A Case Report: Patient-Specific 3D Osteotomy System for Distal Radius Malunion

Malunion of distal radius fractures with intra-articular displacement and radial shortening can cause pain and limited range of motion. Intra-articular corrective osteotomy is helpful to regain mobility; however, the procedure is complex and carries risks of osteonecrosis and nonunion. This report presents a case of malunion in a distal radius intra-articular fracture with supination restriction, where an extra-articular osteotomy using a patient-specific cutting guide and deformity correction system (Accurio® Teijin Nakashima Medical Co., LTD) has significantly improved the range of motion.

The patient was a 68-year-old female who suffered from a dorsally angulated intra-articular displaced distal radius fracture due to a fall 6 months prior. She was initially treated conservatively elsewhere; she was referred to our institution due to persistent limitation of motion. Physical examination revealed palmar/dorsal flexion of 30°/25° (healthy side 65°/70°)　and pronation/supination of 70°/10°(healthy side 80°/85°), respectively. Wrist pain was absent, but her Quick DASH score was 29.5. Radiographic examination showed a Radial Inclination (RI) of 24°, Volar Tilt (VT) of 26°, and Ulnar Variance (UV) of 5.5mm. The arthritic changes were not severe. CT scans revealed volar subsidence of the bone fragments, radial shortening, and dorsal subluxation of the ulnar head. Despite three months of physical therapy, no improvement was noted, leading to the decision for surgical intervention. Given the absence of wrist pain and limited arthritic changes, we planned to perform internal fixation by extra-articular corrective osteotomy utilizing 3D simulation system and patient-specific volar locking plate to correct the radioulnar alignment.

At the final observation, the patient’s range of motion improved to palmar/dorsal flexion of 50°/70°, pronation/supination of 80°/85°. Patient satisfaction was high, and her Quick DASH score improved to 0. Radiographically, RI remained at 24°, VT improved from 26° to 16°, and UV was corrected from 5.5 mm to 0 mm. CT scans confirmed realignment of the carpal bones and reposition of the dorsal subluxation of the ulna. A transient median nerve dysfunction postoperatively improved with conservative treatment. The plate was removed 12 months post-surgery after bone healing was confirmed.

Extra-articular osteotomy for malunited intra-articular distal radius fractures, utilizing 3D simulation and a patient-specific cutting guide, can achieve precise alignment correction and significantly improve the range of motion. This method could serve as a viable treatment option for similar cases, offering an alternative to intra-articular osteotomy.

Keywords: distal radius fracture, malunion, 3D osteotomy, patient-specific guide