Functional improvement in forearm malunion by minimally-invasive stepwise treatment

A fracture of the forearm (radius and/or ulna) is one of the most common
fractures in children. Fractures with significant displacement are
repositioned, and all fractures are stabilised with pins and/or cast to achieve
fracture healing. In 30% of children treated with cast only, secondary
displacement of the fracture occurs. If this displacement is not corrected, a
malunited fracture occurs.
A malunion can cause functional impairment in addition to pain and cosmetic
complaints. In many cases, this limitation consists of no longer being able to
(fully) rotate the forearm, which can cause much discomfort in daily life.
The standard treatment is a corrective osteotomy of both the radius and ulna
using three-dimensional printed patient-specific guides to correct the
alignment of the bones. This is a major procedure involving a lengthy
rehabilitation period and large scars. Using four-dimensional techniques, we
can now better predict what causes the rotational restriction: too-tight soft
tissue or bone impingement. In the case of too-tight soft tissue (central
ligament between radius and ulna), it may be sufficient to cut this ligament,
while in the case of bone impingement, it may not always be necessary to
correct both bones. Because restoration of function is more critical for a
patient than the restoration of the exact pre-traumatic anatomy, in this study,
we will make an individual treatment plan for each patient that is as minimally
invasive as possible. This is the minimally invasive stepwise treatment. As an
escape, a peroperative two-bone corrective osteotomy with patient-specific
guides can always be performed, which is the standard treatment.

The aim of this study is to investigate whether a minimally-invasive stepwise
treatment leads to sufficient improvement of forearm rotation in patients with
malunion after fracture of the radius and/or ulna.

Prospective pilot study with a one year follow-up

Patients are treated using a minimally-invasive stepwise treatment.

Patients will have the standard risks associated with surgery. They will also
have radiation exposure from the X-rays (pre- and postoperative) and the CT
scans.
The extra load for patients participating in the study in comparison to
patients not participating are:
-An additional CT scan 1 year postoperatively (extra radiation 0.4 mSv).
-Time load for filling in the questionnaires at 4 timepoints and physical
examinations.