It is safe to use the ulnar length difference to correct the radial length difference in the 3D-planning process of a radius osteotomy in patients with a distal radius malunion

Background
A corrective radius osteotomy is often performed in patients with a symptomatic distal radius malunion. In 3D-planned osteotomies, the unaffected radius is mirrored over the malunited radius after adjusting for left-right length differences using both ulnae. This approach assumes that ulnar length differences in a malunion population are similar to those in a healthy population. This study was conducted to analyze the difference in ulnar length in a distal radius malunion population and to assess the potential influence of age, sex, or malunion side on this difference.

Methods
We evaluated 65 adult patients with distal radius malunion using bilateral forearm CT scans. 3D models of both ulnae were constructed, and length differences were determined along a standardized length axis. The results were compared to two populations without a radius malunion.

Results
The average absolute ulnar length difference was 2.57 mm (SD 1.81), which was comparable to the two healthy populations. This difference was not significantly affected by age, sex, or malunion side.

Conclusion
This study demonstrated that using the ulnar length difference to correct for radial length difference in the current 3D planning process, before using the contralateral radius as a template for a corrective osteotomy in patients with radius malunion, is safe.