Correction of severe wrist deformity following physeal arrest of the distal radius with the aid of a three-dimensional computer simulation
Growth arrest following physeal injury may result in severe limb deformity. We report a case of complex wrist deformity caused by injury to the distal radial physis resulting in radial shortening and abnormal inclination of the radial articular surface, which was successfully treated by gradual correction after computer simulation. The simulation enabled us to develop an appropriate operative plan by accurately calculating the axis of the three-dimensional (3D) deformity using computer bone models. In the simulative surgery with a full-size stereolithography bone model, an Ilizarov external fixator was applied to the radius such that its two hinges were located on the virtual axis of the deformity, which was reproduced in the actual surgery. This technique of 3D computer simulation is a useful alternative to plan accurate correction of complex limb deformities following growth arrest.
KeywordsComputer simulation Deformity correction Gradual lengthening Physeal arrest Distal radius
One of the authors (T.M.) has received a grant from Japan Science and Technology Agency. The authors thank Ryoji Nakao, computer programmer, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine for his contributions to this study.
Supplementary video. This video shows the AP, lateral, and frontal views of the radius while its distal segment is rotating around the 3D deformity axis by 40°. Appropriate correction of the radial and dorsal inclination of the articular surface along with adequate lengthening was achieved by simple rotation (MPG 11027 kb)
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