Intra-Articular Osteotomy of the Distal Radius with the Use of Inexpensive In-House 3D Printed Surgical Guides and Arthroscopy: A Case Report.

CASE: An 18-year-old man complained about persistent wrist pain and functional impairment due to intra-articular malunion, 1 year after volar plating of a distal radius fracture. We designed and produced patient-specific surgical guides (PSSGs) in-house with a benchtop three-dimensional printer to perform an arthroscopy-assisted intra-articular osteotomy of the radial column without dorsal arthrotomy. The procedure was performed without complications. After 1 year, there was no osteoarthritis and the patient's wrist function was practically normalized. CONCLUSIONS: Virtual surgical planning, design, and production of PSSGs were feasible without consultation of an external medical engineering company and without dorsal arthrotomy.

Nonoperative treatment of the medial malleolus in bimalleolar and trimalleolar ankle fractures: a randomized controlled trial.

OBJECTIVES: To compare internal fixation with no fixation of the medial malleolus after open reduction and internal fixation of the lateral malleolus and if needed, the posterior malleolus. DESIGN: Randomized prospective trial. SETTING: Level III trauma center in a metropolitan area. PATIENTS: One hundred patients with bimalleolar or trimalleolar Orthopaedic Trauma Association type 44 ankle fractures and displacement of the medial malleolus less than 2 mm after open reduction and internal fixation of the lateral component. INTERVENTION: Internal fixation or nonoperative treatment of the medial malleolus. MAIN OUTCOME MEASUREMENTS: American Orthopaedic Foot and Ankle Society ankle hind foot score (AOFAS), The Olerud Molander Ankle (OMA) score, and visual analogue pain scale (VAS). RESULTS: Median follow-up time was 39 months (range: 24-72). There were no significant differences between the 2 groups with respect to OMA (P = 0.91), AOFAS (P = 0.85), VAS (P = 0.85), or development of osteoarthritis (P = 0.22). Reoperation and complication rates were also comparable, but 4 patients treated nonoperatively developed nonunion of the medial malleolus. These patients reported no functional disabilities and presented OMA, AOFAS, and VAS scores better than average. CONCLUSIONS: Our data indicate that nonoperative treatment of minimally displaced fractures of the medial malleolus after operative fixation of the fibula yields satisfactory results. However, long-term follow-up is needed due to increased risk of nonunion and uncertainty regarding the development of posttraumatic arthritis. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.