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Three-Dimensional Compared with Two-Dimensional Preoperative Planning of Corrective Osteotomy for Extra-Articular Distal Radial Malunion

Journal article
Authors G. A. Buijze
N. L. Leong
F. Stockmans
Peter Axelsson
R. Moreno
Allan Sørensen
J. B. Jupiter
Published in Journal of Bone and Joint Surgery-American Volume
Volume 100
Issue 14
Pages 1191-1202
ISSN 0021-9355
Publication year 2018
Published at Institute of Clinical Sciences
Institute of Clinical Sciences, Department of Orthopaedics
Pages 1191-1202
Language en
Links dx.doi.org/10.2106/jbjs.17.00544
Keywords randomized controlled-trials, no significant difference, colles, fracture, orthopedic literature, complications, outcomes, adults, wrist, fixation, guides, Orthopedics, Surgery
Subject categories Orthopedics

Abstract

Background: Malunion is the most frequent complication seen after a fracture of the distal end of the radius. The primary aim of this study was to compare patient-reported outcome measures (PROMs) after corrective osteotomy for malunited distal radial fractures with and without 3-dimensional (3D) planning and use of patient-specific surgical guides. Methods: From September 2010 to May 2015, 40 adult patients with a symptomatic extra-articular malunited distal radial fracture were randomized to 3D computer-assisted planning or conventional 2-dimensional (2D) planning for corrective osteotomy. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist Evaluation (PRWE) score, pain and satisfaction scores, grip strength, and radiographic measurements at 3, 6, and 12 months postoperatively. Results: From baseline to 12 months of follow-up, the reduction in the mean DASH score was 230.7 +/- 18.7 points for the 3D planning group compared with220.1 +/- 17.8 points for 2D planning (p = 0.103). Secondary functional outcome by means of the PRWE resulted in a similar reduction of 234.4 +/- 22.9 points for the 3D planning group compared with -26.6 +/- 18.3 points for the 2D planning group (p = 0.226). There were no significant differences in pain, satisfaction, range of motion, and grip strength. Radiographic analysis showed significant differences in the mean residual volar angulation (by 3.3 degrees; p = 0.04) and radial inclination (by 2.7 degrees; p = 0.028) compared with the templated side, in favor of 3D planning and guidance. The duration of preoperative planning and surgery as well as complication rates were comparable. Conclusions: Although there was a trend toward a minimal clinically important difference in PROMs in favor of 3D computer-assisted guidance for corrective osteotomy of extra-articular distal radial malunion, it did not attain significance because of (post hoc) insufficient power. Despite the challenge of feasibility, a trial of large magnitude is warranted to draw definitive conclusions regarding clinical advantages of this advanced, more expensive technology.

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