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Chrz K, Bruthans J, Ptáčník J, Štuka Č. A Cost-Affordable Methodology of 3D Printing of Bone Fractures Using DICOM Files in Traumatology. J Med Syst 2024; 48:66. [PMID: 38976137 PMCID: PMC11231013 DOI: 10.1007/s10916-024-02084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/27/2024] [Indexed: 07/09/2024]
Abstract
Three-dimensional (3D) printing has gained popularity across various domains but remains less integrated into medical surgery due to its complexity. Existing literature primarily discusses specific applications, with limited detailed guidance on the entire process. The methodological details of converting Computed Tomography (CT) images into 3D models are often found in amateur 3D printing forums rather than scientific literature. To address this gap, we present a comprehensive methodology for converting CT images of bone fractures into 3D-printed models. This involves transferring files in Digital Imaging and Communications in Medicine (DICOM) format to stereolithography format, processing the 3D model, and preparing it for printing. Our methodology outlines step-by-step guidelines, time estimates, and software recommendations, prioritizing free open-source tools. We also share our practical experience and outcomes, including the successful creation of 72 models for surgical planning, patient education, and teaching. Although there are challenges associated with utilizing 3D printing in surgery, such as the requirement for specialized expertise and equipment, the advantages in surgical planning, patient education, and improved outcomes are evident. Further studies are warranted to refine and standardize these methodologies for broader adoption in medical practice.
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Affiliation(s)
- Kristián Chrz
- 1st Surgical Department, General Teaching Hospital, Prague, Czech Republic
| | - Jan Bruthans
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
- Department of Anesthesiology and Intensive Care, General Teaching Hospital, Prague, Czech Republic.
| | - Jan Ptáčník
- 1st Surgical Department, General Teaching Hospital, Prague, Czech Republic
| | - Čestmír Štuka
- Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic
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Martinelli F, Rota C, Pederzini LA, Celli A. Three-dimensional printed models for surgery planning of post-traumatic stiff elbow: Current concepts. J ISAKOS 2024; 9:490-495. [PMID: 38582454 DOI: 10.1016/j.jisako.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024]
Abstract
The post-traumatic stiff elbow is a challenge for the surgeon, requiring expertise for the treatment choice and accurate planning. Stiffness can result from traumatic injury involving the periarticular soft tissues and the joint articular surfaces. In this article, we want to assess the impact of three-dimensional (3D) printed models in selecting the appropriate surgical strategy for this pathology. Six cases of increasing complexity regarding post-traumatic stiff elbow were submitted to four expert elbow surgeons who had the possibility to evaluate videos and reports of clinical examination, plain radiograms and CT with 3D reconstruction for each case. After a first treatment proposition given by the experts for each patient, a three-dimensional printed model of each elbow based on the CT was provided to the surgeons, asking them to evaluate again all the cases having the possibility to assess also the 3D models. In the four most complex cases all surgeons found more beneficial the use of three-dimensional representation for treatment planning and rate the risk of complications than the sole CT imaging with 3D reconstruction and many of them changed surgical strategy after analysing the model. 3D printing technology is a useful tool in surgery planning for treating complex cases of post traumatic elbow stiffness, especially in the presence of joint deformity. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
| | - Clelia Rota
- Hesperia Hospital, Via Arquà, 80, 41125, Modena, MO, Italy.
| | | | - Andrea Celli
- Hesperia Hospital, Via Arquà, 80, 41125, Modena, MO, Italy.
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Zhao CX, Yam M. Role of patient specific 3D printed models in patient confidence, understanding and satisfaction of care in Singapore. J Orthop 2024; 52:28-32. [PMID: 38404701 PMCID: PMC10881444 DOI: 10.1016/j.jor.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Patient specific 3D models have been widely used for pre-op planning and intra-op guidance in orthopaedic surgery. These models however are not often used in pre-operative doctor-patient communication. This study evaluates the roles of customized 3D models in improving patient understanding, confidence, and satisfaction of patient care when they were used during preoperative counselling. Materials and methods A prospective survey was conducted on 33 orthopaedic trauma patients who were required to rate on a scale of 1-5, the effectiveness of patient specific 3D models in: 1) improving patient's understanding and, 2) helping patients cope with the condition, 3) boosting patients' confidence in the treatment and 4) in the surgeon; and on a scale of 0-10, their overall satisfaction. Subgroup analysis was done to compare ratings of patients by age and by education levels. Results Over 90% patients rated agree or strongly agree on customised 3D models' effectiveness in improving understanding of injury and boosting confidence in treatments and surgeons. 87% patients agreed or strongly agreed that the models enhanced patient self-efficacy. No significant correlation was identified between age and patients' perceived effectiveness of customised 3D models in improving patient care. Ratings on four areas evaluated by pre-secondary and post-secondary groups were comparable. Post-secondary group had significantly higher satisfaction level than the pre-secondary group. Conclusion Customized 3D models help patients visualise complex pathology to facilitate patients' understanding of their condition and treatment, resulting in improved self-efficacy, confidence, and overall satisfaction. The use of patient specific 3D models in pre-operative counselling allows greater patient involvement therefore prompting patient-centred healthcare. Age does not influence patients' perceived effectiveness of customised 3D models in improving patient care. Patients with higher education level are likely to experience higher satisfaction level due to their willingness to take responsibility for their care.
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Affiliation(s)
- Carol Xiaoshu Zhao
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Michael Yam
- Orthopaedic Department, Tan Tock Seng Hospital, 308433, Singapore
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Moreau A, Rony L, Robelet A, Laubacher H, Lebelle-Dehaut AV. In vitro comparative study of deformation of 3D-printed models using different polylactic acids treated by steam sterilization. Orthop Traumatol Surg Res 2024:103849. [PMID: 38428488 DOI: 10.1016/j.otsr.2024.103849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION 3D printing, which is becoming ever more widespread in orthopedic surgery, requires specific materials. Polylactic acid (PLA) is the most widely used in general-purpose 3D printing, but its thermosensitivity can be incompatible with sterilization. Even so, it is easy to use, inexpensive, non-toxic and biodegradable. Controversy surrounds its use. 3D printing of directly sterilizable PLA parts according to surgeons' needs would be highly advantageous, but doubts remain. We therefore performed an in vitro study to determine which PLAs resist steam sterilization regarding deformation. HYPOTHESIS The study hypothesis was that, depending on make and shape, 3D-printed PLA parts can retain their properties after steam sterilization. MATERIAL AND METHODS We selected 4 makes of PLA and used each to print 4 simple cubes and 4 complex shapes corresponding to cuboid bones. They were subjected to steam sterilization under normal French hospital conditions. The size of the cubes was measured before and after sterilization, using a digital caliper. RESULTS Cuboid parts in HT-PLA and PLA-WANAO showed mean deformation of -0.02mm and -0.4mm, respectively after sterilization, the differences being non-significant (p=0.679 and p=0.241, respectively). Cuboid parts in PLA-SUNLU and PLA-G3D showed significant mean deformation: respectively, -1.37mm (p=0.026) and -35.03mm (p>0.001). Cubes in all types of PLA showed significant mean deformation: HT-PLA, -0.61mm (p=0.004); PLA-SUNLU, -2.70mm (p=0.002); PLA-G3D, -28.64mm (p>0.001); and PLA-WANAO, -1.33mm (p=0.010). DISCUSSION The study confirmed recent findings that steam sterilization is feasible with certain PLA-printed parts, with deformations less than 1mm, and that choice of PLA is crucial for success. Computer-designed objects (here, cubes) did not resist sterilization without significant deformation. Analysis of resistance to various stresses was not performed, and therefore it cannot be claimed that the process could be used other than for printing anatomic parts. Use of 3D printing in French hospitals is probably a real source of innovation and improvement in care quality; however, a legal framework needs establishing for the use of 3D-printed parts, to ensure patient safety and promote research in this field. LEVEL OF EVIDENCE III; prospective in vitro study.
