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Wood L, Ahmed Z. Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024; 50:21-35. [PMID: 36418394 PMCID: PMC10924018 DOI: 10.1007/s00068-022-02176-7] [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: 08/15/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The systematic review aims to establish the value of using 3D printing-assisted pre-operative planning, compared to conventional planning, for the operative management of foot and ankle fractures. METHODS The systematic review was performed according to PRISMA guidelines. Two authors performed searches on three electronic databases. Studies were included if they conformed to pre-established eligibility criteria. Primary outcome measures included intraoperative blood loss, operation duration, and fluoroscopy time. The American orthopaedic foot and ankle score (AOFAS) was used as a secondary outcome. Quality assessment was completed using the Cochrane RoB2 form and a meta-analysis was performed to assess heterogeneity. RESULTS Five studies met the inclusion and exclusion criteria and were eventually included in the review. A meta-analysis established that using 3D printed models for pre-operative planning resulted in a significant reduction in operation duration (mean difference [MD] = - 23.52 min, 95% CI [- 39.31, - 7.74], p = 0.003), intraoperative blood loss (MD = - 30.59 mL, 95% CI [- 46.31, - 14.87], p = 0.0001), and number of times fluoroscopy was used (MD = - 3.20 times, 95% CI [- 4.69, - 1.72], p < 0.0001). Using 3D printed models also significantly increased AOFAS score results (MD = 2.24, 95% CI [0.69, 3.78], p = 0.005), demonstrating improved ankle health. CONCLUSION The systematic review provides promising evidence that 3D printing-assisted surgery significantly improves treatment for foot and ankle fractures in terms of operation duration, intraoperative blood loss, number of times fluoroscopy was used intraoperatively, and improved overall ankle health as measured by the AOFAS score.
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Affiliation(s)
- Lea Wood
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Zubair Ahmed
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Zamri MF, Ng BW, Jamil K, Abd Rashid AH, Abd Rasid AF. Office Three-Dimensional Printed Osteotomy Guide for Corrective Osteotomy in Fibrous Dysplasia. Cureus 2023; 15:e36384. [PMID: 37090315 PMCID: PMC10115740 DOI: 10.7759/cureus.36384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/22/2023] Open
Abstract
Fibrous dysplasia is a benign condition but can lead to severe long-bone deformities. Three-dimensional (3D) printing technology is a rapidly developing field that has now been popularized to aid surgeons in preoperative planning. We report a case of hip deformity in a 21-year-old woman who suffered from fibrous dysplasia and underwent a corrective osteotomy. We utilized open-source 3D computing software for preoperative planning before producing an osteotomy guide to aid in the operation.
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Hong JK, Bae IS, Kang HI, Kim JH, Jwa C. Development of a Pedicle Screw Fixation Simulation Model for Surgical Training Using a 3-Dimensional Printer. World Neurosurg 2023; 171:e554-e559. [PMID: 36563851 DOI: 10.1016/j.wneu.2022.12.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Training surgeons in pedicle screw fixation (PSF) techniques during actual surgery is limited because of patient safety, complications, and surgical efficiency issues. Recent technical developments are leading the world to an era of personalized three-dimensional (3D) printing. This study aimed to evaluate the educational effect of using a 3D-printed spine model to train beginners in PSF techniques to improve screw accuracy and procedure time. METHODS Computed tomography (CT) scan data were used in a 3D printer to produce a life-size lumbar spine replica of L1-3 vertebrae. Four residents performed PSF thrice. Each resident performed 18 screw fixations on both sides (6 screws per trial). The time to complete the procedure and pedicle violation was recorded. RESULTS The average time for the 3 procedures was 42.1±2.9 minutes, 38.8±3.3 minutes, and 32.1±2.5 minutes, respectively. Furthermore, the average pedicle screw score for the 3 procedures was 13.0±0.8, 14.5±0.6, and 16.0±0.8, respectively. As the trial was repeated, the procedure time decreased and the accuracy of screw fixation tended to be more accurate. CONCLUSIONS It was possible to decrease the procedure time and increase accuracy through repeated training using the 3D-printed spine model. By implementing a 3Dprinted spine model based on the patient's actual CT data, surgeons can perform simulation surgery before the actual surgery. Therefore, this technology can be useful in educating residents to improve their surgical skills.
