{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T04:49:47Z","timestamp":1783226987562,"version":"3.54.6"},"reference-count":36,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T00:00:00Z","timestamp":1653868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Three-dimensional planning and guided osteotomy utilizing patient-specific instrumentation (PSI) with the contralateral side used as a reference have been proven as effective in the treatment of malunions following complex fractures of the distal radius. However, this approach has not yet been described in relation to fracture reduction of the distal radius. The aim of this study was to assess the technical and logistical feasibility of computer-assisted surgery in a clinical setting using PSI for fracture reduction and fixation. Materials and Methods: Five patients with varied fracture patterns of the distal radius underwent operative treatment with using PSI. The first applied PSI guide allowed specific and accurate placement of Kirschner wires inside the multiple fragments, with subsequent concurrent reduction using a second guide. Results: Planning, printing of the guides, and operations were performed within 5.6 days on average (range of 1\u201310 days). All patients could be treated within a reasonable period of time, demonstrating good outcomes, and were able to return to work after a follow-up of three months. Mean wrist movements (\u00b0) were 58 (standard deviation (SD) 21) in flexion, 62 (SD 15) in extension, 73 (SD 4) in pronation and 74 (SD 10) in supination at a minimum follow-up of 6 months. Conclusions: Three-dimensional planned osteosynthesis using PSI for treatment of distal radius fractures is feasible and facilitates reduction of multiple fracture fragments. However, higher costs must be taken into consideration for this treatment.<\/jats:p>","DOI":"10.3390\/medicina58060744","type":"journal-article","created":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T10:05:14Z","timestamp":1653905114000},"page":"744","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Three-Dimensional Planning and Patient-Specific Instrumentation for the Fixation of Distal Radius Fractures"],"prefix":"10.3390","volume":"58","author":[{"given":"Tatjana","family":"Pastor","sequence":"first","affiliation":[{"name":"Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland"},{"name":"Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, 3007 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladislav","family":"Nagy","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"F\u00fcrnstahl","sequence":"additional","affiliation":[{"name":"Computer-Assisted Research and Development Team, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Roner","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4357-236X","authenticated-orcid":false,"given":"Torsten","family":"Pastor","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Schweizer","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"647","DOI":"10.2106\/00004623-198668050-00003","article-title":"Intra-articular fractures of the distal end of the radius in young adults","volume":"68","author":"Knirk","year":"1986","journal-title":"J. Bone Jt. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.jhsa.2020.05.023","article-title":"Accuracy and Early Clinical Outcome After 3-Dimensional Correction of Distal Radius Intra-Articular Malunions Using Patient-Specific Instruments","volume":"45","author":"Roner","year":"2020","journal-title":"J. Hand Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2339","DOI":"10.1016\/j.jhsa.2013.09.023","article-title":"Three-Dimensional Correction of Distal Radius Intra-Articular Malunions Using Patient-Specific Drill Guides","volume":"38","author":"Schweizer","year":"2013","journal-title":"J. Hand Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/s11999-008-0234-3","article-title":"Correction of Forearm Malunion Guided by the Preoperative Complaint","volume":"466","author":"Nagy","year":"2008","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1302\/0301-620X.84B7.0841070","article-title":"The effect of rotational malunion of the radius and the ulna on supination and pronation: An experimental investigation","volume":"84","author":"Dumont","year":"2002","journal-title":"J. Bone Jt. Surgery. Br. Vol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"894","DOI":"10.2106\/00004623-199506000-00010","article-title":"Operative treatment of malunited fractures of the forearm","volume":"77","author":"Trousdale","year":"1995","journal-title":"J. Bone Jt. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"839","DOI":"10.2106\/00004623-198971060-00007","article-title":"Open reduction and internal fixation of displaced, comminuted intra-articular fractures of the distal end of the radius","volume":"71","author":"Bradway","year":"1989","journal-title":"J. Bone Jt. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.2106\/00004623-199612000-00004","article-title":"Operative Treatment of Volar Intra-Articular Fractures of the Distal End of the Radius","volume":"78","author":"Jupiter","year":"1996","journal-title":"J. Bone Jt. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.cjtee.2019.07.006","article-title":"Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma","volume":"22","author":"Mishra","year":"2019","journal-title":"Chin. J. Traumatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.2106\/JBJS.18.00477","article-title":"Computer-Assisted Virtual Surgical Technology versus Three-Dimensional Printing Technology in Preoperative Planning for Displaced Three and Four-Part Fractures of the Proximal End of the Humerus","volume":"100","author":"Chen","year":"2018","journal-title":"J. Bone Jt. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.jhsa.2017.03.024","article-title":"Conventional Versus Computer-Assisted Corrective Osteotomy of the Forearm: A Retrospective Analysis of 56 Consecutive Cases","volume":"42","author":"Bauer","year":"2017","journal-title":"J. Hand Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1177\/1753193411433227","article-title":"Corrective osteotomy of distal radial deformities: A new method of guided locking fixed screw positioning","volume":"38","author":"Farshad","year":"2011","journal-title":"J. Hand Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1024\/0040-5930\/a000528","article-title":"3D kontrollierte Planung und Durchf\u00fchrung von Osteotomien an Vorderarm und Hand","volume":"71","author":"Schweizer","year":"2014","journal-title":"Ther. Umsch."