Corrective osteotomy for malunited distal radius fracture using an augmented reality (AR) osteotomy guide

Distal radius fracture malunion can result in functional limitations, and corrective osteotomy has been used to treat symptomatic cases. This study aimed to evaluate the precision of corrective osteotomy for distal radius malunion by projecting a virtual osteotomy guide onto the surgical field using augmented reality (AR). Six patients with a mean age of 48 years underwent corrective osteotomy using an AR osteotomy guide. Preoperative planning involved creating 3D bone models from computed tomography (CT) data and simulating osteotomy using medical computer-aided design software. The 3D data were converted into a hologram and installed on a head-mounted display (HoloLens). During surgery, the hologram was overlaid onto the patient’s radius and osteotomy was performed in alignment with the AR osteotomy plane. Radius was corrected by inserting a bone graft which was shaped along a 3D simulation model and fixed with a locking plate. Bone union was achieved at a mean of 4.0 months postoperatively. Clinical outcomes, including range of motion, grip strength, and patient-reported outcomes, improved postoperatively. Radiographic evaluation revealed improvements in the volar tilt, radial inclination, and ulnar variance. Accuracy analysis revealed a difference of 3.3 mm in osteotomy level and deviations of 7.0° in flexion-extension and 3.3° in radioulnar from the simulation. The correction angle showed a difference of 6.5° in the flexion-extension direction and 3.9°in the radioulnar direction compared with the simulation. This study demonstrates the potential of using an AR osteotomy guide for corrective osteotomy in distal radius malunion treatment. However, improvements in the accuracy of volar tilt reduction and simplicity of the technique are required for clinical applications. Therapeutic LEVEL IV Technical note and Case series.