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Glenohumeral adduction contractures with residual neonatal brachial plexus injury

mm Kirschner wire to stimulate bleeding and an iliac bone graft, with exact dimensions as the 3-D model, was prepared and inserted into the nonunion site (Figure 2(c)). To achieve the fully planned reduction, the dorsal callus needs to be removed completely (Schweizer et al., 2012). A volar scaphoid locking plate (Medartis, Basel, Switzerland) was used for fixation of the fragments and to maintain anatomic reduction. Postoperatively, the wrist was immobilized with a scaphoid cast for 8 weeks, followed by a removable brace for 4 weeks. A follow-up CT scan showed bridging trabeculae at 3 months postoperatively (Figure 2(d)). To date, the patient’s pain symptoms, wrist mobility and strength had progressively improved with rehabilitation. The presented technique has many potential advantages; with the help of computer planning, visualization of the scaphoid deformity and required bone graft dimensions can be estimated. Planning also allows for preoperative selection of the most appropriate fixation options and hardware positioning. The technique is applicable to scaphoid waist nonunions in which a nonvascularized (e.g. iliac crest graft) or vascularized graft (e.g. medial femoral condyle graft) is used, before the appearance of advanced osteoarthritis (e.g. SNAC II–III). The disadvantages of this technique are the time and costs needed for specific computer software, the employment of a dedicated clinical engineer and 3-D printing of the models. Further clinical research is necessary to objectify the cost benefits of this technique.