Clinical Scorecard: Customized Plates for Navigation and Stabilization in Distal Radius Fractures: A Case Series Analysis

At a Glance

Key Highlights

• Conventional plates often require subjective bending and may not fit deformed radius bones optimally, leading to suboptimal repositioning and poorer outcomes.
• 3D preoperative planning using CT scans of both affected and contralateral forearms enables precise anatomical alignment planning in three dimensions.
• Patient-specific plates and drilling/cutting guides manufactured via 3D printing facilitate accurate transfer of the surgical plan, potentially reducing tendon rupture risk and secondary surgeries.

Guideline-Based Recommendations

Diagnosis

• Use CT scanning of both affected and contralateral forearms for 3D modeling and evaluation of distal radius malunion.
• Exclude patients with congenital upper limb disorders or contralateral fractures to ensure accurate reference modeling.

Management

• Perform corrective osteotomy guided by patient-specific polyamide drilling/cutting guides.
• Use patient-specific titanium plates designed to fit the patient's bone contour for fixation to optimize anatomical alignment.
• Preoperative planning should include segmentation, clipping of bone segments, and registration to mirrored contralateral bone for target positioning.

Monitoring & Follow-up

• Postoperative CT scans at approximately 6 weeks and 6 months to evaluate initial and final bone positioning and consolidation.

Risks

• Potential for tendon ruptures if anatomical alignment is not accurately restored.
• Secondary surgeries for plate removal are common with standard plates but may be reduced with patient-specific plates.

Patient & Prescribing Data

Ten patients with complex distal radius malunion, aged over 16 years, presenting with pain, limited motion, or decreased hand function.

Patient-specific plates designed via 3D planning and printed in titanium showed promising clinical, functional, and radiological outcomes by improving anatomical alignment.

Clinical Best Practices

• Obtain bilateral CT scans to enable accurate 3D modeling and planning using the contralateral radius as a reference.
• Use custom software for segmentation and registration to quantify malalignment and plan osteotomy precisely.
• Employ patient-specific drilling and cutting guides to transfer the surgical plan accurately to the operative field.
• Design and utilize patient-specific plates that conform to the bone surface to improve fixation and reduce complications.
• Perform postoperative imaging to assess bone healing and alignment to guide rehabilitation.

References

• Malunion incidence and symptoms
• Corrective osteotomy procedures
• 3D preoperative planning techniques
• Patient-specific plate preclinical and clinical evaluations
• Marching cubes algorithm for bone modeling