In-House 3D Planning for Corrective Osteotomy of the Distal Radius: Prospective Cohort Study With 1-Year Radiological and Clinical Follow-Up

Abstract Background Distal radius malunions occur in 5% to 17% of fractures and may lead to pain and functional impairment. While 3D surgical planning with patient-specific guides has demonstrated high accuracy and reduced fluoroscopy use compared with conventional 2D techniques, its routine clinical implementation remains limited, particularly for in-house hospital-based workflows. Objective This study aimed to evaluate the precision of corrective osteotomy for distal radius malunions using in-house–designed 3D patient-specific surgical guides 1 year after surgery. Secondary objectives were to assess clinical and patient-reported outcomes and document intraoperative fluoroscopy use. Methods Corrective osteotomies of extra-articular distal radius malunions were performed in 16 consecutive patients using in-house 3D surgical planning and patient-specific surgical guides. Accuracy was evaluated by comparing preoperative plans with 1-year postoperative computed tomography–based 3D models, assessing ulnar variance, volar tilt, and radial inclination. Acceptable error margins were defined as 5° or less for volar tilt and 2 mm or less for ulnar variance. Clinical outcomes were evaluated using patient-reported outcome measures and range of motion, lift, grip, and torque strength measurements. Results The mean absolute error was 1 (SD 0.8) mm in ulnar variance, 4.9° (SD 2.7°) in volar tilt, and 1.9° (SD 3.6°) in radial inclination. The corrections were within predefined equivalence bounds of the virtual plans in terms of ulnar variance but not volar tilt. Significant improvements were observed in Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores; pain during activity; pain at rest; lift strength; wrist flexion; and ulnar deviation. In total, 12.5% (2/16) of the patients experienced complications following concomitant ulnar shortening procedures and were transferred to standard care. The median intraoperative fluoroscopy duration was 56 (IQR 26‐72) seconds. Conclusions In-house 3D planning was feasible and associated with generally favorable radiological and clinical outcomes at 1 year. However, the predefined equivalence criterion was not achieved for volar tilt, and the findings should be interpreted considering the small sample size and observed complications. In-house 3D planning supports continuous surgical refinement and quality improvement.