1.0 mm, 2.8 ± 2.0 mm, 1.7 ± 0.8 mm, and 1.8 ± 1.2 mm for reference points (1), (2), (3), and the barycenter, respectively. The difference in reference point (1) was significantly smaller in the image fusion group than in the control group (P < 0.05).ConclusionCorrective osteotomy using an image fusion system will become a new surgical support method for fracture malunion. Trial registration Registered as NCT03764501 at ClinicalTrials.gov.
| S-EPMC8244167 | biostudies-literature
Project description:Background Malunion is a common complication of distal radius fractures. Ulnar shortening osteotomy (USO) may be an effective treatment for distal radius malunion when appropriate indications are observed. Methods The use of USO for treatment of distal radius fracture malunion is described for older patients (typically patients >50 years) with dorsal or volar tilt less than 20 degrees and no carpal malalignment or intercarpal or distal radioulnar joint (DRUJ) arthritis. Description of Technique Preoperative radiographs are examined to ensure there are no contraindications to ulnar shortening osteotomy. The neutral posteroanterior (PA) radiograph is used to measure ulnar variance and to estimate the amount of ulnar shortening required. An ulnar, mid-sagittal incision is used and the dorsal sensory branch of the ulnar nerve is preserved. An USO-specific plating system with cutting jig is used to create parallel oblique osteotomies to facilitate shortening. Intraoperative fluoroscopy and clinical range of motion are checked to ensure adequate shortening and congruous reduction of the ulnar head within the sigmoid notch. Results Previous outcomes evaluation of USO has demonstrated improvement in functional activities, including average flexion-extension and pronosupination motions, and patient reported outcomes. Conclusion The concept and technique of USO are reviewed for the treatment of distal radius malunion when specific indications are observed. Careful attention to detail related to surgical indications and to surgical technique typically will improve range of motion, pain scores, and patient-reported outcomes and will reduce the inherent risks of the procedure, such as ulnar nonunion or the symptoms related to unrecognized joint arthritis. Level IV.
| S-EPMC4117692 | biostudies-other
Project description:Background Malunions following distal radius fractures are common, with shortening, translation, and rotation occurring. The patients frequently lose forearm rotation, but there is no data to indicate whether this is due to mechanical misalignment between the radius and the ulna or to contracture of the soft tissues. Material and Methods Seven fresh cadaveric specimens were used to determine the loss of forearm rotation with varying simulated distal radius fracture malalignment patterns. Uniplanar malunion patterns consisting of dorsal tilt, radioulnar translation, or radial shortening were simulated by creating an osteotomy at the distal end of the radius. Description of Technique By orienting the distal fragment position using an external fixator and maintaining the position with wedges and a T-plate, varying degrees of malunion of the distal radius could be simulated. Rotation of the forearm was produced by fixing the elbow in a flexed position and applying a constant torque to the forearm using deadweights. Forearm rotation was measured with a protractor. Results Dorsal tilt to 30° and radial translation to 10 mm led to no significant restriction in forearm pronation or supination ranges of motion. A 5-mm ulnar translation deformity resulted in a mean 23% loss of pronation range of motion. Radial shortening of 10 mm reduced forearm pronation by 47% and supination by 29%. Conclusion Because a severe osseous misalignment was required to produce a significant loss in rotation, contracture of the soft tissues is most likely the cause of the loss of rotation in most cases.
| S-EPMC3922873 | biostudies-other
Project description:BackgroundA corrective radius osteotomy is often performed in patients with a symptomatic distal radius malunion. In 3D-planned osteotomies, the unaffected radius is mirrored over the malunited radius after adjusting for left-right length differences using both ulnae. This approach assumes that ulnar length differences in a malunion population are similar to those in a healthy population. This study was conducted to analyze the difference in ulnar length in a distal radius malunion population and to assess the potential influence of age, sex, or malunion side on this difference.MethodsWe evaluated 65 adult patients with distal radius malunion using bilateral forearm CT scans. 3D models of both ulnae were constructed, and length differences were determined along a standardized length axis. The results were compared to two populations without a radius malunion.ResultsThe average absolute ulnar length difference was 2.57 mm (SD 1.81), which was comparable to the two healthy populations. This difference was not significantly affected by age, sex, or malunion side.ConclusionThis study demonstrated that using the ulnar length difference to correct for radial length difference in the current 3D planning process, before using the contralateral radius as a template for a corrective osteotomy in patients with radius malunion, is safe.