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Affiliation(s)
- Antoine Moreau
- Service de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - Louis Rony
- Service de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Antoine Robelet
- Service de stérilisation, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Hélène Laubacher
- Service de stérilisation, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
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Miao K, Wang J, Yu K, Hong J, Lu X. Percutaneous reduction and cannulated screw fixation assisted by 3D printing technology of calcaneal fractures in children. J Orthop Sci 2024; 29:236-242. [PMID: 36550014 DOI: 10.1016/j.jos.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Percutaneous reduction and cannulated screw fixation (PR + CSF) for treatment of calcaneal fractures in pediatric patients has been proven to achieve satisfactory outcomes with few complications. But it is also a difficult technology due to the limited exposure and surgeons are unable to reduce articular surface under direct vision. The purpose of this study was to analyze the outcomes of applying 3D printing technology to preoperative preparation and Intraoperative operating for the treatment of calcaneal fractures in children. METHODS Pediatric patients with calcaneal fractures from January 2010 to December 2018 were reviewed during study period. Preoperative radiographs and computed tomography scans were collected to classify the fractures, reconstruct 3D printed model and evaluate postoperative outcomes. The blood loss, operative time, number of fluoroscopies, surgeon and patient satisfaction were used to assess the effectiveness, feasibility and safety of 3D printing technology. Functional results were measured by American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. RESULT 12 patients (10 boys and 2 girls) with 17 fractures were involved in our study. There were significant differences in the average Böhler angle before operation compared with that after operation and at last follow-up (P < 0.001). Similarly, the calcaneal height and length postoperatively and at the end of follow-up time were proved to have significant difference (P < 0.05) compared to preoperative. CT scan showed good reduction of the posterior facet according to Goldzak index. The average subjective AOFAS hindfoot score was 94.1. Both patients and surgeon made sense of the 3D printed model that can help them getting more information about the factures and making preoperative plans. No wound complication was found in this study. CONCLUSION This study indicated that percutaneous reduction and cannulated screw fixation (PR + CSF) assisted by 3D printing technology in the treatment of calcaneal fractures in pediatric patients achieve good outcomes, with specific preoperative preparation, satisfactory functional recovery and fewer complications. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Keze Miao
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
| | - Jianshun Wang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
| | - Kehe Yu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
| | - Jianjun Hong
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
| | - Xiaolang Lu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
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Liang H, Zhang H, Chen B, Yang L, Xu R, Duan S, Cai Z. 3D printing technology combined with personalized plates for complex distal intra-articular fractures of the trimalleolar ankle. Sci Rep 2023; 13:22667. [PMID: 38114629 PMCID: PMC10730506 DOI: 10.1038/s41598-023-49515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023] Open
Abstract
This study investigated the effectiveness of 3D printing technology in combination with personalized custom-made steel plates in the treatment of complex distal intra-articular trimalleolar fractures, with the aim of providing a new approach to improve ankle joint function in patients. The 48 patients with complex distal intra-articular trimalleolar fractures included in the study were randomly divided into two groups: the personalized custom-made steel plate group (n = 24) and the conventional steel plate group (n = 24). A comparison was made between the two groups in terms of preoperative preparation time, hospitalization duration, surgical time, fracture reduction and internal fixation time, intraoperative fluoroscopy instances, surgical incision length, fracture healing time, follow-up duration, degree of fracture reduction, ankle joint functional recovery, and the occurrence of complications. The personalized steel plate group exhibited longer preoperative preparation time and hospitalization duration compared to the conventional steel plate group (p < 0.001). However, the personalized steel plate group demonstrated significantly shorter surgical duration, time for fracture reduction and internal fixation, reduced intraoperative fluoroscopy frequency, and a shorter overall surgical incision length (p < 0.001). Both groups displayed similar fracture healing times and follow-up durations (p > 0.05). The personalized steel plate group showed a higher rate of successful fracture reduction (87.5% vs. 79.2%, p > 0.05) and a lower incidence of complications (8.3% vs. 20.8%, p = 0.22), although these differences did not reach statistical significance. Furthermore, the personalized steel plate group exhibited superior ankle joint function scores during follow-up compared to the conventional steel plate group (p < 0.05). By utilizing 3D printing technology in conjunction with personalized custom-made steel plates, personalized treatment plans are provided for patients with complex comminuted tri-malleolar ankle fractures, enabling safer, more efficient, and satisfactory orthopedic surgeries.
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Affiliation(s)
- Hairui Liang
- Department of Orthopedics Surgery, Central Hospital Afliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China
| | - He Zhang
- Department of Orthopedics Surgery, Central Hospital Afliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China
| | - Beibei Chen
- Department of Orthopedics Surgery, Central Hospital Afliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China
| | - Lei Yang
- School of Pharmacy, Inner Mongolia Medical University, 5 Xinhua Street, Hohhot, 010107, Inner Mongolia Autonomous Region, China
| | - Rongda Xu
- Department of Orthopedics Surgery, Central Hospital Afliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China
| | - Siyu Duan
- Department of Orthopedics Surgery, Central Hospital Afliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China
| | - Zhencun Cai
- Department of Orthopedics Surgery, Central Hospital Afliated to Shenyang Medical College, 5 Nanqi West Road, Shenyang, 110075, Liaoning, China.
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Grunert R, Winkler D, Frank F, Moebius R, Kropla F, Meixensberger J, Hepp P, Elze M. 3D-printing of the elbow in complex posttraumatic elbow-stiffness for preoperative planning, surgery-simulation and postoperative control. 3D Print Med 2023; 9:28. [PMID: 37801133 PMCID: PMC10559461 DOI: 10.1186/s41205-023-00191-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Restoration of mobility of the elbow after post-traumatic elbow stiffening due to osteophytes is often a problem. METHODS The anatomical structures were segmented within the CT-scan. Afterwards, the Multi Jet Fusion 3D-printing was applied to create the model made of biocompatible and steam-sterilizable plastic. Preoperative simulation of osteophyte resection at the 3D-model was performed as well as the direct comparison with the patient anatomy intraoperatively. RESULTS The patient-specific was very helpful for the preoperative simulation of the resection of elbow osteophytes. The 3D anatomical representation improved the preoperative plan its implementation. A high degree of fidelity was found between the 3D Printed Anatomical representation and the actual joint pathology. CONCLUSIONS Arthrolysis of complex post-traumatic bony changes is an important indication for the use of 3D models for preoperative planning. Due to the use of 3D printing and software simulation, accurate resection planning is feasible and residual bony stiffening can be avoided. 3D printing models can lead to an improvement in surgical quality.
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Affiliation(s)
- Ronny Grunert
- Department of Neurosurgery, University Leipzig, Liebigstr. 20, Leipzig, 04103, Germany.
- Fraunhofer Institute for Machine Tools and Forming Technology, Theodor-Koerner-Allee 6, Zittau, 02763, Germany.
| | - Dirk Winkler
- Department of Neurosurgery, University Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Franziska Frank
- Department of Neurosurgery, University Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Robert Moebius
- Department of Neurosurgery, University Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Fabian Kropla
- Department of Neurosurgery, University Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Juergen Meixensberger
- Department of Neurosurgery, University Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Pierre Hepp
- Department Orthopedics, Trauma Surgery and Plastic Surgery, University Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
| | - Maria Elze
- Department Orthopedics, Trauma Surgery and Plastic Surgery, University Leipzig, Liebigstr. 20, Leipzig, 04103, Germany
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Liao GJ, Su Q, Zhang YQ, Chang LM. Resection for malignant tumors in the elbow and individualized reconstruction under assistance of 3D printing technology: A case report. Medicine (Baltimore) 2023; 102:e34854. [PMID: 37657014 PMCID: PMC10476851 DOI: 10.1097/md.0000000000034854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/31/2023] [Indexed: 09/03/2023] Open
Abstract
RATIONALE With a high failure rate and multiple postoperative complications, the resection for tumors in the elbow and reconstruction present a formidable challenge to orthopedic surgeons. The maturation of 3-dimension (3D) printing technology has facilitated the preoperative design, intraoperative navigation, and reconstruction of bone defects in patients with complex malignant tumors of the elbow joint. In order to improve prognosis, we explored a method of tumor resection and elbow reconstruction aided by 3D printing technology in this research. PATIENT CONCERNS The patient underwent nephrectomy for clear cell carcinoma of the left kidney 3 years ago. Six months ago, the patient presented with limited movement and lateral tenderness in the right elbow joint. The tumor puncture biopsy demonstrated renal clear cell carcinoma metastasis. DIAGNOSES Renal clear cell carcinoma with distal humerus bone metastasis. INTERVENTIONS Thin-layer CT scan data of the patient was acquired, and a 3D reconstruction of both upper limb bones and joints was conducted, followed by a simulation of diseased tissue excision. According to the model, individualized osteotomy guidelines and elbow prostheses were designed and manufactured. Then, prior to the completion of the actual operation, a simulation of the preoperative phase was performed. OUTCOMES The operation was completed without incident. At the 1-, 3-, and 6-month postoperative examinations, both the position and mobility of the prosthesis were found to be satisfactory, and no complications were observed. The hospital for special surgery score and mayo elbow performance score scores increased in comparison to the preoperative period. LESSONS For patients with complex tumors in the elbow joint, 3D printing technology may assist in the precise excision of the tumor and provide an individualized elbow joint prosthesis that is more precise and effective than traditional surgery. It can accomplish a satisfactory treatment effect for patients when combined with early postoperative scientific rehabilitation training, so it is a method worth promoting.
