PMC7476685_01
Clinical examination of the wrist with the protrusion of the ulnar head and the fovea sign.
JOCR-10-21-g001.jpg
PMC7476685_01_JOCR-10-21-g001.jpg
F1
It revealed distal radioulnar instability with a protrusion of the ulnar head (Fig. 1) without instability of the extensor carpi ulnaris tendon.
X-rays of both wrists.
JOCR-10-21-g002.jpg
PMC7476685_01_JOCR-10-21-g002.jpg
F2
X-rays of the wrist revealed a shortening of the radius with a high radioulnar index (11mm on the anteroposterior view) and an ulnocarpal impingement (Fig. 2).
Magnetic resonance imaging of the wrist showing the ulnocarpal conflict with the related overpressure cysts.
JOCR-10-21-g003.jpg
PMC7476685_01_JOCR-10-21-g003.jpg
F3
T1sequence of the wrist that revealed overpressure cysts of the triquetrum (Fig. 3). The radioulnar joint surface on the radial side was flat.
Pre-operative three-dimensional (3D) planification from the wrist computed tomographyscans of both sides. (a) Evaluation of the elongation target length. (b) 3D modelization of the patient-specific guide. (c) Assessment of the position and the orientation of the osteotomy. (d) Measures of the needed graft. (e) Graft and plate in final position.
JOCR-10-21-g004.jpg
PMC7476685_01_JOCR-10-21-g004.jpg
F4
The final position of the plate, the length of its screws, and the dimensions of the graft were also generated (Fig. 4).
Pre-operative steps of the radial lengthening. (a) Positioning of the patient-specific guide on the distal extremity of the radius. (b) Fluoroscopic control of the position of the K-wire marker. (c) Osteotomy of the radius with the drilled holes of the final plate. (d) Iliac crest bone graft (1) and three-dimensional-printed planned surrogate (2). (e) Graft and plate in their final position. (f) Front and side wrist final X-rays.
JOCR-10-21-g005.jpg
PMC7476685_01_JOCR-10-21-g005.jpg
F5
The plate was screwed on the radius using the previously drilled holes (Fig. 5).
Clinical and radiological results at 6 months of follow-up. The clinical deformation of the wrist is reduced and the radioulnar index has been improved.
JOCR-10-21-g006.jpg
PMC7476685_01_JOCR-10-21-g006.jpg
F6
At 6-month post-operative(Fig. 6), the radius was consolidated with no more clinical deformation.