Osteotomy and grafting of the distal radius using virtual planning and patient specific guides

Corrective osteotomy of the distal radius for malunion has always been a challenging procedure. Deformity involves length, angulation and rotation. Planning an osteotomy on plain x-rays is difficult and in-exact. Reproducing that planned osteotomy in the operating theatre is even more difficult. Attempts to improve accuracy with the use of CT scanning and even the production of models have met with varying success. More recently however, software (Materialise N.V, Belgium) has been developed which allows the generation of virtual 3-D models of the bones of both forearms from a CT scan following a specific protocol. These models can be manipulated in a virtual environment. The contralateral model can be mirrored and superimposed on the malunion. Following a virtual osteotomy the fragment of the malunited radius can be manoeuvred into a desired post-operative position using the normal radius as a template for correction. Virtual