PMC5702871_01
Preoperative photographs of the patient depicting his range of motion and deformity.
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Our patient was an eighteen-year-old male who had 40  cubitus varus deformity with 20  flexion and extension deficits due to a right humerus supracondylar fracture, obtained eight years ago (Fig. 1).
Preoperative AP x-ray of the case and superimposed images of injured and uninjured (mirrored) humerus to depict deformity.
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Later, both models were visually aligned over each other in the 3D working environment to better visualize and comprehend the deformity (Fig. 2).
(a and b) Graphics simulation and 3D print-out rehearsals for surgery if done with traditional method.
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Analyzing osteotomy options in the 3D environment we found out that resecting a 40  wedge, all at once to correct the deformity would either result in joint translation in coronal plane or poor bone contact with possible fixation difficulties (Fig. 3a,b).
(a, b and c) Graphics simulation and 3D print-out rehearsals for surgery when done with our intercalary method.
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As a result, the intercalary osteotomy proved to have much better bone contact with stronger fixation and elimination of the cosmetic problem of prominent lateral condyle (Fig. 4a-c).
(a and b) Photographs showing the osteotomy and resulting intercalary graft. (c) C-arm output showing temporary fixation of flipped intercalary grafting.
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The sterilized patient specific osteotomy guide was used to make the osteotomies flawlessly and (Fig. 5a,b). After obtaining the one and only C-arm verification to prove everything was as planned, plate and screw fixation was performed to finish the procedure (Fig. 5c).
Early postoperative x-rays showing the alignment, final fixation and barely visible osteotomy lines.
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The postoperative x-ray of the patient showed perfect conformity of the plate and screw fixation with a very hard to see, faint osteotomy line perfectly matching the preoperative plans (Fig. 6).
Postoperative photographs of the patient at 3 months after surgery showing restored range of motion and cosmetic results.
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His third month follow up revealed full range of motion with no pain and confirmation of osteotomy site union (Fig. 7).