Neglected Distal Radius-Ulna Fracture Using 3D Printing for Pre-operative Planning: A Case Report

Distal radius fractures are one the most common upper extremity injuries and one major complication of distal radius fractures is malunion, which can be intra-articular or extraarticular and was reported in 0 to 33 % of total cases. This condition is treated with fracture repositioning and position maintenance with cast immobilization and internal or external fixation. However, unreduced or unrecognized fractures result in malunion, arthrosis, and functional decrease of the forearm, wrist, and fingers. It usually causes pain, deformity, limited range of motion (ROM), and loss of strength. Therefore, proper surgical management to satisfactorily unite the fragment is necessary. In a case of neglected distal radius fractures, treatment option is an osteotomy which is frequently required to realign the radiocarpal and radioulnar joints. However, intraarticular distal radius fractures are difficult to treat. Reduced intraarticular fracture necessitates careful observation of the fracture pattern, cartilage injury, soft tissue condition, and carpal malalignment. Many authors have attempted to use developments in 3D printing into planning for malunion distal radius fracture correction. This method has not been commonly used in orthopedics centers in Malaysia, thus the purpose of this study is to report on the use of 3D printing in planning for the treatment of neglected distal radius-ulna fracture with malunion.

A 16-year-old man presented to the hospital with primary complaint of difficulties moving his left wrist following a motorbike accident 5 months prior. The patient was massaged by a traditional healer. The patient went to the hospital when his symptoms did not improve despite repeated massages. According to the physical examination, the ROM of flexion, extension, supination, and pronation were 54, 44, 45, and 54 degree, respectively. Pre-operative CT scan and 3D reconstruction demonstrating intraarticular distal radius and ulna malunion and the reconstruction results were printed using a 3D printer. Corrective osteotomy was then performed on the patient.

Patient was discharged from the hospital one day after the procedure. A range of motion gain protocol was started with the supervision of a physiotherapist. 2-month post-operative follow-up demonstrating good range of motion.

Utilizing a three-dimensional model during surgery planning using the impression of the model from the 3D reconstruction of the computed tomography in cases of distal radius malunion may help the surgeon in the correct choice of implant, direction, and location of the corrective osteotomy. This preoperative planning anticipates and optimizes the stages of the operation, which makes the deformity correction more predictable. They are also crucial variables that aid in the successful treatment of malunion distal radius fractures.

Keywords: 3D reconstruction, 3D printing, Neglected Distal Radius-Ulna Fracture