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CT virtual reality in the preoperative workup of malunited distal radius fractures: preliminary results

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Our objective was to evaluate the usefulness of CT virtual preoperative planning in the surgical repositioning of malunited distal radius fracture. Eleven patients with malunited distal radius fracture underwent multislice CT of both wrists. A preoperative workup was performed in a virtual reality environment created from the CT data sets. Virtual planning comprised three main procedures, carrying out the virtual osteotomy of the radius, prediction of the final position of the distal radius after osteotomy and computer-assisted manufacturing of a repositioning device, which was later placed at the surgical osteotomy site to reposition objectively the distal radius fragment before fixation with the osteosynthesis. All patients tolerated the surgical procedure well. During surgery, the orthopedic surgeons were not required in any of the cases to alter the position of the distal radius that was determined by the repositioning device. At postoperative follow-up, the anatomic relationship of the distal radius was restored (radial inclination, 21.4°; volar tilt, 10.3°; ulnar variance, 0.5 mm). Clinically, a significant improvement of pronation (P=0.012), supination (P=0.01), flexion (P=0.001) and extension (P=0.006) was achieved. Pain decreased from 54 to 7 points. CT virtual reality is a valuable adjunct for the preoperative workup and surgical reposition of malunited distal radius fractures.

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  1. Rodt T, Bartling S, Schmidt AM, Weber BP, Lenarz T, Becker H (2002) Virtual endoscopy of the middle ear: experimental and clinical results of a standardised approach using multi-slice helical computed tomography. Eur Radiol 12:1684–1692

    Article  PubMed  Google Scholar 

  2. Luboldt W, Mann C, Tryon CL et al (2002) Computer-aided diagnosis in contrast-enhanced CT colonography: an approach based on contrast. Eur Radiol 12:2236–2241

    PubMed  Google Scholar 

  3. Bernhardt TM, Schmidl H, Philipp C, Allhoff EP, Rapp-Bernhardt (2003) Diagnostic potential of virtual cyctoscopy of the bladder: MRI vs CT. Preliminary report. Eur Radiol 13:305–312

    CAS  PubMed  Google Scholar 

  4. Hsieh MS, Tsai MD, Chang WC (2002) Virtual reality simulator for osteotomy and fusion involving the musculoskeletal system. Comput Med Imaging Graph 26:91–101

    Article  PubMed  Google Scholar 

  5. Montgomery K, Stephanides M, Schendel S (2000) Development and application of a virtual environment for reconstructive surgery. Comput Aided Surg 5:90–97

    Article  CAS  PubMed  Google Scholar 

  6. Handels H, Ehrhardt J, Plötz W, Pöppl SJ (2001) Three-dimensional planning and simulation of hip operations and computer assisted construction of endoprostheses in bone tumor surgery. Comput Aided Surg 6:65–76

    Article  CAS  PubMed  Google Scholar 

  7. McGrory BJ, Amadio PC (1998) Malunion of the distal radius: In: Cooney WP, Linscheid RL, Dobyns JH (eds) The wrist: diagnosis and oparative treatment. Mosby, St Louis, pp 356–384

  8. Hunt TR, Hastings H II, Graham TJ (1998) A systematic approach to handling the distal radio-ulnar joint in cases of malunited distal radius fractures. Hand Clin 14:239–249

    CAS  PubMed  Google Scholar 

  9. Bronstein AJ, Trumble TE, Tencer AF (1997) The effects of distal radius fracture malalignment on forearm rotation: a cadaveric study. J Hand Surg 22:258–262

    CAS  PubMed  Google Scholar 

  10. Melendez EM (1997) Opening-wedge osteotomy, bone graft, and external fixation for correction of radius malunion. J Hand Surg 22:785–791

    CAS  Google Scholar 

  11. Prommersberger KJ, Van Schoonhoven J, Lanz UB (2002) Outcome after corrective osteotomy for malunited fractures of the distal end of the radius. J Hand Surg 27:55–65

    Article  CAS  Google Scholar 

  12. Athwal GS, Ellis RE, Small CF, Pichora DR (2003) Computer-assisted distal radius osteotomy. J Hand Surg 28:951–958

    Article  Google Scholar 

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Correspondence to Michael Rieger.

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Rieger, M., Gabl, M., Gruber, H. et al. CT virtual reality in the preoperative workup of malunited distal radius fractures: preliminary results. Eur Radiol 15, 792–797 (2005).

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