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Affiliation(s)
- Joon-Ki Hong
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - In-Suk Bae
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
| | - Hee In Kang
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Cheolsu Jwa
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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Safali S, Berk T, Makelov B, Acar MA, Gueorguiev B, Pape HC. The Possibilities of Personalized 3D Printed Implants-A Case Series Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020249. [PMID: 36837451 PMCID: PMC9959288 DOI: 10.3390/medicina59020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
Background and Objectives: Following the most recent software and 3D printing developments, the use of personalized 3D printed orthopedic implants for treatment of complicated surgical cases has gained more popularity. Today, orthopedic problems that cannot be solved with standard implants may be effectively addressed using personalized prostheses. The aim of this study is to present the designing, modeling and production stages of four different personalized 3D printed prostheses and their application in clinical cases of patients who underwent treatment in various anatomical locations with a precisely specified indication for implantation. Materials and Methods: Based on computed tomography scanning, personalized 3D printed prostheses were designed, produced and used in four patients within a period of three to five days after injury or admission. Results: Early term follow-ups demonstrated good to excellent results. Conclusions: Personalized 3D printed prostheses offer an opportunity for a treatment of choice and provide good anatomical and functional results, shortened surgical time, less complications, and high satisfaction in patients with appropriate indications. The method should be considered primarily for patients with large bone defects, or such indicated for resection. Personalized 3D printed prostheses have the potential to become more common and beneficial in the future.
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Affiliation(s)
- Selim Safali
- Orthopaedics and Traumatology Department, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland
- Department of Trauma, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Biser Makelov
- University Multiprofile Hospital for Active Treatment ‘Prof. Stoyan Kirkovitch’, Trakia University, 6003 Stara Zagora, Bulgaria
| | - Mehmet Ali Acar
- Orthopaedics and Traumatology Department, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland
- Correspondence:
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Park HJ, You KH, Huang B, Yoon JH, Kim HN. Can 3-Dimensional Printing for Calcaneal Fracture Surgery Decrease Operation Time and Improve Quality of Fracture Reduction? J Foot Ankle Surg 2022; 62:21-26. [PMID: 35418345 DOI: 10.1053/j.jfas.2022.03.004] [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: 04/27/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 02/03/2023]
Abstract
We investigated whether 3-dimensional (3D) printed models can decrease operation time and improve the quality of reduction for calcaneal fractures. The study involved 48 patients with unilateral intra-articular calcaneal fractures, who were retrospectively case-matched according to Sander's classification, age, and sex. Group A (24 patients) was operated using 3D printed models as a preoperative and intraoperative tool, and group B (24 patients) was operated using standard techniques without 3D printed model. Operation time was significantly shorter for group A, compared to group B (82.3 ± 13.2 vs 91.4 ± 16.0, p = .036). The differences between the radiological parameters of operated calcaneus, compared to the normal side was similar between the 2 groups (Böhler angle, 5.3° ± 3.9° vs 4.2° ± 4.7°, p = .45, Gissane angle, 5.9° ± 12.5° vs 8.4° ± 11.0°, p = .54). The number of screws projecting more than 5 mm from the cortex was lower in group A than in group B (7/187, 4% vs 16/208, 8%, p = .11). The number of screw holes of the plate cut intraoperatively was significantly lower for group A compared to group B (1 vs 138). Although group A started weightbearing 3 to 4 weeks earlier than group B, the radiological parameters were similar between groups that early weightbearing was possible for group A using the 3D printed models (Böhler angle, - 1.5° ± 0.8° vs - 1.8° ± 1.2°, p = .28, Gissane angle, 2.5° ± 2.6° vs 3.5° ± 4.3°, p = .39). The operation time was shorter while using the 3D printed models, compared to that of the standard technique without using the 3D printed model. The radiological parameters were not statistically different, and the quality of fracture reduction seemed similar. However, with the use of 3D printed models, early weightbearing was possible without significant subsidence of reduced fragments or failure of fracture reduction, comparable to non-weightbearing cases.
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Affiliation(s)
- Hyun-Jin Park
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ki-Han You
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Bingzhe Huang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Joon Hyeok Yoon
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
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Lei M, Zhang M, Luo N, Ye J, Lin F, Chen Y, Chen J, Xiao M. The clinical performance of ultra-low-dose shoulder CT scans: The assessment on image and physical 3D printing models. PLoS One 2022; 17:e0275297. [PMID: 36155982 PMCID: PMC9512178 DOI: 10.1371/journal.pone.0275297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Evaluation of the clinical performance of ultra-low-dose computed tomography (CT) images of the shoulder joint on image-based diagnosis and three-dimensional (3D) printing surgical planning. Materials and methods A total of 93 patients with displaced shoulder fractures were randomly divided into standard-dose, low-dose, and ultra-low-dose groups. Three-dimensional printing models of all patients’ shoulder joints were fabricated. The subjective image quality and 3D-printing model were evaluated by two senior orthopedic surgeons who were blinded to any scanning setting. A 3-point scale system was used to quantitatively assess the image quality and 3D printing model, where more than 2 points meant adequate level for clinical application. Results Compared with the standard dose protocol, ultra-low-dose technique reduced the radiation dose by 99.29% without loss of key image quality of fracture pattern. Regarding the subjective image quality, the assessment scores for groups of standard, low, and ultra-low doses were 3.00, 2.76, 2.00 points on scapula and humerus, and 3.00, 2.73, 2.44 points on clavicle. Scores of the three groups for the assessment of 3D printing models were 3.00, 2.80, 1.34 on scapula and humerus, and 3.00, 2.90, 2.06 on clavicle. In the ultra-low-dose group, 24 out of 33 (72.7%) 3D printing models of scapula and humerus received lower than 2 points of the evaluation score, while nearly 94% of the clavicle models reached the adequate level. Conclusion An ultra-low-dose protocol is adequate for the diagnosis of either displaced or non-displaced fractures of the shoulder joint even though minor flaws of images are present. Three-dimensional printing models of shoulder joints created from ultra-low-dose CT scans can be used for surgical planning at specific bone like the clavicle but perform insufficiently in the overall surgical planning for shoulder injuries due to the significant geometric flaws.
