Improving standard volar plate fixation in 3D-guided corrective osteotomy of the distal radius: evaluation of a shim instrument

Authors

  • Emilia Gryska Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden https://orcid.org/0000-0002-7912-2232
  • Katleen Libberecht Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden https://orcid.org/0009-0003-4030-106X
  • Charlotte Stor Swinkels Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden https://orcid.org/0009-0005-8481-7935
  • Peter Axelsson Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden https://orcid.org/0000-0003-2318-6824
  • Per Fredrikson Sahlgrenska University Hospital, University of Gothenburg https://orcid.org/0000-0001-9753-8787
  • Anders Björkman Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden

DOI:

https://doi.org/10.2340/jphs.v59.39839

Keywords:

Virtual surgical planning, 3D, PaPatient-specific instruments, Distal radius, Extra-articular, Osteotomy

Abstract

Standard volar plates often do not fit the surface of the malunited distal radius after osteotomy, necessitating an offset angle for accurate volar tilt correction. The correction can be achieved if the plate is held at the correct angle when the distal screws are locked. With the advantage of 3D surgical planning and patient-specific instruments, we developed a shim instrument to assist the surgeon in securing the plate at the intended angle when locking the distal screws, and evaluated radiological results. Five female patients aged 63–74 with dorsally angulated extra-articular malunions underwent surgery using 3D-printed guides and the shim instrument. The plate position, drilling guide alignment, screw placements, and distal radius correction on postoperative CTs were compared with the surgical plans. Errors were measured using an anatomical coordinate system, and standard 2D radiographic measures were extracted. Preoperative dorsal tilt ranged from 16° to 35°, and postoperative volar tilt from 1° to 11°. 3D analysis revealed mean absolute correction errors of 6.1° in volar tilt, 1.6° in radial inclination, and 0.6 mm in ulnar variance. The volar tilt error due to the shim instrument, indicated by the mean angle error of the distal screws to the plate, was 2.1° but varied across the five patients. Settling of the distal radius, due to tension during and after reduction, further contributed to a mean loss of 3.5° in volar tilt. The shim instrument helped with securing plates at the intended angle; however, further correction improvements should consider the tension between the fragments of osteoporotic bone.

Downloads

Download data is not yet available.

Author Biographies

Emilia Gryska, Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden

Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Katleen Libberecht, Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden

Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Charlotte Stor Swinkels, Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden

Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden

Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden

Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Peter Axelsson, Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden

Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden

Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Per Fredrikson, Sahlgrenska University Hospital, University of Gothenburg

Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden

Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Anders Björkman, Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden

Department of Hand Surgery, Sahlgrenska University Hospital, Mölndal, Sweden

Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

References

Prommersberger KJ, Van Schoonhoven J, Lanz UB. Outcome after corrective osteotomy for malunited fractures of the distal end of the radius. J Hand Surg. 2002;27(1):55–60.

https://doi.org/10.1054/JHSB.2001.0693 DOI: https://doi.org/10.1054/JHSB.2001.0693

Vroemen JC, Dobbe JGG, Strackee SD, et al. Positioning evaluation of corrective osteot-omy for the malunited radius: 3-D CT versus 2-D radiographs. Orthopedics. 2013 Feb;36(2):e193–e199.

https://doi.org/10.3928/01477447-20130122-22 DOI: https://doi.org/10.3928/01477447-20130122-22

von Campe A, Nagy L, Arbab D, et al. Corrective osteotomies in malunions of the distal radius: do we get what we planned? Clin Orthop Relat Res. 2006;450:179–185.

https://doi.org/10.1097/01.blo.0000223994.79894.17 DOI: https://doi.org/10.1097/01.blo.0000223994.79894.17

de Muinck Keizer RJO, Lechner KM, Mulders MAM, et al. Three-dimensional virtual plan-ning of corrective osteotomies of distal radius malunions: a systematic re-view and meta-analysis. Strat Traum Limb Recon. 2017;12(2):77–89.

https://doi.org/10.1007/s11751-017-0284-8 DOI: https://doi.org/10.1007/s11751-017-0284-8

Roner S, Carrillo F, Vlachopoulos L, et al. Improving accuracy of opening-wedge osteot-omies of distal radius using a patient-specific ramp-guide technique. BMC Musculoskeletal Disorders. 2018;19(1):374.

https://doi.org/10.1186/s12891-018-2279-0 DOI: https://doi.org/10.1186/s12891-018-2279-0

Ma B, Kunz M, Gammon B, et al. A laboratory comparison of computer navigation and in-dividualized guides for distal radius osteotomy. Int J CARS. 2014;9(4):713–724.

https://doi.org/10.1007/s11548-013-0966-8 DOI: https://doi.org/10.1007/s11548-013-0966-8

Oka K, Murase T, Moritomo H, et al. Accuracy of corrective osteotomy using a custom-designed device based on a novel computer simulation system. J Orthop Sci. 2011;16(1):85–92.

https://doi.org/10.1007/s00776-010-0020-4 DOI: https://doi.org/10.1007/s00776-010-0020-4

Sariali E, Kajetanek C, Catonné Y. Comparison of custom cutting guides based on three-dimensional computerized CT-scan planning and a conventional ancillary system based on two-dimensional planning in total knee arthroplasty: a randomized controlled trial. Int Orthop. 2019;43(11):2529–2538.

https://doi.org/10.1007/s00264-019-04357-3 DOI: https://doi.org/10.1007/s00264-019-04357-3

