|Beitragstitel||Computer-assisted corrective osteotomies of midshaft clavicle malunions - a novel contact-optimized lengthening stepped osteotomy|
The incidence of clavicle malunions, after conservative and operative treatment of clavicle fractures, was assumed in the past to be low. Recent studies revealed that symptomatic malunions occur in 9% of non-operatively treated patients with a displaced midshaft clavicle fracture The surgical treatment of malunions after midshaft clavicle fractures is associated with a number of potential complications and the surgical procedure is challenging. However, with appropriate and meticulous preoperative surgical planning, the surgical correction yields satisfactory results. The purpose of this study was to provide a guideline and detailed overview for the computer-assisted planning and three-dimensional (3D) correction of malunions of the clavicle.
3D bone surface models of the pathological and contralateral side were created based on CT data. The computer-assisted assessment of the deformity, the preoperative plan, and the design of patient-specific guides enabling compression plating were described.
We demonstrate the benefit and versatility of computer-assisted planning for corrective osteotomies of malunions of the midshaft clavicle. In combination with patient-specific guides and compression plating technique, the correction can be performed in a more standardized fashion. We describe the determination of the contact-optimized osteotomy plane. An osteotomy along this plane facilitates the correction and enlarges the contact between the fragments at once. We further developed a novel technique of a stepped osteotomy that is based on the calculation of the contact-optimized osteotomy plane. The stepped osteotomy enables to restore the length without the need of structural bone graft. The application of the stepped osteotomy is presented for malunions of the clavicle with shortening and excessive callus formation.
3D preoperative planning and patient-specific guides for corrective osteotomies of the clavicle may help to reduce the number of potential complications and yield results that are more predictable.