Corrective osteotomies at the distal humerus and forearm: a practical review

Complex deformities of the distal humerus and forearm of either posttraumatic or hereditary origin have a significant negative impact on the functional integrity of the affected limb. They lead to pain, instability in both the elbow and the proximal/distal radioulnar joint, and profound motion deficit. Corrective procedures and more advanced surgical interventions for the main index procedures at the proximal forearm are extremely challenging for the treating upper extremity specialist due to the complex pathoanatomy in this region. This practical review focuses on the main aspects of correcting deformities of the distal humerus (malunion and non-union), the proximal forearm (differential therapy of chronic radial dislocation in children and adolescents), and the restoration of forearm rotation using rapid prototyping templates and computerized planning as the evolving standard technique in this region. In addition to the technical aspects, focus is put on planning (conventional vs. modern computerized three-dimensional (3D) planning), on different osteotomy techniques, and the surgical armamentarium that the specialist center should have available. Finally, some light is shed on the long-term outcome that can be expected and possible complications that can occur when performing these complex corrective procedures.