Orbay J. Volar plate fixation of distal radius fractures. Hand Clin. 2005;21(3):347–354.

https://doi.org/10.1016/j.hcl.2005.02.003 DOI: https://doi.org/10.1016/j.hcl.2005.02.003

Ring D, Roberge C, Morgan T, et al. Osteotomy for malunited fractures of the distal radius: a comparison of structural and nonstructural autogenous bone grafts. J Hand Surg Am. 2002;27(2):216–222.

https://doi.org/10.1053/jhsu.2002.32076 DOI: https://doi.org/10.1053/jhsu.2002.32076

Dobbe JGG, Vroemen JC, Strackee SD, et al. Patient-tailored plate for bone fixation and accurate 3D positioning in corrective osteotomy. Med Biol Eng Comput. 2013;51(1–2):19–27.

https://doi.org/10.1007/s11517-012-0959-8 DOI: https://doi.org/10.1007/s11517-012-0959-8

Omori S, Murase T, Kataoka T, et al. Three-dimensional corrective osteotomy using a pa-tient-specific osteotomy guide and bone plate based on a computer simu-lation system: accuracy analysis in a cadaver study. Int J Med Robot Com-put Assist Surg. 2014;10(2):196–202.

https://doi.org/10.1002/rcs.1530 DOI: https://doi.org/10.1002/rcs.1530

Schindele S, Oyewale M, Marks M, et al. Three-dimensionally planned and printed pa-tient-tailored plates for corrective osteotomies of the distal radius and forearm. J Hand Surg. 2024;49(3):277.e1–277.e8.

https://doi.org/10.1016/j.jhsa.2022.06.021 DOI: https://doi.org/10.1016/j.jhsa.2022.06.021

Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 and repealing Council Direc-tives 90/385/EEC and 93/42/EEC [Internet]. [cited 2017 May 5]. Available from: http://data.europa.eu/eli/reg/2017/745/2017-05-05/eng

CT scan protocol – osteotomies – upper extremity – English [Internet]. [cited 2023 May 25]. Available from: https://assets-eu-01.kc-usercontent.com/8ff24b0e-57a3-0157-62d1-fa4ac9734eb5/df9e5f44-7ec7-4f0b-b964-ecd50ee45de5/CT%20Scan%20Protocol%20-%20Osteotomies%20-%20Upper%20Extremity%20-%20English%20-%20L-102000-01.pdf

Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clinics. 2005;21(3):279–288.

https://doi.org/10.1016/j.hcl.2005.02.008 DOI: https://doi.org/10.1016/j.hcl.2005.02.008

Besl PJ, McKay ND. Method for registration of 3-D shapes. In: Sensor Fusion IV, editor. Control paradigms and data structures [Internet]. SPIE; 1992 [cited 2023 Oct 16]. p. 586–606. Available from: https://www.spiedigitallibrary.org/conference-proceedings-of-spie/1611/0000/Method-for-registration-of-3-D-shapes/10.1117/12.57955.full

Kreder HJ, Hanel DP, McKee M, et al. X-ray film measurements for healed distal radius fractures. J Hand Surg Am. 1996;21(1):31–39.

https://doi.org/10.1016/S0363-5023(96)80151-1 DOI: https://doi.org/10.1016/S0363-5023(96)80151-1

Suojärvi N, Tampio J, Lindfors N, et al. Computer-aided 3D analysis of anatomy and radio-graphic parameters of the distal radius. Clin Anat. 2021;34(4):574–80.

https://doi.org/10.1002/ca.23615 DOI: https://doi.org/10.1002/ca.23615

Orbay JL, Fernandez DL. Volar fixed-angle plate fixation for unstable distal radius fractu-res in the elderly patient. J Hand Surg Am. 2004;29(1):96–102.

https://doi.org/10.1016/j.jhsa.2003.09.015 DOI: https://doi.org/10.1016/j.jhsa.2003.09.015

Vlachopoulos L, Schweizer A, Graf M, Nagy L, Fürnstahl P. Three-dimensional postopera-tive accuracy of extra-articular forearm osteotomies using CT-scan based patient-specific surgical guides. BMC Musculoskel Disord. 2015 Nov 4;16:336.

https://doi.org/10.1186/s12891-015-0793-x DOI: https://doi.org/10.1186/s12891-015-0793-x

Prommersberger KJ, Pillukat T, Mühldorfer M, et al. Malunion of the distal radius. Arch Orthop Trauma Surg. 2012;132(5):693–702.

https://doi.org/10.1007/s00402-012-1466-y DOI: https://doi.org/10.1007/s00402-012-1466-y

Downloads

Additional Files

Published

2024-05-15

How to Cite

Gryska, E., Libberecht, K., Stor Swinkels, C., Axelsson, P., Fredrikson, P., & Björkman, A. (2024). Improving standard volar plate fixation in 3D-guided corrective osteotomy of the distal radius: evaluation of a shim instrument. Journal of Plastic Surgery and Hand Surgery, 59, 46–52. https://doi.org/10.2340/jphs.v59.39839

Issue

Vol. 59 (2024)

Section

Original Research Articles

License

Copyright (c) 2024 Emilia Gryska, Katleen Libberecht, Charlotte Stor Swinkels, Peter Axelsson, Per Fredrikson, Anders Björkman

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work. 

Crossref
Scopus
Google Scholar
Europe PMC