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Affiliation(s)
- Guang-Jun Liao
- Department of Orthopedic Oncology, Yantaishan Hospital, Yantai, Shandong, China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, Shandong, China
| | - Qing Su
- Department of Orthopedic Oncology, Yantaishan Hospital, Yantai, Shandong, China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, Shandong, China
| | - Yong-Quan Zhang
- Department of Orthopedic Oncology, Yantaishan Hospital, Yantai, Shandong, China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, Shandong, China
| | - Li-Ming Chang
- Department of Orthopedic Oncology, Yantaishan Hospital, Yantai, Shandong, China
- Yantai Key Laboratory for Repair and Reconstruction of Bone & Joint, Yantai, Shandong, China
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Mendonça CJA, Gasoto SC, Belo IM, Setti JAP, Soni JF, Júnior BS. Application of 3D Printing Technology in the Treatment of Hoffa's Fracture Nonunion. Rev Bras Ortop 2023; 58:303-312. [PMID: 37252303 PMCID: PMC10212646 DOI: 10.1055/s-0042-1750760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/28/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate a proposed three-dimensional (3D) printing process of a biomodel developed with the aid of fused deposition modeling (FDM) technology based on computed tomography (CT) scans of an individual with nonunion of a coronal femoral condyle fracture (Hoffa's fracture). Materials and Methods Thus, we used CT scans, which enable the evaluation of the 3D volumetric reconstruction of the anatomical model, as well as of the architecture and bone geometry of sites with complex anatomy, such as the joints. In addition, it enables the development of the virtual surgical planning (VSP) in a computer-aided design (CAD) software. This technology makes it possible to print full-scale anatomical models that can be used in surgical simulations for training and in the choice of the best placement of the implant according to the VSP. In the radiographic evaluation of the osteosynthesis of the Hoffa's fracture nonunion, we assessed the position of the implant in the 3D-printed anatomical model and in the patient's knee. Results The 3D-printed anatomical model showed geometric and morphological characteristics similar to those of the actual bone. The position of the implants in relation to the nonunion line and anatomical landmarks showed great accuracy in the comparison of the patient's knee with the 3D-printed anatomical model. Conclusion The use of the virtual anatomical model and the 3D-printed anatomical model with the additive manufacturing (AM) technology proved to be effective and useful in planning and performing the surgical treatment of Hoffa's fracture nonunion. Thus, it showed great accuracy in the reproducibility of the virtual surgical planning and the 3D-printed anatomical model.
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Affiliation(s)
- Celso Júnio Aguiar Mendonça
- Unidade do Sistema Musculoesquelético, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brasil
- Programa de Pós-Graduação em Engenharia Elétrica e Informática Industrial, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brasil
| | - Sidney Carlos Gasoto
- Programa de Pós-Graduação em Engenharia Elétrica e Informática Industrial, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brasil
| | - Ivan Moura Belo
- Programa de Pós-Graduação em Engenharia Biomédica, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brasil
| | - João Antônio Palma Setti
- Programa de Pós-Graduação em Engenharia Biomédica, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brasil
| | - Jamil Faissal Soni
- Unidade do Sistema Musculoesquelético, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brasil
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brasil
| | - Bertoldo Schneider Júnior
- Programa de Pós-Graduação em Engenharia Elétrica e Informática Industrial, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brasil
- Programa de Pós-Graduação em Engenharia Biomédica, Universidade Tecnológica Federal do Paraná, Curitiba, Paraná, Brasil
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Bodansky DMS, Sandow MJ, Volk I, Luria S, Verstreken F, Horwitz MD. Insights and trends review: the role of three-dimensional technology in upper extremity surgery. J Hand Surg Eur Vol 2023; 48:383-395. [PMID: 36748271 DOI: 10.1177/17531934221150498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.
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Affiliation(s)
- David M S Bodansky
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Ido Volk
- Hadassah Medical Organisation, Jerusalem, Israel
| | - Shai Luria
- Hadassah Medical Organisation, Jerusalem, Israel
| | | | - Maxim D Horwitz
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
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Clinical Applications of Three-Dimensional Printing in Upper Extremity Surgery: A Systematic Review. J Pers Med 2023; 13:jpm13020294. [PMID: 36836528 PMCID: PMC9961947 DOI: 10.3390/jpm13020294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Three-dimensional printing for medical applications in surgery of the upper extremity has gained in popularity as reflected by the increasing number of publications. This systematic review aims to provide an overview of the clinical use of 3D printing in upper extremity surgery. METHODS We searched the databases PubMed and Web of Science for clinical studies that described clinical application of 3D printing for upper extremity surgery including trauma and malformations. We evaluated study characteristics, clinical entity, type of clinical application, concerned anatomical structures, reported outcomes, and evidence level. RESULTS We finally included 51 publications with a total of 355 patients, of which 12 were clinical studies (evidence level II/III) and 39 case series (evidence level IV/V). The types of clinical applications were for intraoperative templates (33% of a total of 51 studies), body implants (29%), preoperative planning (27%), prostheses (15%), and orthoses (1%). Over two third of studies were linked to trauma-related injuries (67%). CONCLUSION The clinical application of 3D printing in upper extremity surgery offers great potential for personalized approaches to aid in individualized perioperative management, improvement of function, and ultimately help to benefit certain aspects in the quality of life.
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Mendonça CJA, Guimarães RMDR, Pontim CE, Gasoto SC, Setti JAP, Soni JF, Schneider B. An Overview of 3D Anatomical Model Printing in Orthopedic Trauma Surgery. J Multidiscip Healthc 2023; 16:875-887. [PMID: 37038452 PMCID: PMC10082616 DOI: 10.2147/jmdh.s386406] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/09/2022] [Indexed: 04/12/2023] Open
Abstract
Introduction 3D object printing technology is a resource increasingly used in medicine in recent years, mainly incorporated in surgical areas like orthopedics. The models made by 3D printing technology provide surgeons with an accurate analysis of complex anatomical structures, allowing the planning, training, and surgery simulation. In orthopedic surgery, this technique is especially applied in oncological surgeries, bone, and joint reconstructions, and orthopedic trauma surgeries. In these cases, it is possible to prototype anatomical models for surgical planning, simulating, and training, besides printing of instruments and implants. Purpose The purpose of this paper is to describe the acquisition and processing from computed tomography images for 3D printing, to describe modeling and the 3D printing process of the biomodels in real size. This paper highlights 3D printing with the applicability of the 3D biomodels in orthopedic surgeries and shows some examples of surgical planning in orthopedic trauma surgery. Patients and Methods Four examples were selected to demonstrate the workflow and rationale throughout the process of planning and printing 3D models to be used in a variety of situations in orthopedic trauma surgeries. In all cases, the use of 3D modeling has impacted and improved the final treatment strategy. Conclusion The use of the virtual anatomical model and the 3D printed anatomical model with the additive manufacturing technology proved to be effective and useful in planning and performing the surgical treatment of complex articular fractures, allowing surgical planning both virtual and with the 3D printed anatomical model, besides being useful during the surgical time as a navigation instrument.
