Journal of Hand Surgery European - 2026-03-31 - Journal Article; Review
Structural balance restoration in complex forearm problems using 3D technology.
Schweizer A, Horwitz MD, Kedgley AE, Honigmann P
Topics
Key Takeaway
3D virtual planning integrating kinematic analysis, ligament tension modeling, and patient-specific instrumentation improves precision of forearm deformity correction beyond what standard anatomic reduction alone achieves, though no comparative outcome numbers are reported.
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Summary
This narrative review addresses complex forearm reconstruction—malunion, congenital deformity, Monteggia lesions—and proposes a surgeon-engineer workflow using 3D imaging, virtual osteotomy planning (single-cut, Z-osteotomy, parallel shortening), kinematic impingement prediction, and IOM/TFCC ligament tension modeling. Contralateral mirroring or statistical shape models provide the reference anatomy for virtual correction. No pooled outcome data or comparative statistics are presented; the article is conceptual and technique-oriented.
Key Limitation
The review presents no clinical outcome data, making it impossible to determine whether 3D-planned corrections produce superior functional results compared to conventional surgical planning.
Original Abstract
INTRODUCTION
The human forearm is a finely tuned system in which the radius and ulna act as an interdependent pair to enable stability, mobility and efficient load transfer. Disruption through trauma, malunion, congenital deformity or failed surgical intervention produces imbalance, presenting with restricted motion, instability, pain, and functional loss. Advances in three-dimensional (3D) imaging, planning, and printing now allow for more accurate analysis and more precise correction of forearm deformities.Reconstruction:Restoration of bone morphology alone does not ensure functional recovery. Effective reconstruction requires integration of kinematic analysis, ligamentous tension and joint congruity. This article presents a comprehensive surgeon-engineer approach to forearm reconstruction. Three-dimensional analysis of the malunion typically uses mirrored contralateral anatomy or statistical shape models, combined with registration of proximal and distal segments. Virtual osteotomy planning may use single-cut planes, Z-osteotomies or parallel shortening techniques allow stable fixation and early rehabilitation. Kinematic analysis helps predict and prevent residual bony impingement, while ligament tension modelling evaluates interosseous membrane and triangular fibrocartilage complex dynamics. Alignment of the elbow, wrist and forearm must be incorporated, particularly in complex cases such as Monteggia lesions. In paediatric and adolescent patients, additional considerations include growth potential, timing of intervention and tolerance of soft tissues and nerves to correction or lengthening. Epiphysiodesis or staged procedures may be required in select cases.
CONCLUSION
Restoring forearm balance demands more than anatomical correction. Individualized, biomechanically informed strategies that combine 3D planning, patient-specific instrumentation and soft tissue considerations are essential to re-establish the delicate equilibrium enabling forearm function.