| S-EPMC11363621 | biostudies-literature
Project description:Displaced mid shaft fractures of the clavicle result in some degree of shortening and rotation. These fractures often heal with some degree of malunion which can be symptomatic. The question arises as to whether surgical correction of the deformity will relieve the symptoms associated with the malunion. Ten patients with a symptomatic malunion of the clavicle were treated by means of a corrective osteotomy with plate and screw fixation. Outcome measurement was a pre and postoperative DASH score, range of motion and patient satisfaction. At follow up after a mean duration of 37 months there was a significant improvement of the DASH score, eight patients were satisfied, and range of motion did not differ significantly. Two patients had a complication resulting from the surgical procedure.
| S-EPMC2322841 | biostudies-other
Project description:Medial opening wedge high tibial osteotomy (OW-HTO) is an excellent surgical option for patients with varus knee osteoarthritis. This article presents a technique of performing a minimally invasive OW-HTO using a patient-specific cutting guide (PSCG). Preoperative 3-dimensional planning with computed tomography imaging is essential. The correction parameters, the final plate position, as well as the 3-dimensional position of the hinge as well as wedge are verified preoperatively before the PSCG is produced. After exposure with an oblique incision over the posteromedial tibia, the hamstring tendons are released for later re-attachment and the medial collateral ligament is released slightly. The PSCG is then used to perform the OW-HTO with protection of the posterior neurovascular structures by a retractor placed posterior to the medial collateral ligament. The final fixation of the osteotomy is achieved with a low-profile locking plate and a femoral head allograft wedge.
| S-EPMC7917192 | biostudies-literature
Project description:BackgroundNeglected clubfoot in older children is characterized by a stiff, nonreducible deformity with relative elongation of the lateral column of the foot with respect to the medial column. Surgical correction often has involved a double osteotomy with elongation of the medial column and shortening of the lateral column, or the use of an external fixator to achieve more gradual correction. Both approaches have shortcomings.Questions/purposesWe therefore (1) used objective physical examination measurements and a functional assessment to evaluate the effectiveness of cuboid osteotomy combined with a selective soft tissue release to achieve correction of neglected clubfoot in older children, (2) determined the rate of complications, and (3) ascertained whether the initial correction achieved was maintained.MethodsWe reviewed 31 patients (56 feet) older than 5 years with severe, neglected nonreducible clubfoot deformity who underwent the index procedure. Minimum followup was 2 years (average, 6 years; range, 2-9 years). Postoperatively, the Laaveg and Ponseti classification and Dimeglio score were used to grade correction. Complication rates were tallied.ResultsAccording to the Laaveg and Ponseti classification, 24 feet showed excellent correction, 20 good, nine fair, and three poor at 1-year followup. These results were maintained up to the latest followup. Patients showed significant improvement of Dimeglio score after surgery (p < 0.0001). Two patients had postoperative skin-related complications that healed without additional surgery.ConclusionsCuboid subtraction osteotomy combined with posteromedial release is an effective approach to manage a stiff nonreducible neglected clubfoot deformity in older children.
| S-EPMC3705072 | biostudies-literature
Project description:Knowledge of anatomic variation in vasculature is critical to safe medical intervention as conduits vary in morphology, architecture, and course. Tortuosity is a common anatomic variant in certain arterial beds; however, its prevalence in ulnar arteries is not well documented in the literature. Here we report two cases of tortuous ulnar arteries in patients being evaluated for upper extremity hemodialysis access.
| S-EPMC7396824 | biostudies-literature