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Affiliation(s)
- Celso Junio Aguiar Mendonça
- Musculoskeletal System Unit, Hospital of Federal University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Electrical Engineering and Industrial Informatics, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
- Correspondence: Celso Junio Aguiar Mendonça, Postgraduate Program in Electrical Engineering and Industrial Informatics – CPGEI, Federal Technological University of Paraná – UTFPR, Av. Sete de Setembro, 3165 – Rebouças, Curitiba, Paraná, 80230-901, Brazil, Tel +55 41 999973900, Email
| | - Ricardo Munhoz da Rocha Guimarães
- Cajuru University Hospital, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Biomedical Engineering, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Carlos Eduardo Pontim
- Postgraduate Program in Biomedical Engineering, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Sidney Carlos Gasoto
- Postgraduate Program in Electrical Engineering and Industrial Informatics, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - João Antonio Palma Setti
- Postgraduate Program in Biomedical Engineering, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Jamil Faissal Soni
- Musculoskeletal System Unit, Hospital of Federal University of Paraná, Curitiba, Paraná, Brazil
- Cajuru University Hospital, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Bertoldo Schneider
- Postgraduate Program in Electrical Engineering and Industrial Informatics, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Biomedical Engineering, Hospital of the Federal University of Paraná, Curitiba, Paraná, Brazil
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Ozturk AM, Ozer MA, Suer O, Derin O, Govsa F, Aktuglu K. Evaluation of the effects of using 3D - patient specific models of displaced intra - articular calcaneal fractures in surgery. Injury 2022; 53 Suppl 2:S40-S51. [PMID: 32456955 DOI: 10.1016/j.injury.2020.04.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND It was aimed to compare conventional surgery and three-dimensional (3D) model-assisted surgery used in the treatment of calcaneal fractures. MATERIALS & METHODS A total of 37 patients with unilateral calcaneal fractures were randomly divided into two groups as a conventional surgery group (n: 19) and a 3D model-assisted surgery group (n: 18). The preoperative, postoperative and last follow up angles of the Bohler and Gissane, calcaneal width and facet height were measured. The duration of the operation, blood loss volume, fluoroscopy usage, instrumentation time for both groups were recorded. Finally, the follow-up AOFAS scores were evaluated. A questionnaire was used to determine the perceptions of the resident doctors about the 3D model. RESULTS The duration of the operation, blood loss volume, fluoroscopy usage, instrumentation time for 3D model-assisted surgery group were 83.3 ± 4.6 minutes, 83.6 ± 4.6 ml, 6.8 ± 1.4 times and 13.0 ± 0.8 weeks, and as for conventional group they were 130.0 ± 5.8 minutes, 105.1 ± 5.6 minutes, 11.7 ± 1.5 ml, 22.2 ± 2.4 times and 13.3 ± 0.8 weeks, respectively (p < 0.0001). The both groups significantly restored Bohler angle, Gissane angle, calcaneal width and calcaneal facet height after operation (p < 0.0001). The 3D model-assisted group was significantly more succesful in restoration and protection of achieved correction of calcanel facet height (p < 0.0001). The difference was determined among the groups at the final follow-up examination with respect to the amount of change according the values achieved post-op. were significant in Bohler angle (p < 0.001), calcaneal facet height (p < 0.0001) and calcaneal widht (p = 0.017). There was no significant difference between AOFAS scores of the two groups at last follow-up. Resident doctors exhibited high scores of overall satisfaction with the use of a 3D printing model. CONCLUSIONS Compared to the conventional group, the 3D model-assisted group provide successful intervention and reduce operation, instrumentation time and the fluoroscopy usage with less blood loss. Performing 3D-assisted surgery helps the quality of reduction during the surgery and stability of internal fixation to protect achieved reduction at follow-up more succesfully.
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Affiliation(s)
- Anil Murat Ozturk
- Department of Ortopaedic Surgery, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Mehmet Asim Ozer
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Onur Suer
- Department of Ortopaedic Surgery, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Okan Derin
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Figen Govsa
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, TURKEY
| | - Kemal Aktuglu
- Department of Ortopaedic Surgery, Faculty of Medicine, Ege University, Izmir, TURKEY.
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Marinelli A, Guerra E, Rotini R, Mortellaro M, Minopoli P, Pietroluongo LR, Russo R. Computer-Aided Planning and 3D-Printed Surgical Guide in Patients with Extreme Cubitus Varus Deformity: A Report of 2 Cases. JBJS Case Connect 2022; 12:01709767-202212000-00002. [PMID: 36206363 DOI: 10.2106/jbjs.cc.22.00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/15/2022] [Indexed: 11/05/2022]
Abstract
CASE We describe 2 patients with extreme triplanar cubitus varus deformity, treated with step-cut corrective virtually planned osteotomies and performed with custom-made surgical guides. The surgery was simulated on the patients' bone 3D-printed model to verify the effectiveness of the surgical plans. At a medium 21-month follow-up after surgery, in both patients, clinical and radiological results were fully satisfactory, and no complications have been reported. CONCLUSION The precision of computer-aided surgical planning and custom-made surgical guides allow to perform reproducible and relatively safe surgeries even in extreme deformities where the surgical complexity could discourage attempts at surgical correction.
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Affiliation(s)
| | - Enrico Guerra
- Shoulder and Elbow Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | | | - Raffaele Russo
- Department of Orthopedic Surgery, Pineta Grande Hospital, Caserta, Italy
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15
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Grosshauser M, Ohletz T, Oesch V, Muller CO. Tips and Tricks—3 Use Cases of Interdisciplinary Knowledge Transfer in Minimally Invasive Pediatric Surgery. CHILDREN 2022; 9:children9091270. [PMID: 36138579 PMCID: PMC9497707 DOI: 10.3390/children9091270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 11/16/2022]
Abstract
In the pediatric surgical environment, we can enrich our knowledge and improve our skills through interdisciplinary knowledge transfer in exchange with other surgical or even non-surgical disciplines. To demonstrate this, we present in this article three patient cases of method transfer enabling new techniques in minimally invasive pediatric surgery. 1. The somewhat modified application of the AeroStat rigid tip laparoscopic cholangiography catheter during the single-step laparoscopic cholecystectomy facilitates the safe intraoperative cholangiography with common bile duct flushing. 2. A magnetic rod is used during laparoscopic enterotomy to locate and retrieve ingested magnets. 3. Using a patient-specific MRI 3D model representing a syndromic high anorectal malformation improves surgical planning and parental education.
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Affiliation(s)
- Mareike Grosshauser
- Department of Paediatric Surgery, Cantonal Hospital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
- Correspondence: ; Tel.: +41-62-838-2767
| | - Tim Ohletz
- Department of Radiology and 3D Lab, Cantonal Hospital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
| | - Valérie Oesch
- Department of Paediatric Surgery, Cantonal Hospital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
| | - Cécile Olivia Muller
- Department of Paediatric Surgery, Cantonal Hospital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
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16
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Use of 3D printing and pre-contouring plate in the surgical planning of acetabular fractures: A systematic review. Orthop Traumatol Surg Res 2022; 108:103111. [PMID: 34648997 DOI: 10.1016/j.otsr.2021.103111] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/15/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acetabular fractures are caused by high energy injuries. The treatment aims to reconstruct the articular surface, restoring the anatomical structure. The surgical management of these fractures is difficult because it requires familiarity with the 3D anatomy of the pelvis. With the use of 3D printing technique for planning surgery, this limitation could be overcome. HYPOTHESIS Studies examining the use of 3D printing in pre-operative planning of acetabular fractures tend to agree on its usefulness. METHODS A systematic review of two electronic medical databases was performed by three independent authors, using the following inclusion criteria: any type of acetabular fracture and pre-operative use of 3D printing to plan the surgery. RESULTS Among 93 screened articles, following selection criteria, six randomised controlled human trials (hRCT) were eligible for the study; articles compare a group in which a pre-contouring plate was performed through 3D printing with a control group in which the plate was intraoperatively modelled. CONCLUSION This review demonstrates the advantage of 3D printing in terms of surgical time, reduction of blood losses, quality of fracture reduction, and fixation, and reporting best clinical outcomes. LEVEL OF EVIDENCE II.
