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J Hand Surg Am. 2013 Dec;38(12):2339-47. doi: 10.1016/j.jhsa.2013.09.023. Epub 2013 Nov 1.

Three-dimensional correction of distal radius intra-articular malunions using patient-specific drill guides.

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  • 1Department of Orthopaedic Surgery, University of Zurich, Uniklinik Balgrist, Zurich, Switzerland. Electronic address: andreas.schweizer@balgrist.ch.



To analyze the feasibility of combining computer-assisted 3-dimensional planning with patient-specific drill guides and to evaluate this technology's surgical outcomes for distal radius intra-articular malunions.


Six symptomatic patients with intra-articular malunions of the distal radius with a stepoff of more than 2 mm were treated with an outside-in corrective osteotomy. The described cases consist of 2 malunited volar Barton fractures, 2 radial styloid fractures, 1 AO-type C1 fracture, and 1 die-punch fracture. The osteotomies were guided by 3-dimensionally generated aiming guides that allowed precise cutting and the reduction of up to 2 fragments. All 6 patients were examined clinically and radiologically after 1 year. The surgical outcomes were quantitatively analyzed by comparing the preoperative and postoperative computed tomographic data.


In all 6 cases, the osteotomies were consolidated 8 weeks postoperatively. After 1 year, 4 patients were pain-free, 1 had mild pain, and 1 experienced moderate pain during heavy work. Wrist motion and grip strength were improved in all patients. The postoperative radiographs showed no articular stepoff or degenerative changes.


Patient-specific aiming guides provided a reliable method to correct intra-articular malunions of the distal radius. This technique allows the surgeon to safely perform difficult intra-articular osteotomies and may help limit the need for salvage procedures such as partial or complete wrist arthrodesis.


Therapeutic IV.

Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.


Computer-assisted 3-dimensional planning; contralateral side; intra-articular radius osteotomy; patient-specific guides; rapid prototyping

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