3DOOM I STUDY
Inclusion finished, published 

Re-displacement after closed treatment of pediatric diaphyseal forearm fractures can result in symptomatic malunion. Such malunions may lead to significant limitations in forearm pro-supination and require corrective osteotomy. These prospective study evaluated the functional outcomes and accuracy of three-dimensional (3D) planned corrective osteotomy with patient-specific surgical guides for pediatric malunited diaphyseal forearm fractures. 

Fifteen patients (mean age at injury 9.6 years, mean time to osteotomy 5.9 years) underwent 3D corrective osteotomy. Preoperatively, mean forearm pro-supination was severely impaired, averaging 67° (44% of the contralateral side). At 12 months follow-up, pro-supination improved substantially to a mean of 128°, corresponding to 85% of the unaffected forearm. Anatomic correction, defined as a residual deformity angle ≤ 5° and residual malrotation ≤ 15°, was achieved in 10 of 15 patients and resulted in significantly greater functional improvement than non-anatomic correction. 

Multivariate analyses showed that greater functional gain was associated with more severe preoperative motion limitation, a shorter interval between injury and osteotomy, greater radial angulation, and accurate anatomic correction. Residual malrotation of the radius was a key predictor of inferior functional outcomes. 

 

Conclusion 

Three-dimensional corrective osteotomy is a reliable and effective technique for treating pediatric forearm malunions, providing accurate anatomic correction and substantial improvement in forearm rotation. Achieving precise correction—particularly avoiding residual radial malrotation—is crucial for optimal functional recovery. 

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