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17
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Papotto G, Testa G, Mobilia G, Perez S, Dimartino S, Giardina SMC, Sessa G, Pavone V. Use of 3D printing and pre-contouring plate in the surgical planning of acetabular fractures: A systematic review. ORTHOPAEDICS & TRAUMATOLOGY: SURGERY & RESEARCH 2022; 108:103111. [DOI: https:/doi.org/10.1016/j.otsr.2021.103111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
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18
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Robb H, Scrimgeour G, Boshier P, Przedlacka A, Balyasnikova S, Brown G, Bello F, Kontovounisios C. The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review. Surg Endosc 2022; 36:5907-5920. [PMID: 35277766 PMCID: PMC9283150 DOI: 10.1007/s00464-022-09176-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND 3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research. METHODS A scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated. RESULTS A total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found. CONCLUSION The use of 3D reconstruction is in its infancy in oesophagogastric surgery. The quality of evidence is low and key themes, such as patient engagement and education, remain unexplored. Without high quality research evaluating the application and benefits of 3D modelling, oesophagogastric surgery may be left behind.
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Affiliation(s)
- Henry Robb
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Piers Boshier
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Anna Przedlacka
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Gina Brown
- Imperial College London, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Christos Kontovounisios
- Imperial College London, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
- Chelsea Westminster NHS Foundation Trust, London, UK.
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19
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Traynor G, Shearn AIU, Milano EG, Ordonez MV, Velasco Forte MN, Caputo M, Schievano S, Mustard H, Wray J, Biglino G. The use of 3D-printed models in patient communication: a scoping review. JOURNAL OF 3D PRINTING IN MEDICINE 2022; 6:13-23. [PMID: 35211330 PMCID: PMC8852361 DOI: 10.2217/3dp-2021-0021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022]
Abstract
3D models have been used as an asset in many clinical applications and a variety of disciplines, and yet the available literature studying the use of 3D models in communication is limited. This scoping review has been conducted to draw conclusions on the current evidence and learn from previous studies, using this knowledge to inform future work. Our search strategy revealed 269 papers, 19 of which were selected for final inclusion and analysis. When assessing the use of 3D models in doctor-patient communication, there is a need for larger studies and studies including a long-term follow up. Furthermore, there are forms of communication that are yet to be researched and provide a niche that may be beneficial to explore.
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Affiliation(s)
- Gemma Traynor
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | - Andrew IU Shearn
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | - Elena G Milano
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol, BS1 3NU, UK
| | - Silvia Schievano
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
- Institute of Cardiovascular Science, University College London, London, WC1E 6DD, UK
| | - Hannah Mustard
- University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol, BS1 3NU, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- National Heart & Lung Institute, Imperial College London, London, SW3 6LY, UK
- Author for correspondence: Tel.: +44 117 342 3287;
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20
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Wong RMY, Wong PY, Liu C, Chung YL, Wong KC, Tso CY, Chow SKH, Cheung WH, Yung PSH, Chui CS, Law SW. 3D printing in orthopaedic surgery: a scoping review of randomized controlled trials. Bone Joint Res 2021; 10:807-819. [PMID: 34923849 PMCID: PMC8696518 DOI: 10.1302/2046-3758.1012.bjr-2021-0288.r2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aims The use of 3D printing has become increasingly popular and has been widely used in orthopaedic surgery. There has been a trend towards an increasing number of publications in this field, but existing literature incorporates limited high-quality studies, and there is a lack of reports on outcomes. The aim of this study was to perform a scoping review with Level I evidence on the application and effectiveness of 3D printing. Methods A literature search was performed in PubMed, Embase, and Web of Science databases. The keywords used for the search criteria were ((3d print*) OR (rapid prototyp*) OR (additive manufactur*)) AND (orthopaedic). The inclusion criteria were: 1) use of 3D printing in orthopaedics, 2) randomized controlled trials, and 3) studies with participants/patients. Risk of bias was assessed with Cochrane Collaboration Tool and PEDro Score. Pooled analysis was performed. Results Overall, 21 studies were included in our study with a pooled total of 932 participants. Pooled analysis showed that operating time (p < 0.001), blood loss (p < 0.001), fluoroscopy times (p < 0.001), bone union time (p < 0.001), pain (p = 0.040), accuracy (p < 0.001), and functional scores (p < 0.001) were significantly improved with 3D printing compared to the control group. There were no significant differences in complications. Conclusion 3D printing is a rapidly developing field in orthopaedics. Our findings show that 3D printing is advantageous in terms of operating time, blood loss, fluoroscopy times, bone union time, pain, accuracy, and function. The use of 3D printing did not increase the risk of complications. Cite this article: Bone Joint Res 2021;10(12):807–819.
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Affiliation(s)
- Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Pui Yan Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chaoran Liu
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yik Lok Chung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kwok Chuen Wong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chi Yin Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chun Sing Chui
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sheung Wai Law
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
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21
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Preoperative Planning Using 3D Printing Technology in Orthopedic Surgery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7940242. [PMID: 34676264 PMCID: PMC8526200 DOI: 10.1155/2021/7940242] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
The applications of 3D printing technology in health care, particularly orthopedics, continue to broaden as the technology becomes more advanced, accessible, and affordable worldwide. 3D printed models of computed tomography (CT) and magnetic resonance image (MRI) scans can reproduce a replica of anatomical parts that enable surgeons to get a detailed understanding of the underlying anatomy that he/she experiences intraoperatively. The 3D printed anatomic models are particularly useful for preoperative planning, simulation of complex orthopedic procedures, development of patient-specific instruments, and implants that can be used intraoperatively. This paper reviews the role of 3D printing technology in orthopedic surgery, specifically focusing on the role it plays in assisting surgeons to have a better preoperative evaluation and surgical planning.
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22
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González-Alonso M, Hermida-Sánchez M, Martínez-Seijas P, Ruano-Ravina A. Application of 3D printing in the treatment of appendicular skeleton fractures: Systematic review and meta-analysis. J Orthop Res 2021; 39:2083-2092. [PMID: 33280162 DOI: 10.1002/jor.24939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
The objective of this study is to evaluate, through a systematic review of the scientific literature and meta-analysis, the applications of three-dimensional (3D) printing in the surgical treatment of complex fractures of the appendicular skeleton, mainly in terms of effectiveness and safety. A systematic review of the scientific literature was conducted in MEDLINE (PubMed) and the Cochrane Library combining different keywords. A specific methodological assessment scale was developed and applied to included papers. Ten studies were included; all of them were controlled trials, except for one retrospective observational cohort study. We observed statistically significant differences between the group that used 3D printing and the control group in terms of reduction in surgical time, reduction in the volume of blood lost during surgery and reduction in the number of intraoperative fluoroscopies, in favor of the 3D printing group. No statistically significant differences were observed in terms of fracture healing time, postoperative joint function, or postoperative complications. Meta-analysis revealed more favorable results for 3D-printing compared with conventional surgery, with the greatest difference observed for the number of intraoperative fluoroscopies. 3D printing might be considered effective and safe in the surgical treatment of anatomically complex appendicular skeleton fractures, in terms of reducing surgical time, lost blood volume, and radiation exposure of surgeons and patients.
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Affiliation(s)
- María González-Alonso
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Miguel Hermida-Sánchez
- Orthopaedic Surgery and Traumatology Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Pedro Martínez-Seijas
- Oral and Maxillofacial Surgery Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER de EpidemiologíaySaludPública (CIBERESP), Santiago de Compostela, Galicia, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
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23
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Yang S, Lin H, Luo C. Meta-Analysis of 3D Printing Applications in Traumatic Fractures. Front Surg 2021; 8:696391. [PMID: 34532337 PMCID: PMC8439573 DOI: 10.3389/fsurg.2021.696391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Traumatic fracture is a common orthopaedic disease, and application of 3D printing technology in fracture treatment, which entails utilisation of pre-operative printed anatomic fracture model, is increasingly gaining popularity. However, effectiveness of 3D printing-assisted surgery lacks evidence-based findings to support its application. Materials and Methods: Embase, PubMed and Cochrane Library databases were systematically searched until October, 2020 to identify relevant studies. All randomised controlled trials (RCTs) comparing efficacy of 3D printing-assisted surgery vs. conventional surgery for traumatic fractures were reviewed. RevMan V.5.3 software was used to conduct meta-analysis. Results: A total of 12 RCTs involving 641 patients were included. Pooled findings showed that 3D printing-assisted surgery had shorter operation duration [standardised mean difference (SMD) = −1.52, 95% confidence interval (CI) – 1.70 ~ −1.34, P < 0.00001], less intraoperative blood loss (SMD = 1.34, 95% CI 1.74 ~ 0.94, P < 0.00001), fewer intraoperative fluoroscopies (SMD = 1.25, 95% CI 1.64 ~ 0.87, P < 0.00001), shorter fracture union time (SMD = −0.15, 95% CI −0.25 ~ −0.05, P = 0.003), and higher rate of excellent outcomes (OR = 2.40, 95% CI 1.07 ~ 5.37, P = 0.03) compared with conventional surgery. No significant differences in complication rates were observed between the two types of surgery (OR = 0.69, 95% CI 0.69 ~ 1.42, P = 0.32). Conclusions: Indicators including operation duration, intraoperative blood loss, number of intraoperative fluoroscopies, fracture union time, and rates of excellent outcomes showed that 3D printing-assisted surgery is a superior alternative in treatment of traumatic fractures compared with conventional surgery. Moreover, the current study did not report significant differences in incidence of complications between the two approaches. Systematic Review Registration: CRD42021239507.
