Three-dimensional compared with two-dimensional preoperative planning of corrective osteotomy for extra-articular distal radial malunion: A multicenter randomized controlled trial
| Autor: | Filip Stockmans, Rodrigo Moreno, Peter Axelsson, Natalie L. Leong, Allan Ibsen Sörensen, Jesse B. Jupiter, Geert A. Buijze |
|---|---|
| Přispěvatelé: | Orthopedic Surgery and Sports Medicine |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Patient Care Planning Radial fractures law.invention Disability Evaluation 03 medical and health sciences Imaging Three-Dimensional 0302 clinical medicine Randomized controlled trial law Hand strength medicine Humans Orthopedics and Sports Medicine Diagnosis Computer-Assisted Patient Reported Outcome Measures 030212 general & internal medicine Malunion Range of Motion Articular Fractures Malunited Aged Pain Measurement 030222 orthopedics Corrective osteotomy Preoperative planning Hand Strength business.industry Outcome measures Recovery of Function General Medicine Middle Aged medicine.disease Osteotomy Surgery Patient Satisfaction Female Radius Fractures Range of motion business |
| Zdroj: | Journal of bone and joint surgery. American volume, 100(14), 1191-1202. Journal of Bone and Joint Surgery Inc. |
| ISSN: | 0021-9355 |
| Popis: | Background: Malunion is the most frequent complication seen after a fracture of the distal end of the radius. The primary aim of this study was to compare patient-reported outcome measures (PROMs) after corrective osteotomy for malunited distal radial fractures with and without 3-dimensional (3D) planning and use of patient-specific surgical guides. Methods: From September 2010 to May 2015, 40 adult patients with a symptomatic extra-articular malunited distal radial fracture were randomized to 3D computer-assisted planning or conventional 2-dimensional (2D) planning for corrective osteotomy. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist Evaluation (PRWE) score, pain and satisfaction scores, grip strength, and radiographic measurements at 3, 6, and 12 months postoperatively. Results: From baseline to 12 months of follow-up, the reduction in the mean DASH score was -30.7 ± 18.7 points for the 3D planninggroup compared with -20.1 ± 17.8 points for 2D planning (p = 0.103). Secondary functional outcome by means of the PRWE resulted in a similar reduction of -34.4 ± 22.9 points for the 3D planning group compared with -26.6 ± 18.3 points for the 2D planninggroup (p = 0.226). There were no significant differences in pain, satisfaction, range of motion, and grip strength. Radiographic analysis showed significant differences in the mean residual volar angulation (by 3.3°; p = 0.04) and radial inclination (by 2.7°; p = 0.028) compared with the templated side, in favor of 3D planning and guidance. The duration of preoperative planning and surgery as well as complication rates were comparable. Conclusions: Although there was a trend toward a minimal clinically important difference in PROMs in favor of 3D computer-assisted guidance for corrective osteotomy of extra-articular distal radial malunion, it did not attain significance because of (post hoc) insufficient power. Despite the challenge of feasibility, a trial of large magnitude is warranted to draw definitive conclusions regarding clinical advantages of this advanced, more expensive technology. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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