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1007\/s11999-010-1748-z","article-title":"Distal Radius Osteotomy with Volar Locking Plates Based on Computer Simulation","volume":"469","author":"Miyake","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1016\/j.jhsa.2013.05.018","article-title":"Image-Guided Distal Radius Osteotomy Using Patient-Specific Instrument Guides","volume":"38","author":"Kunz","year":"2013","journal-title":"J. Hand Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.2106\/JBJS.G.01299","article-title":"Three-Dimensional Corrective Osteotomy of Malunited Fractures of the Upper Extremity with Use of a Computer Simulation System","volume":"90","author":"Murase","year":"2008","journal-title":"J. Bone Jt. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1053\/jhsu.2002.31731","article-title":"An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability","volume":"27","author":"Adams","year":"2002","journal-title":"J. Hand Surg."},{"key":"ref_18","first-page":"859","article-title":"Wrist arthroscopy assisted reduction and Herbert screw fixation for the treatment of type B distal radius fractures","volume":"29","author":"Cheng","year":"2016","journal-title":"Zhongguo Gu Shang China\/J. Orthop. Traumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.2106\/00004623-199908000-00005","article-title":"Intra-Articular Fractures of the Distal Aspect of the Radius","volume":"81","author":"Doi","year":"1999","journal-title":"J. Bone Jt. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1016\/j.jhsa.2011.07.021","article-title":"Technical Tips for (Dry) Arthroscopic Reduction and Internal Fixation of Distal Radius Fractures","volume":"36","year":"2011","journal-title":"J. Hand Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.jhsa.2014.02.013","article-title":"Arthroscopic Reduction of Comminuted Intra-Articular Distal Radius Fractures with Diaphyseal-Metaphyseal Comminution","volume":"39","author":"Klausmeyer","year":"2014","journal-title":"J. Hand Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1177\/145749690809700405","article-title":"Dry Arthroscopy of the Wrist: Its Role in the Management of Articular Distal Radius Fractures","volume":"97","year":"2008","journal-title":"Scand. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"897","DOI":"10.2106\/00004623-199606000-00013","article-title":"Arthrodesis of the Wrist for Post-Traumatic Disorders","volume":"78","author":"Hastings","year":"1996","journal-title":"J. Bone Jt. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.2106\/00004623-199274070-00014","article-title":"The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults","volume":"74","author":"Schemitsch","year":"1992","journal-title":"J. Bone Jt. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.2106\/00004623-199709000-00003","article-title":"Displaced Intra-Articular Fractures of the Distal Aspect of the Radius. Long-Term Results in Young Adults after Open Reduction and Internal Fixation","volume":"79","author":"Catalano","year":"1997","journal-title":"JBJS"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.jhsa.2006.01.008","article-title":"Fifteen-Year Outcome of Displaced Intra-Articular Fractures of the Distal Radius","volume":"31","author":"Goldfarb","year":"2006","journal-title":"J. Hand Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S0363-5023(96)80098-0","article-title":"Displaced intra-articular fractures of the distal radius: The effect of fracture displacement on contract stresses in a cadaver model","volume":"21","author":"Baratz","year":"1996","journal-title":"J. Hand Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s00776-012-0226-8","article-title":"Distal radial fracture arthroscopic intraarticular gap and step-off measurement after open reduction and internal fixation with a volar locked plate","volume":"17","author":"Ono","year":"2012","journal-title":"J. Orthop. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e50","DOI":"10.2106\/JBJS.17.00829","article-title":"Restoration of the Patient-Specific Anatomy of the Proximal and Distal Parts of the Humerus","volume":"100","author":"Vlachopoulos","year":"2018","journal-title":"J. Bone Jt. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"F\u00fcrnstahl, P., Fuchs, T., Schweizer, A., Nagy, L., Sz\u00e9kely, G., and Harders, M. (2008, January 14\u201317). Automatic and robust forearm segmentation using graph cuts. Proceedings of the 2008 5th IEEE International Symposium on Biomedical Imaging: From Nano to Macroa, Paris, France.","DOI":"10.1109\/ISBI.2008.4540936"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.media.2017.10.006","article-title":"A scale-space curvature matching algorithm for the reconstruction of complex proximal humeral fractures","volume":"43","author":"Vlachopoulos","year":"2018","journal-title":"Med. Image Anal."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1177\/02692155211036674","article-title":"Immediate mobilization of distal radius fractures stabilized by volar locking plate results in a better short-term outcome than a five week immobilization: A prospective randomized trial","volume":"36","author":"Quadlbauer","year":"2022","journal-title":"Clin. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.jphys.2017.08.009","article-title":"Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: A systematic review","volume":"63","author":"Bruder","year":"2017","journal-title":"J. Physiother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1055\/s-0036-1587317","article-title":"Early Rehabilitation of Distal Radius Fractures Stabilized by Volar Locking Plate: A Prospective Randomized Pilot Study","volume":"06","author":"Pezzei","year":"2017","journal-title":"J. Wrist Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e0012","DOI":"10.2106\/JBJS.OA.19.00012","article-title":"Early Mobilization and Physiotherapy vs. Late Mobilization and Home Exercises After ORIF of Distal Radial Fractures","volume":"4","author":"Clementsen","year":"2019","journal-title":"JBJS Open Access"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.2106\/JBJS.G.01368","article-title":"Wrist Mobilization Following Volar Plate Fixation of Fractures of the Distal Part of the Radius","volume":"90","author":"Souer","year":"2008","journal-title":"J. Bone Jt. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/6\/744\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:22:07Z","timestamp":1760138527000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/6\/744"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,30]]},"references-count":36,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["medicina58060744"],"URL":"https:\/\/doi.org\/10.3390\/medicina58060744","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,30]]}}}