DRUJ INSTABILITY
Inclusion finished, article under review
Background:
Diaphyseal forearm fractures account for approximately 15% of all pediatric fractures and are commonly treated with closed reduction and cast immobilization due to the high remodeling potential of growing bone. Nevertheless, up to one-third of displaced fractures re-displace, potentially resulting in malunion. Anterior radial bowing due to malunion alters distal radioulnar joint (DRUJ) biomechanics by affecting sigmoid notch alignment and interosseous membrane tension, which may progressively lead to DRUJ instability and ulnar-sided wrist pain.
Rationale:
DRUJ instability is traditionally managed with soft-tissue reconstruction procedures targeting the triangular fibrocartilage complex or related stabilizing structures. However, underlying bony deformities increase the risk of failure of ligamentous reconstruction. Previous studies have demonstrated that corrective osteotomy alone may restore DRUJ stability, but these interventions were planned using two-dimensional imaging, potentially resulting in suboptimal correction. Advances in three-dimensional (3D) planning and patient-specific instrumentation may allow more accurate deformity correction and improved clinical outcomes without the need for additional soft-tissue reconstruction.
Objective:
To evaluate the effect of 3D-planned corrective osteotomy using patient-specific 3D-printed drilling and cutting guides on DRUJ instability and ulnar-sided wrist pain in patients with malunited diaphyseal forearm fractures sustained during childhood.
Methods:
This retrospective study with prospectively collected data included patients treated at a tertiary referral center. Eligible participants had symptomatic DRUJ instability due to diaphyseal forearm malunion, sustained before the age of 18 years, with preserved forearm rotation (≥50° pronation–supination). Corrective osteotomies of the radius and/or ulna were planned using bilateral forearm CT scans and executed with patient-specific 3D-printed guides. Outcomes were assessed preoperatively and at 3 and 12 months postoperatively.
Outcomes:
The primary outcome was functional improvement measured by the Patient-Rated Wrist/Hand Evaluation (PRWHE). Secondary outcomes included pain intensity (Numerical Rating Scale), patient-specific functional performance, patient satisfaction, DRUJ stability, range of motion, and grip strength. Clinical relevance was assessed using minimal clinically important differences.
Hypothesis:
Three-dimensionally planned corrective osteotomy will restore DRUJ stability and alleviate ulnar-sided wrist pain without the need for additional soft-tissue reconstruction.