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Affiliation(s)
- Ming Lei
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Meng Zhang
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Niyuan Luo
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Jingzhi Ye
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Fenghuan Lin
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Yanxia Chen
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Jun Chen
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Mengqiang Xiao
- Department of Imaging, Zhuhai Hospital Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
- * E-mail:
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Malikov A, Secen AE, Divanlioglu D, Gunerhan G, Ocal O, Gunduz UK. The feasibility of creating Image-Based Patient-Specific Drill Guides for the Atlantoaxial Instabilities using open-source CAD software and desktop 3D printers. World Neurosurg 2022; 163:e377-e383. [PMID: 35390495 DOI: 10.1016/j.wneu.2022.03.137] [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: 01/22/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE C1/2 cervical pedicle screw fixation is a well-known procedure for treating severely damaged and unstable C1/2 fractures. On the other hand, C1/C2 screw fixation is not safe and can lead to potentially disastrous consequences. The importance of personalized 3D printed navigational guides in avoiding these consequences cannot be overstated. MATERIALS AND METHODS We retrospectively reviewed the neuroimaging data of 16 patients who had undergone fixation for treatment of C1/2 diseases. We created patient-specific C1/2 models and drill guide models using open-source 3D editing software and a desktop 3D printer. The drill guides were then placed over the respective vertebrae models and fixated with 3.5 mm screws. Following fixation, the parts were scanned with a thin-slice (01 mm) CT scan, and the screw trajectories in the transverse and sagittal planes were measured at each level. RESULTS Of the total of 62 screws, 58 were type I (93.54%), 4 were type II (6.45%), and no screws were type III (Tab 2). The results showed that there was no significant deviation in the screw trajectories and the accuracy of the drill guides was 93.54% (Table 3). In our study, type I and type II screws were deemed acceptable, and the acceptable rates of C1/2 screw fixation were 100%. CONCLUSIONS In this preclinical study, we demonstrated that it is possible to create patient-specific pedicle drill guides using open source editing software and a commercially available desktop PLA printer, resulting in high accuracy rates in pedicle screw placement in C1/2 patient models.
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Affiliation(s)
- Azad Malikov
- Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey.
| | - Ahmet Eren Secen
- Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey
| | | | - Goksal Gunerhan
- Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey
| | - Ozgur Ocal
- Department of Neurosurgery, Ankara City Hospital, Ankara, Turkey
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Zabala-Travers S. Biomodeling and 3D printing: A novel radiology subspecialty. ANNALS OF 3D PRINTED MEDICINE 2021. [DOI: 10.1016/j.stlm.2021.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Chan PK, Fang C, Fang E, Leung M, Yan CH, Chiu KY. Three-Dimensional Printing and Computer Navigation for Correction of Multiple Deformities in Osteogenesis Imperfecta: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00075. [PMID: 34003809 DOI: 10.2106/jbjs.cc.20.00501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 44-year-old man with osteogenesis imperfecta presented with multiple debilitating musculoskeletal deformities. Bi-level osteotomies, assisted by 3-dimensional (3D)-printed patient-specific cutting guides, were performed to correct extraarticular valgus and procurvatum tibial deformities. Concomitant computer-navigated total knee arthroplasty was performed to restore neutral mechanical alignment. Postoperative x-ray showed good correction of deformities, and 1 year postoperatively, the patient is able to walk unaided with significant resolution of knee pain. CONCLUSION 3D-printed osteotomy guides and computer navigation can be instrumental in procedures requiring a high degree of precision. With sufficient training, modern orthopaedic technologies can be implemented by surgeons themselves and combined to facilitate precise and personalized management of challenging conditions.
