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Computer-assisted corrective osteotomy of malunited pediatric radial neck fractures - Three-dimensional postoperative accuracy and clinical outcome


Weigelt, Lizzy; Fürnstahl, Philipp; Schweizer, Andreas (2017). Computer-assisted corrective osteotomy of malunited pediatric radial neck fractures - Three-dimensional postoperative accuracy and clinical outcome. Journal of Orthopaedic Trauma:Epub ahead of print.

Abstract

Neglected or incorrect treatment of pediatric radial neck fractures may lead to symptomatic malunions. Computer-assisted corrective osteotomies with patient-specific guides have been proposed as a promising technique for the reconstruction of malunited long bone deformities. The aim of this study was to evaluate the accuracy and clinical outcome of this technique in children with malunited fractures of the radial neck. Four children (two male, two female; mean age 12 (10-16) years) underwent computer-assisted closing wedge osteotomy of the radial neck. The contralateral uninjured side was used as a reconstruction template. CT scans were performed eight weeks postoperatively to confirm bony consolidation and to quantify residual 3D rotational and translational displacement error. Clinical outcome (pain, range of motion) and overall satisfaction were documented. Preoperative subluxation of the radial head could be corrected in two of three patients. One patient had to be revised due to secondary traumatic loss of reduction. At the last follow-up (mean 16 (range, 12-24) months), all patients were pain free for activities of daily living (preoperative pain: visual analogue scale 6). Pain during sport activities could be substantially reduced (visual analogue scale 8→2). Although the procedure failed to improve range of motion, none of the patients had limitations regarding work, daily or sports activities. Yet, restricted range of motion was considered as a cosmetic problem in one patient. Full consolidation of the osteotomy site, with no signs of avascular necrosis of the radial head, was achieved in all patients. The deformity could be substantially reduced, from a 3D angle of 13-40° to 3-7° (58-89% deformity correction). Computer-assisted corrective osteotomy is a novel technique for the treatment of radial neck malunions that led to adequate pain reduction and 3D accuracy of deformity correction in our small case series. Despite the lack of improved range of motion, all patients were satisfied and would undergo the same procedure again.

LEVEL OF EVIDENCE

Level IV, Case Series, Treatment Study.

Abstract

Neglected or incorrect treatment of pediatric radial neck fractures may lead to symptomatic malunions. Computer-assisted corrective osteotomies with patient-specific guides have been proposed as a promising technique for the reconstruction of malunited long bone deformities. The aim of this study was to evaluate the accuracy and clinical outcome of this technique in children with malunited fractures of the radial neck. Four children (two male, two female; mean age 12 (10-16) years) underwent computer-assisted closing wedge osteotomy of the radial neck. The contralateral uninjured side was used as a reconstruction template. CT scans were performed eight weeks postoperatively to confirm bony consolidation and to quantify residual 3D rotational and translational displacement error. Clinical outcome (pain, range of motion) and overall satisfaction were documented. Preoperative subluxation of the radial head could be corrected in two of three patients. One patient had to be revised due to secondary traumatic loss of reduction. At the last follow-up (mean 16 (range, 12-24) months), all patients were pain free for activities of daily living (preoperative pain: visual analogue scale 6). Pain during sport activities could be substantially reduced (visual analogue scale 8→2). Although the procedure failed to improve range of motion, none of the patients had limitations regarding work, daily or sports activities. Yet, restricted range of motion was considered as a cosmetic problem in one patient. Full consolidation of the osteotomy site, with no signs of avascular necrosis of the radial head, was achieved in all patients. The deformity could be substantially reduced, from a 3D angle of 13-40° to 3-7° (58-89% deformity correction). Computer-assisted corrective osteotomy is a novel technique for the treatment of radial neck malunions that led to adequate pain reduction and 3D accuracy of deformity correction in our small case series. Despite the lack of improved range of motion, all patients were satisfied and would undergo the same procedure again.

LEVEL OF EVIDENCE

Level IV, Case Series, Treatment Study.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:24 July 2017
Deposited On:11 Oct 2017 12:25
Last Modified:11 Oct 2017 12:36
Publisher:Lippincott Williams & Wilkins
ISSN:0890-5339
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1097/BOT.0000000000000970
PubMed ID:28742788

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