Patient-Specific Guide for Corrective Osteotomy: Closing an Angle and a Rotation in One Move

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Correcting a cubitus valgus deformity of the distal humerus with a patient-specific guide for corrective osteotomy rarely comes down to a single angle. Alongside the coronal malalignment, a rotational component is often present, and both have to close together for the elbow to sit right. Dr. Robert Elbaum in Brussels, referred a distal humerus closing wedge osteotomy combining a 20° medial closing correction with a 12° derotation.

Two Corrections, One Motion

A guide built only for the angle would leave the rotation to freehand judgment, and the reverse would leave the wedge imprecise. The answer was a guide system built around four K-wires placed before any cut is made. Positioned divergently across the future osteotomy, these same four wires become parallel only once the angular closing and the rotation have been applied together, in the exact position planned preoperatively, a direct, visible signal that the correction is complete, with no navigation or fluoroscopic measurement required.

Patient-Specific Guide Design for Corrective Osteotomy

Planning began with the deformity assessment on the patient's imaging, then a resection plan proposing the 20° medial closing and 12° rotation correction, reviewed and confirmed before manufacturing. The cutting guide carries the four K-wires and the two cutting planes; the corresponding aligning guide is built to fit only once those four wires sit parallel in the corrected position.

Once the wedge is cut, the cutting guide is removed and the four K-wires stay in the bone as the only remaining reference. Closing the wedge and applying the rotation together brings the wires into the planned parallel position; the aligning guide, built to that exact geometry, then slides onto them and locks the correction while the humerus is fixed.

*Not available in the US. Upper extremity indications are outside current FDA clearance.