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Fixation-Based Surgery: A New Technique for Distal Radius Osteotomy

Objective: The objective was to develop a fixation-based three-dimensional presurgical planner and an intraoperative guidance system for distal radius osteotomy. Fixation-based surgery is a technique premised on using a fixation device, such as a fracture-fixation plate, during the alignment and distraction phases of an osteotomy. Materials and Methods: The planning system and guidance system were coded using OpenGL on UNIX workstations. In vitro tests were performed to compare the reproducibility of the computer-enhanced technique to that of the traditional technique, and an in vivo pilot study was initiated. Results: In vitro, the computer-enhanced technique produced a significant reduction by more than one half in both the maximum error of correction and the standard deviation of the correction error. Preliminary in vivo results on six patients suggest that similar error diminution will occur during regular clinical application of the technique. Conclusions: Both studies showed that the computer system is simple to use. The planning system allowed the surgeon to perform multiple simulations of the surgical procedure preoperatively, which were used to optimize the plan and identify potential problems during realignment. The use of a fixation-based technique avoided the complexity of attempting to guide the surgeon to realign a bone fragment in six degrees of freedom of correction, and eliminated the use of X-ray fluoroscopy for achieving the alignment.