Journal of shoulder and elbow surgery · 2026
Image-based quantitative osteotomy planning for congenital proximal radioulnar synostosis: plan-execution discrepancy and postoperative radiographic outcomes.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Chen Yi-Chih, Shih Hua-Ju, Chang Chia-Hsieh, Wang Ting-Ming, Yang Chen-Yu, Shih Po-Jen
Аннотация
BACKGROUND: Proximal radioulnar synostosis is a rare congenital anomaly that restricts forearm rotation and significantly impairs daily function. Surgical correction typically involves radial osteotomy with shortening and derotation; however, planning of osteotomy level, bone shortening, and rotational correction remains largely subjective and relies heavily on surgeon experience. This study retrospectively evaluated an image-based quantitative planning framework designed to provide objective geometric parameters for osteotomy in congenital proximal radioulnar synostosis.
METHODS: Preoperative anteroposterior and lateral radiographs from 8 unilateral cases were reconstructed to derive patient-specific deformity geometry, central bone axes, cut points, predicted cutting angles, and model-estimated radial shortening. The planning algorithm uses polynomial fitting and calculus-based minimization to identify osteotomy points. These predictions were compared with intraoperative measurements and postoperative radiographic and functional outcomes.
RESULTS: All procedures were complication-free, and 7 of 8 forearms showed improved rotational range. At final follow-up, 2 forearms had concentric radial head alignment, whereas 6 showed mild subluxation or dislocation. Observationally, larger discrepancies between model-estimated and surgeon-applied shortening were associated with suboptimal postoperative radial head alignment. In one representative case, a substantial discrepancy corresponded with progressive radial head dislocation despite preserved clinical motion.
CONCLUSION: This study highlights the potential value of quantitative, image-based modeling to support osteotomy planning by providing transparent, reproducible parameters that may reduce variability in surgical decision-making. Although limited by its small sample size, retrospective design, and reliance on radiographs, this work establishes a foundation for future prospective validation of computational decision-support tools in pediatric orthopedic deformity correction.
METHODS: Preoperative anteroposterior and lateral radiographs from 8 unilateral cases were reconstructed to derive patient-specific deformity geometry, central bone axes, cut points, predicted cutting angles, and model-estimated radial shortening. The planning algorithm uses polynomial fitting and calculus-based minimization to identify osteotomy points. These predictions were compared with intraoperative measurements and postoperative radiographic and functional outcomes.
RESULTS: All procedures were complication-free, and 7 of 8 forearms showed improved rotational range. At final follow-up, 2 forearms had concentric radial head alignment, whereas 6 showed mild subluxation or dislocation. Observationally, larger discrepancies between model-estimated and surgeon-applied shortening were associated with suboptimal postoperative radial head alignment. In one representative case, a substantial discrepancy corresponded with progressive radial head dislocation despite preserved clinical motion.
CONCLUSION: This study highlights the potential value of quantitative, image-based modeling to support osteotomy planning by providing transparent, reproducible parameters that may reduce variability in surgical decision-making. Although limited by its small sample size, retrospective design, and reliance on radiographs, this work establishes a foundation for future prospective validation of computational decision-support tools in pediatric orthopedic deformity correction.