Title : 3D-Planned corrective osteotomy for the treatment of Distal RadioUlnar Joint (DRUJ) instability in diaphyseal forearm malunion
Abstract:
Introduction and Research Question: Forearm fractures are common in children. A potential complication is symptomatic malunion, which typically results in limited pronation and/or supination. In rare cases, rotational movement is preserved, but the malunion causes instability of the Distal RadioUlnar Joint (DRUJ) and ulnar-sided wrist pain. Soft tissue procedures are often employed to address this instability. This study evaluates the effect of a 3D-planned corrective osteotomy using patient-specific drill and cutting guides to improve DRUJ stability and reduce ulnar wrist pain.
Methods: In this retrospective cohort study, patients with a diaphyseal forearm malunion sustained during childhood, presenting with DRUJ instability but no evident limitation in forearm rotation, were included. All patients underwent a corrective osteotomy of the radius and/or ulna using 3D-printed patient-specific drill and cutting guides. The primary outcome was pain, measured by the Numeric Rating Scale (NRS) at rest and under load, six months postoperatively. Secondary outcome was subjective function, assessed using the Patient- Rated Wrist/Hand Evaluation (PRWHE) score.
Results: Ten patients were included (mean age: — years; 50% male). Postoperatively, all patients demonstrated a stable DRUJ without the need for an additional soft tissue procedure. NRS pain under load decreased significantly from 5.1 to 2.4 (p = 0.02). Pain at rest showed no significant change. The PRWHE score improved significantly from 53 to 23 (p = 0.04).
Conclusion: A 3D-planned corrective osteotomy without adjunctive soft tissue procedures results in significant improvements in both pain and function in patients with DRUJ instability secondary to diaphyseal forearm malunion.
