Causes and Symptoms
Malalignments of the forearm or wrist usually result from a bone fracture that did not heal along its original axis. Less commonly, they are congenital or the result of a growth disorder. Affected individuals often notice limited rotational movement of the forearm, pain during activity, a visible misalignment, or a loss of strength and range of motion in the wrist. If such a misalignment remains untreated, it can eventually lead to premature wear and tear of the adjacent joints. The forearm consists of two bones, the radius and the ulna, which rotate around each other when the hand is turned—for example, when turning a key or holding a cup—and must remain closely coordinated with one another. Because this interaction is so finely tuned, even minor misalignments of either bone—which may seem insignificant at first glance—can significantly disrupt the rotational movement of the forearm and lead to restricted movement and instability in the wrist or elbow joint. Such malocclusions are therefore often complex in this area. Although a conventional X-ray shows the fracture or a general axial deviation, it is often insufficient to capture the exact extent of a three-dimensional rotation. In many cases, such rotational errors can only be
reliably verify and measure using a three-dimensional analysis.
Procedure
Treatment therefore begins with a modern, computer-aided 3D analysis: Using computed tomography, a precise three-dimensional bone model of the affected arm is created and directly compared on the computer with the model of the healthy opposite side. Since a person’s two arms are usually very similar, the healthy bones serve as an individual template for the anatomically correct shape. Only through this digital side-by-side comparison can complex malalignments of the radius and ulna—particularly rotational malalignments—be reliably detected, as they often go undetected on two-dimensional X-rays. Based on this 3D analysis, the correction is planned using computer-aided design on the virtual bone model: the location, angle, and extent of the necessary bone resection, as well as the target correction position, are precisely determined, using the healthy opposite side as a reference. The true strength of this modern technology becomes apparent in its application: Based on computer-aided planning, we use a 3D printer to produce precisely fitting templates that replicate the correction planned on the screen exactly in the operating room. These instruments fit exclusively to the bone surface of the individual patient and apply the previously planned correction directly during surgery and
with millimeter precision on the bone, so that the axis can be reliably restored without the need for estimation and can then be secured with a plate.
This approach offers several advantages for patients: The correction is not estimated during the surgery but is precisely planned in advance and carried out accordingly, which increases accuracy while also shortening the duration of the surgery. Because the navigation templates directly specify the planned correction, fewer X-ray checks are needed during the procedure. A precisely restored axis also reduces the risk of subsequent, premature joint wear and contributes to a better functional outcome.
Follow-up Care
After the surgery, the arm is immobilized for a few weeks, usually with a splint. The exact timing for the resumption of range of motion and the start of hand therapy depends on the specific surgical technique used and is discussed with the patients. Regular clinical and radiological follow-ups ensure that healing proceeds as planned and that the correction achieved is maintained.