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Affiliation(s)
- Sha Yang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Huapeng Lin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong Luo
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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Lebowitz C, Massaglia J, Hoffman C, Lucenti L, Dheer S, Rivlin M, Beredjiklian PK. The Accuracy of 3D Printed Carpal Bones Generated from Cadaveric Specimens. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:432-438. [PMID: 34423093 DOI: 10.22038/abjs.2020.50236.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/11/2020] [Indexed: 11/06/2022]
Abstract
Background Computer assisted three-dimensional (3D) printing of anatomic models using advanced imaging has wide applications within orthopaedics. The purpose of this study is to evaluate the 3D printing accuracy of carpal bones. Methods Seven cadaveric wrists underwent CT scanning, after which select carpal bones (scaphoid, capitate, lunate, and trapezium) were dissected in toto. Dimensions including length, circumference, and volume were measured directly from the cadaver bones. The CT images were converted into 3D printable stereolithography (STL) files. The STL files were converted into solid prints using a commercially available 3D printer. The 3D printed models' dimensions were measured and compared to those of the cadaver bones. A paired t-test was performed to determine if a statistically significant difference existed between the mean measurements of the cadavers and 3D printed models. The intraclass correlation coefficients (ICC) between the two groups were calculated to measure the degree of agreement. Results On average, the length and circumference of the 3D printed models were within 2.3 mm and 2.2 mm, respectively, of the cadaveric bones. There was a larger discrepancy in the volume measured, which on average was within 0.65 cc (15.9%) of the cadaveric bones. These differences were not statistically significant (P > 0.05). There was strong agreement between all measurements except the capitate's length and lunate's volume. Conclusion 3D printing can add value to patient care and improve outcomes. This study demonstrates that 3D printing can both accurately and reproducibly fabricate boney models that closely resemble the corresponding cadaveric anatomy.
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Affiliation(s)
- Cory Lebowitz
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Joseph Massaglia
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Christopher Hoffman
- Department of Hand & Upper Extremity Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ludovico Lucenti
- Department of Hand & Upper Extremity Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sachin Dheer
- Department of Radiology, Thomas Jefferson University Hospitals, Cherry Hill, NJ, USA
| | - Michael Rivlin
- Department of Hand & Upper Extremity Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Pedro K Beredjiklian
- Department of Hand & Upper Extremity Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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25
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Dai G, Shao Z, Weng Q, Zheng Y, Hong J, Lu X. Percutaneous reduction, cannulated screw fixation and calcium sulfate cement grafting assisted by 3D printing technology in the treatment of calcaneal fractures. J Orthop Sci 2021; 26:636-643. [PMID: 32798112 DOI: 10.1016/j.jos.2020.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Percutaneous reduction, cannulated screw fixation and calcium sulfate cement grafting (PR + CSC) for treatment of displaced and intra-articular calcaneal fractures (DIACFs) is a difficult technique, because the minimally invasive treatment has limited exposure and cannot be used to reduce articular surface under direct vision. The goal of this study was to apply 3D printing technology to preoperative planning and surgery of DIACFs, and to evaluate its effectiveness, feasibility and safety in fracture repair. METHODS We enrolled 81 patients with DIACFs in the study from August 2015 to August 2017. Patients with DIACFs in our hospital were randomly divided into the 3D printing group (40 cases) and the conventional group (41 cases). The operation duration, blood loss volume and the number of fluoroscopy were compared. Radiological results were evaluated using radiographs and functional results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score. The complications were also assessed. In addition, we made a questionnaire to verify the usefulness of the 3D printed model for both doctors and patients. RESULTS The operation duration, blood loss volume and the number of fluoroscopy in 3D printing group were significantly less than that in the conventional group. Besides, 3D printing group achieved significantly better radiological results than conventional group both postoperatively and at the final follow-up except the calcaneal width at the final follow-up. The AOFAS score in the 3D printing group was significantly higher than that in the conventional group. In addition, the questionnaire from doctors and patients exhibited high scores of overall satisfaction of the 3D printed models. As for complications, there was no significant difference among the two groups. CONCLUSION This study suggested the clinical feasibility of PR + CSC assisted by 3D printing technology in the treatment of DIACFs. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Gaole Dai
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhenxuan Shao
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qihao Weng
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yijing Zheng
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jianjun Hong
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Xiaolang Lu
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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26
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Oguzkaya S, Misir A, Ozcamdalli M, Eken G, Kizkapan TB, Kurk MB, Uzun E. Impact of the COVID-19 pandemic on orthopedic fracture characteristics in three hospitals in Turkey: A multi-center epidemiological study. Jt Dis Relat Surg 2021; 32:323-332. [PMID: 34145802 PMCID: PMC8343845 DOI: 10.52312/jdrs.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives
In this study, we present the use of case specific three- dimensional (3D) printed plastic models and custom-made acetabular implants in orthopedic surgery. Materials and methods
Between March 2018 and September 2020, surgeries were simulated using plastic models manufactured by 3D printers on the two patients with pilon fractures. Also, custom-made acetabular implants were used on two patients with an acetabular bone defect for the revision of total hip arthroplasty (THA). Results
More comfortable surgeries were experienced in pilon fractures using preoperative plastic models. Similarly, during the follow-up period, the patients that applied custom-made acetabular implants showed a fixed and well-positioning in radiographic examination. These patients did not experience any surgical complications and achieved an excellent recovery. Conclusion
Preoperative surgical simulation with 3D printed models can increase the comfort of fracture surgeries. Also, custom-made 3D printed acetabular implants can perform an important task in patients treated with revision THA surgery due to severe acetabular defects.
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Affiliation(s)
- Sinan Oguzkaya
- Sarkışla Devlet Hastanesi Ortopedi ve Travmatoloji Kliniği, 58400 Sarkışla, Sivas, Türkiye.
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Ferràs-Tarragó J, Sabalza-Baztán O, Sahuquillo-Arce JM, Angulo-Sánchez MÁ, De-La-Calva Ceinos C, Amaya-Valero JV, Baixauli-García F. Autoclave sterilization of an in-house 3D-printed polylactic acid piece: biological safety and heat-induced deformation. Eur J Trauma Emerg Surg 2021; 48:3901-3910. [PMID: 33959787 DOI: 10.1007/s00068-021-01672-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022]
Abstract
AIMS Fused filament fabrication 3D printing with polylactic acid filaments is the most widely used method to generate biomodels at hospitals throughout the world. The main limitation of this manufacturing system is related to the biomodels' temperature sensitivity, which all but prevents them to be sterilized using conventional methods. The purpose of this study is to define an autoclave temperature-resistant FFF-PLA 3D printing protocol to print 3D fractures biomodels during preoperative planning. METHODS AND RESULTS Six different printing protocols were established, each with a different infill percentage. Ten distal radius biomodels were printed with each protocol and each biomodel was subject to 3D scanning. The biomodels were subsequently autoclave-sterilized at 134 °C and subjected to a new scanning process, which was followed by a calculation of changes in area, volume and deformity using the Hausdorff-Besicovitch method. Finally, 192 polylactic acid models were produced using the printing protocol offering the greatest resistance and were contaminated with 31 common nosocomial pathogens to evaluate the effectiveness of sterilizing the model printed using the said protocol. Sterilization resulted in a mean deformation of the biomodel of 0.14 mm, a maximum deformity of 0.75 mm, and a 1% area and a 3.6% volume reduction. Sterilization of the pieces printed using the analyzed protocol was 100% effective. CONCLUSIONS The analyzed 3D printing protocol may be applied with any FFF-PLA 3D printer, it is safe and does not significantly alter the morphology of biomodels. These results indicate that 3D printing is associated with significant advantages for health centers as it increases their autonomy, allowing them to easily produce 3D biomodels that can be used for the treatment of fractures.
