Three-Dimensional Preoperative Planning of Corrective Osteotomies for Distal Radius Malunions: A Systematic Review of Clinical and Radiographic Outcomes.

Abstract

Distal radius malunions (DRMs) are painful and functionally impairing, often necessitating surgical intervention to restore wrist anatomy and function. Traditional corrective osteotomies, which rely on orthogonal radiographs, may overlook complex deformities. This study aims to evaluate the techniques and effectiveness of 3-dimensional (3D)-planned corrective osteotomies, along with their clinical and radiographic outcomes. We conducted a systematic review of literature across PubMed, Ovid, EMBASE, and Web of Science for studies that implemented 3D planning in corrective osteotomies for DRM. We identified 792 articles, of which 24 met the inclusion criteria with a total of 199 corrective osteotomies of symptomatic DRM, of which 127 (64%) were extra-articular and 39 (19.5%) intra-articular, with the remaining being a combination of intra-articular and extra-articular or unspecified. To transfer 3D preoperative plan to patient, 18 out of 24 used 3D-printed patient-specific cutting guides for intraoperative guidance. Two studies implemented the transfer of the preoperative plan using simulated osteotomies on 3D-printed models, while one study used a dynamic referencing body to match real-time surgical actions with the virtual plan. The majority (98.5%, n = 196) demonstrated statistical significance in achieving the acceptable limits of radial inclination (21°-25°), ulnar variance (<3 mm), and volar tilt (≤15° dorsal and ≤20° volar). Functional outcomes significantly improved in all studies (P < .05). Complications were reported in 22 cases (11%) and included partial laceration of the extensor pollicis longus tendon, hardware problems requiring removal, and screw loosening. Future research should focus on balancing the technique's additional costs and logistical demands with its potential long-term benefits.