Accuracy and Early Clinical Outcome After 3-Dimensional Correction of Distal Radius Intra-Articular Malunions Using Patient-Specific Instruments

Purpose To investigate the residual articular incongruity on computed tomography image data and the early clinical outcome of 3-dimensional planned and navigated intra-articular osteotomies of the distal radius. Method We conducted a retrospective analysis of intra-articular osteotomies executed between 2008 and 2016. We identified 37 patients (aged 26-73 years) and performed a combined intraarticular and extra-articular osteotomy on 20 patients. A preoperative 3-dimensional plan with the superimposed bone of the contralateral healthy side was performed in each case to analyze and execute the osteotomy by intraoperative navigation. The residual articular incongruity was assessed by quantification of the maximal stepoff in the coronal or sagittal computed tomography scans. Clinical outcome, including range of motion, grip strength, and return to work, was assessed after a minimum follow-up of 12 months and compared with preoperative measurements. Results On average, the preoperative intra-articular stepoff was 2.5 mm (+/- 0.6 mm; range, 1.4-4.2 mm) and was significantly reduced to 0.8 mm (+/- 0.2 mm) after surgery. After surgery, 30 patients had a stepoff less than 1 mm; in 7, a stepoff of 1.1 to 1.4 mm was measured. After 1 year, 22 had no pain, 9 had slight pain during heavy work, and 5 had moderate pain with no improvement compared with their preoperative status, although wrist strength and range of motion improved in all 37 patients. One patient underwent a secondary radioscapholunate arthrodeses owing to persistent pain despite a congruent joint with a small residual intra-articular stepoff (0.6 mm). Conclusion Intra-articular osteotomies of the distal radius treated by 3-dimensional preoperative planning and patient-specific guides are an accurate technique to reduce articular incongruity to an average stepoff of 0.8 mm (range, 0.3-1.4 mm) The early clinical outcomes demonstrated overall reduction in pain and improvement of range of motion and grip strength in 36 of 37 patients. Copyright (C) 2020 by the American Society for Surgery of the Hand. All rights reserved.