Simultaneous Intra-articular and Extra-articular Corrective Osteotomies Using a Patient-Matched Surgical Guide and Plate for Malunion After Distal Radius Fractures: A Report of Two Cases.

Abstract

Malunion after distal radial fractures with intra-articular and extra-articular deformities is difficult to treat. We report two cases of simultaneous intra-articular and extra-articular corrective osteotomies for malunion after distal radius fractures using a patient-matched surgical guide and plate (patient-matched instruments [PMIs]) created based on a preoperative computer simulation. Both patients experienced pain and limited range of motion in the wrist and forearm. Three-dimensional models were created using CT to simulate corrective osteotomy. Two types of PMIs were created to correct the extra-articular deformity and intra-articular step-off. Intra-articular and extra-articular corrective osteotomies were simultaneously performed using the PMIs. In postoperative imaging evaluations, the average step-offs were reduced from 4.5 to 0 mm and extra-articular deformities were anatomically corrected. The average visual analog scale score decreased from 55/100 to 12/100 mm, indicating substantial pain relief. In addition, there was a notable improvement in range of motion: flexion increased from 42.5° to 62.5°, extension from 57.5° to 75°, pronation from 67.5° to 85°, and supination from 47.5° to 82.5°. Simultaneous intra-articular and extra-articular corrective osteotomy using a patient-matched surgical guide and plate is a valuable technique for correcting complex deformities and ensuring precise osteotomy.