Pain after a multilevel corrective osteotomy of the radius​

​Dr Philipp Honigmann is a Hand surgeon and an active clinical researcher. He has been publishing on the use of 3D printing in clinical practices since 2017. He is the team leader of Hand surgery at the Kantonsspital Baselland in Switzerland, co-Leader of Swiss Medical Additive Manufacturing Research Group University of Basel, and Board Member of the Swiss Society for Surgery of the Hand SSSH, SGH, SSCM and of the Swiss College of Surgeons.

---

PRESENTATION
A patient who ten years earlier had been treated with a multilevel corrective osteotomy of the radius due to malunion of a distal radius fracture, presented with ulnocarpal pain and 20° lack of supination.  

INITIAL EXAMINATION AND OPERATIVE PLAN
After comparing the injured side with the healthy mirrored side in 3D (Figure 1) we decided to virtually plan a corrective osteotomy of the distal radius using a standard plate and a patient-specific guide designed for the osteotomy according to the following values:

• 14.7° clockwise on axial plane 
• 3.5° volarly on sagittal plane 
• 1.2° ulnarly on coronal plane 
• Ulna plus of 1 mm​​​

Figure 1 Comparison of the pre-operative left radius and the healthy side, mirrored radius. 

VERIFICATION OF PRELIMINARY RESULTS​
The additional analysis of the cone-beam computer tomography (CBCT) images facilitated by the Bonelogic™ 2 software enabled 3D visualization, automated measurements, and distance mapping that helped us assess the bone-to-bone distance in detail.
​The virtual osteotomy tool of Bonelogic™ 2 allowed us to simulate the post-operative outcome after a 14.7° rotation of the radius as planned.​ The bone-to-bone distance mapping revealed an overload on the dorsal surface of the sigmoid notch (Figure 2).

Figure  2  Distance mapping performed with the Bonelogic® 2.0 to quantify the simulated post-operative outcome after performing a 14.7° rotation. 

ALTERNATIVE OPERATIVE PLAN
​The simulation of the post-operative outcome shown above suggested that a different surgical approach was more appropriate and lead us to perform a de-rotation and shortening of the ulna using patient-specific guides and a standard plate. 
​​
​PRELIMINARY RESULTS 
​Six weeks after the osteotomy, we used the distance mapping in Bonelogic™ 2 again to assess the post-operative outcome (Figure 3). The patient reported symptom relief and improved functionality in the hand. 
The additional information provided by Bonelogic™ 2 and the virtual surgical planning in the software helped guiding the choice of surgical approach in this complex case and facilitated providing the patient with the best possible treatment.

Figure 3. Distance mapping performed with the Bonelogic™ 2 to assess the post-operative outcome six weeks after corrective osteotomy.

---

Thank you for taking the time to read this case study.

---

honigmann_casestudy.pdf
File Size:	448 kb
File Type:	pdf

Download File

---

---

Disior™ Bonelogic™ was built specifically to help clinicians make diagnoses and plan patient treatment. Bonelogic™ takes DICOMs from CT, CBCT or WBCT and generates accurate models and analytics that describe the relationships between bones, like those used in this case study.

If you're interested in learning how Disior's products can aid in your clinical practice, talk to one of our experts. In a 30 minute meeting we can talk through your current image analysis workflow and discuss what we can do to improve patient outcomes together.

---

TALK TO US