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Affiliation(s)
- Joan Ferràs-Tarragó
- Orthopaedic Surgery and Traumatology, Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain.
| | | | | | | | | | - Jose Vicente Amaya-Valero
- Orthopaedic Surgery and Traumatology, Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
| | - Francisco Baixauli-García
- Orthopaedic Surgery and Traumatology, Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
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Thomrungpiyathan T, Luenam S, Lohwongwatana B, Sirichativapee W, Nabudda K, Puncreobutr C. A custom-made distal humerus plate fabricated by selective laser melting. Comput Methods Biomech Biomed Engin 2021; 24:585-596. [PMID: 33797978 DOI: 10.1080/10255842.2020.1840560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aims to evaluate the mechanical performance of custom 3D-printed titanium plates in the treatment of distal humerus fractures. Rigidity of four plating configurations were investigated by finite element analysis. The results reveal that implementation of custom designs with minimal screw holes, lateral-medial linking screw and lateral brim could significantly improve stiffness and consequently leads to better biomechanical stability as compared to standard osteosynthesis design. Biomechanical testing was also performed to validate practical usability. The results confirm that newly designed custom plates fabricated by selective laser melting is a possible alternative for the treatment of distal humerus fracture.
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Affiliation(s)
- Thansita Thomrungpiyathan
- Advanced Materials Analysis Research Unit, Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Suriya Luenam
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Boonrat Lohwongwatana
- Advanced Materials Analysis Research Unit, Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.,Biomedical Engineering Research Center, Chulalongkorn University, Bangkok, Thailand
| | - Winai Sirichativapee
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kriengkrai Nabudda
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chedtha Puncreobutr
- Advanced Materials Analysis Research Unit, Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.,Biomedical Engineering Research Center, Chulalongkorn University, Bangkok, Thailand
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29
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Ferràs-Tarragó J, Sabalza-Baztán O, Sahuquillo-Arce JM, Angulo-Sánchez MÁ, Amaya-Valero J, De-La-Calva Ceinos C, Baixauli-García F. Security of 3D-printed polylactide acid piece sterilization in the operating room: a sterility test. Eur J Trauma Emerg Surg 2021; 48:3895-3900. [PMID: 33452547 DOI: 10.1007/s00068-020-01564-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/19/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION 3D-printing technology has become very popular the last 10 years, and their advantages have been widely proved. However, its safety in the operating room after sterilization has not been evaluated. Thus, the use of 3D printing is still questioned. The aim of this work is to evaluate the security of polylactic acid (PLA) to print surgical models after its sterilization. MATERIALS AND METHODS One hundred and eighty-six PLA plates and 6 negative controls without microorganisms were seeded. After 10 days of culture, the PLA plates were randomized into three groups: A, B, and C. Group A underwent a sterilization process using an autoclave program at 134 °C. Group B was seeded in different culture media and group C was used to make crystal violet stains on the biofilms formed on the PLA. Mechanical properties of PLA after autoclave sterilization including, the breaking load, deformation and breaking load per surface were calculated. RESULTS Hundred percent of the group B showed monomicrobial growth. Stains performed on group C PLA showed biofilms in all PLA pieces. After sterilization, no pathogen growth was observed in group A during the culture observation period showing 100% sterilization effectiveness. A filling percentage of 5% obtained a breaking load of 6.36 MPa, and its elastic limit occurred after an elongation of 167.4%. A 10% infill was mechanically safe. CONCLUSIONS Autoclave sterilization of PLA-printed pieces is safe for the patient and mechanically strong for the surgeon. This is the first 3D-printing protocol described and evaluated to implement 3D-printing technology safely in the operating room. SIGNIFICANCE AND IMPACT OF STUDY This is the first 3D-printing protocol described to print and sterilize 3D biomodels using an autoclave showing its biological safety and its mechanical resistance.
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Affiliation(s)
- Joan Ferràs-Tarragó
- Orthopaedic Surgery and Traumatology. Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain.
| | | | | | | | - Jose Amaya-Valero
- Orthopaedic Surgery and Traumatology. Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
| | | | - Francisco Baixauli-García
- Orthopaedic Surgery and Traumatology. Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
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Levesque JN, Shah A, Ekhtiari S, Yan JR, Thornley P, Williams DS. Three-dimensional printing in orthopaedic surgery: a scoping review. EFORT Open Rev 2020; 5:430-441. [PMID: 32818070 PMCID: PMC7407871 DOI: 10.1302/2058-5241.5.190024] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Three-dimensional printing (3DP) has become more frequently used in surgical specialties in recent years. These uses include pre-operative planning, patient-specific instrumentation (PSI), and patient-specific implant production.The purpose of this review was to understand the current uses of 3DP in orthopaedic surgery, the geographical and temporal trends of its use, and its impact on peri-operative outcomesOne-hundred and eight studies (N = 2328) were included, published between 2012 and 2018, with over half based in China.The most commonly used material was titanium.Three-dimensional printing was most commonly reported in trauma (N = 41) and oncology (N = 22). Pre-operative planning was the most common use of 3DP (N = 63), followed by final implants (N = 32) and PSI (N = 22).Take-home message: Overall, 3DP is becoming more common in orthopaedic surgery, with wide range of uses, particularly in complex cases. 3DP may also confer some important peri-operative benefits. Cite this article: EFORT Open Rev 2020;5:430-441. DOI: 10.1302/2058-5241.5.190024.
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Affiliation(s)
- Jasmine N. Levesque
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - James R. Yan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Thornley
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dale S. Williams
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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31
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Montgomery SJ, Kooner SS, Ludwig TE, Schneider PS. Impact of 3D Printed Calcaneal Models on Fracture Understanding and Confidence in Orthopedic Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2020; 77:472-478. [PMID: 32033916 DOI: 10.1016/j.jsurg.2019.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/23/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine if three-dimensionally printed (3Dp) fracture models can improve orthopedic trainee education. DESIGN A prospective comparison study of orthopedic trainees and attending surgeons was performed, where a range of calcaneal fractures were used for creating anonymized 3Dp models. Study participants rotated through workstations viewing computed tomography images and either a digital 3D volume rendering or 3Dp model of the fractured calcaneus. Diagnosis, time for evaluation, confidence of fracture understanding, perceived model accuracy, and proposed treatment were compared using a standardized questionnaire. PARTICIPANTS Sixteen resident trainees and 5 attending surgeons participated in this study. Attending surgeons were required to have fellowship training in trauma or foot and ankle surgery and manage calcaneal fractures as part of their current practice. RESULTS Junior residents had the slowest time of assessment (mean = 121 ± 54 seconds) and lowest percentage of correct diagnoses (69%), although these findings did not reach significance compared to the other residency years. Residents displayed higher levels of confidence in fracture understanding with increasing residency year of training (p < 0.0001), and this confidence was greater for cases that included a 3Dp model (p < 0.03). Perceived accuracy of cases with 3Dp models was significantly higher than cases without 3Dp models (7.0 vs 5.5 p < 0.001). CONCLUSIONS This study found that 3Dp models increase the perceived accuracy of fracture assessment, though no statistically significant improvement in diagnostic accuracy was observed. The 3Dp models did improve trainee confidence, although this effect diminished with increasing residency year. In orthopedic residency training programs, 3Dp models of complex fractures can be a valuable educational tool, especially for junior trainees.
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Morgan C, Khatri C, Hanna SA, Ashrafian H, Sarraf KM. Use of three-dimensional printing in preoperative planning in orthopaedic trauma surgery: A systematic review and meta-analysis. World J Orthop 2020; 11:57-67. [PMID: 31966970 PMCID: PMC6960300 DOI: 10.5312/wjo.v11.i1.57] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/25/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in three-dimensional (3D) printing, there has been an increased interest in the concept. It has been shown that 3D models allow surgeons to better visualise anatomy, aid in planning and performing complex surgery. It is however not clear how best to utilise the technique and whether this results in better outcomes.
