Diaphyseal forearm malunions with distal radioulnar joint instability treated by 3D-planned osseous correction

Introduction: This study evaluates the effect of a three-dimensional (3D)-planned corrective osteotomy using patient-specific drilling and cutting guides in patients with a diaphyseal forearm malunion and distal radioulnar joint (DRUJ) instability following a childhood forearm fracture. Methods: Nine patients (mean age at trauma, 12 years) with malunion and preserved forearm rotation but symptomatic DRUJ instability underwent a corrective osteotomy of the radius and/or ulna. Function and pain were assessed using the Patient-Rated Wrist/Hand Evaluation (PRWHE) score, the Numeric Rating Scale (NRS) and the Patient-Specific Functional Scale (PSFS). Furthermore, baseline clinical assessments were compared with findings at 12 months of follow-up. Results: At 12 months, all patients demonstrated significant and clinically relevant improvement in function and pain as well as a stable DRUJ without additional soft-tissue repair. Median PRWHE scores improved from 44.5 to 5.5 ( p = 0.009). NRS pain scores improved from 2 to 0 ( p = 0.057) at rest and from 7 to 1 ( p = 0.014) during activity. The PSFS scores improved from 7 to 2 ( p = 0.010). All outcomes showed clinically relevant improvements according to the minimal clinically important difference. Conclusion: These findings indicate that precision 3D-guided osteotomy can restore DRUJ stability and improve symptoms in patients with a diaphyseal forearm malunion without the need for (additional) soft-tissue reconstruction. Level of evidence: IV