AIM To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.
METHODS We performed a comprehensive systematic review of the literature and a meta-analysis. Medline, Ovid and Embase were searched from inception to February 8, 2018. Randomised controlled trials, case-control studies, cohort studies and case series of five patients or more were included across any area of orthopaedic trauma. The primary outcomes were operation time, intra-operative blood loss and fluoroscopy used.
RESULTS Seventeen studies (922 patients) met our inclusion criteria and were reviewed. The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85% [95% confidence intervals (CI): (-22.99, -16.71)], intra-operative blood loss of 25.73% [95%CI: (-31.07, -20.40)], and number of times fluoroscopy was used by 23.80% [95%CI: (-38.49, -9.10)].
CONCLUSION Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time, intraoperative blood loss and the number of times fluoroscopy is used.
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Affiliation(s)
- Catrin Morgan
- Trauma and Orthopaedics, Imperial College NHS Trust, London W2 1NY, United Kingdom
| | - Chetan Khatri
- Trauma and Orthopaedics, Imperial College NHS Trust, London W2 1NY, United Kingdom
| | - Sammy A Hanna
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Khaled M Sarraf
- Trauma and Orthopaedics, Imperial College NHS Trust, London W2 1NY, United Kingdom
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Xiong L, Li X, Li H, Chen Z, Xiao T. The efficacy of 3D printing-assisted surgery for traumatic fracture: a meta-analysis. Postgrad Med J 2019; 95:414-419. [DOI: 10.1136/postgradmedj-2019-136482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 02/06/2023]
Abstract
BackgroundRecent years have witnessed a rapid development of three-dimensional (3D) printing technology applied in orthopaedic surgery. To be assisted by 3D printing is a potent method to realise accurate and individualised operation. The objective of this meta-analysis was to assess the efficacy of 3D printing technology in the management of trauma fractures.MethodsPubMed, Embase and the Cochrane Library were systematically searched up until January 2019 to identify relevant studies. All clinical studies comparing conventional surgery and 3D printing-assisted surgery in the management of orthopaedic trauma were obtained. The meta-analysis was performed with RevMan V.5.3 software.ResultsFour randomised controlled trials, four retrospective comparative studies and two prospective comparative studies involving 521 patients were included. Compared with conventional surgery, 3D printing-assisted surgery leads to shorter operation duration (mean difference (MD) −16.59 (95% CI −18.60 to –14.58), p<0.001), less intraoperative blood loss (standardised mean difference (SMD) −1.02 (95% CI –1.25 to –0.79), p<0.001) and fewer intraoperative fluroscopies (SMD −2.20 (95% CI –2.50 to –1.90), p<0.001). However, 3D printing-assisted surgery leads to longer hospital stay (MD 2.51 (95% CI 0.31 to –4.72), p=0.03). No significant results were found regarding fracture healing time, the rate of excellent and good outcomes, anatomical reduction and complications.ConclusionsThese results suggest that 3D printing-assisted surgery outperforms conventional surgery in the management of orthopaedic trauma fractures with shorter operation duration, less intraoperative blood loss and fewer intraoperative fluoroscopies.
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Michielsen M, Van Haver A, Vanhees M, van Riet R, Verstreken F. Use of three-dimensional technology for complications of upper limb fracture treatment. EFORT Open Rev 2019; 4:302-312. [PMID: 31210970 PMCID: PMC6549117 DOI: 10.1302/2058-5241.4.180074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In malunion cases, restoration of anatomy is a key factor in obtaining a good functional outcome, but this can be technically very challenging. Three-dimensional printed bone models can further improve understanding of the malunion pattern. The use of three-dimensional (3D) computer planning, and the assembly of patient-specific instruments and implants, especially in complex deformities of the upper limb, allow accurate correction while reducing operation time, blood loss volume and radiation exposure during surgery. One of the major disadvantages of the 3D technique is the additional cost because it requires specific computer software, a dedicated clinical engineer, and a 3D printer. Further technical developments and clinical investigations are necessary to better define the added value and cost/benefit relationship of 3D in the treatment of complex fractures, non-unions, and malunions.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180074
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Affiliation(s)
- Maartje Michielsen
- Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Annemieke Van Haver
- Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Matthias Vanhees
- Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium.,Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Roger van Riet
- Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium.,Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Frederik Verstreken
- Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium.,Department of Orthopaedic Surgery, University Hospital Antwerp, Antwerp, Belgium
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Babu S, Turner J, Seewoonarain S, Chougule S. Madelung's Deformity of the Wrist-Current Concepts and Future Directions. J Wrist Surg 2019; 8:176-179. [PMID: 31192036 PMCID: PMC6546486 DOI: 10.1055/s-0039-1685488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
Madelung's deformity of the wrist arises from premature closure of the medial and volar aspect of the distal radial physis. True Madelung deformities reveal the presence of a "Vickers" ligament which is a short, volar, radioulnar ligament. Clinically, patients report increasing deformity, pain, and poor range of motion. Radiological features include increased radial inclination, volar tilt of the distal radius, and a positive ulnar variance. Surgical intervention usually comprises either a "Vickers" ligament release and distal radius physiolysis or a radial dome osteotomy. In future, EOS Imaging could aid diagnosis by providing more detailed images of the deformity while minimizing radiation exposure. Furthermore, three-dimensional printing and computer-navigated deformity correction could revolutionize management by facilitating simulation training, expediting surgery, and reducing intraoperative error.
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Affiliation(s)
- Satish Babu
- Frimley Park Hospital, Portsmouth Road, Frimley, United Kingdom
| | - Joseph Turner
- East Surrey Hospital, Canada Avenue, Redhill, United Kingdom
| | | | - Sanjay Chougule
- East Surrey Hospital, Canada Avenue, Redhill, United Kingdom
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36
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Comparison of 3 Pediatric Pelvic Osteotomies for Acetabular Dysplasia Using Patient-specific 3D-printed Models. J Pediatr Orthop 2019; 39:e159-e164. [PMID: 30300278 DOI: 10.1097/bpo.0000000000001271] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with developmental dysplasia of the hip may require a pelvic osteotomy to treat acetabular dysplasia. Three osteotomies are commonly performed in these patients (Pemberton, Dega, and San Diego), though comparative studies of each are limited. The purpose of this study was to compare changes in acetabular morphology (acetabular version, volume, and octant coverage angles) created by these 3 osteotomies using matched patient-specific 3D-printed pelvic models. METHODS Fourteen patients with developmental dysplasia of the hip and preoperative computed tomography (CT) imaging were retrospectively included. For each patient CT, bone and cartilage tissues were independently segmented, and 3 identical pelvises were 3D-printed using a dual material printer. Bone was printed with rigid material and cartilage with flexible material to simulate the flexibility of the triradiate cartilage and pubic symphysis. Pemberton, Dega, and San Diego acetabular osteotomies were performed on the triplicate set of 3D prints. Acetabular version, volume, and octant coverage angles (posterior, superior-posterior, superior, superior-anterior, and anterior) were determined before and after each mock surgery by morphologic assessment using preoperative and postoperative CT images. RESULTS San Diego osteotomy yielded a small increase (+3.34±1.71 degrees) in version, compared with decreases with Pemberton (-5.47±1.54 degrees) and Dega (-8.57±1.21 degrees, P<0.05). Acetabular volume decreased similarly for Pemberton (-13.36%±2.88%), Dega (-19.21%±2.73%), and San Diego (-19.29%±2.44%; P=0.215) osteotomies. San Diego osteotomy tended to have a larger postoperative increase in the posterior regions, and the Dega and Pemberton osteotomies tended to have larger postoperative increases in the anterior coverage regions. CONCLUSIONS Quantifiable differences were identified in acetabular octant coverage angles and version between the 3 pelvic osteotomies. San Diego osteotomy increased acetabular coverage posteriorly resulting in acetabular anteversion, whereas Pemberton and Dega had greater superior-anterior coverage resulting in relative acetabular retroversion. This study is the first known to utilize 3D-printed models for comparison of surgical approaches in pediatric pelvic osteotomies.
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