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Affiliation(s)
- Ping-Keung Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Three-dimensional Printing in Orthopaedic Surgery: Current Applications and Future Developments. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:e20.00230-11. [PMID: 33877073 PMCID: PMC8059996 DOI: 10.5435/jaaosglobal-d-20-00230] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/09/2021] [Indexed: 12/27/2022]
Abstract
Three-dimensional (3D) printing is an exciting form of manufacturing technology that has transformed the way we can treat various medical pathologies. Also known as additive manufacturing, 3D printing fuses materials together in a layer-by-layer fashion to construct a final 3D product. This technology allows flexibility in the design process and enables efficient production of both off-the-shelf and personalized medical products that accommodate patient needs better than traditional manufacturing processes. In the field of orthopaedic surgery, 3D printing implants and instrumentation can be used to address a variety of pathologies that would otherwise be challenging to manage with products made from traditional subtractive manufacturing. Furthermore, 3D bioprinting has significantly impacted bone and cartilage restoration procedures and has the potential to completely transform how we treat patients with debilitating musculoskeletal injuries. Although costs can be high, as technology advances, the economics of 3D printing will improve, especially as the benefits of this technology have clearly been demonstrated in both orthopaedic surgery and medicine as a whole. This review outlines the basics of 3D printing technology and its current applications in orthopaedic surgery and ends with a brief summary of 3D bioprinting and its potential future impact.
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Charbonnier B, Hadida M, Marchat D. Additive manufacturing pertaining to bone: Hopes, reality and future challenges for clinical applications. Acta Biomater 2021; 121:1-28. [PMID: 33271354 DOI: 10.1016/j.actbio.2020.11.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
For the past 20 years, the democratization of additive manufacturing (AM) technologies has made many of us dream of: low cost, waste-free, and on-demand production of functional parts; fully customized tools; designs limited by imagination only, etc. As every patient is unique, the potential of AM for the medical field is thought to be considerable: AM would allow the division of dedicated patient-specific healthcare solutions entirely adapted to the patients' clinical needs. Pertinently, this review offers an extensive overview of bone-related clinical applications of AM and ongoing research trends, from 3D anatomical models for patient and student education to ephemeral structures supporting and promoting bone regeneration. Today, AM has undoubtably improved patient care and should facilitate many more improvements in the near future. However, despite extensive research, AM-based strategies for bone regeneration remain the only bone-related field without compelling clinical proof of concept to date. This may be due to a lack of understanding of the biological mechanisms guiding and promoting bone formation and due to the traditional top-down strategies devised to solve clinical issues. Indeed, the integrated holistic approach recommended for the design of regenerative systems (i.e., fixation systems and scaffolds) has remained at the conceptual state. Challenged by these issues, a slower but incremental research dynamic has occurred for the last few years, and recent progress suggests notable improvement in the years to come, with in view the development of safe, robust and standardized patient-specific clinical solutions for the regeneration of large bone defects.
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Endoscopic Treatment of Symptomatic Foot and Ankle Bone Cyst with 3D Printing Application. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8323658. [PMID: 33426066 PMCID: PMC7781683 DOI: 10.1155/2020/8323658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/12/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022]
Abstract
Objective To study the efficacy of arthroscopy for treating symptomatic bone cysts of the foot and ankle through the follow-up of patients and to further explore the application value of 3D printing technology in this treatment. Methods Twenty-one patients with symptomatic bone cysts in the foot and ankle who underwent arthroscopic surgery in our Center from March 2010 to December 2018 were enrolled, including 11 in the experimental group and 10 in the control group. For the control group, C-arm fluoroscopy was used intraoperatively to confirm the positioning of the cysts; for the experimental group, a 3D model of the lesion tissue and the 3D-printed individualized guides were prepared to assist the positioning of the cysts. Debridement of the lesion tissues was conducted under an arthroscope. Regular follow-ups were conducted. The time of establishing arthroscopic approaches and the times of intraoperative fluoroscopy between the two groups were compared. Significance was determined as P < 0.05. Results The postoperative pathology of the patients confirmed the diagnosis. No significant perioperative complications were observed in either group, and no recurrence of bone cysts was seen at the last follow-up. The VAS scores and AOFAS scores of the two groups at the last follow-up were significantly improved compared with the preoperative data, but there was no statistical difference between the two groups. All surgeries were performed by the same senior surgeon. The time taken to establish the arthroscopic approaches between the two groups was statistically significant (P < 0.001), and the times of intraoperative fluoroscopy required to establish the approach were also statistically significant (P < 0.001). The intraoperative bleeding between the two groups was statistically significant (P < 0.01). There was 1 case in each group whose postoperative CT showed insufficient bone grafting, but no increase in cavity volume was observed during the follow-up. Conclusion With the assistance of the 3D printing technology for treating symptomatic bone cysts of the ankle and foot, the surgeon can design the operation preoperatively and perform the rehearsal, which would make it easier to establish the arthroscopic approach, better understand the anatomy, and make the operation smoother. This trial is registered with http://www.clinicaltrials.govNCT03152916.
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Braun BJ, Grimm B, Hanflik AM, Marmor MT, Richter PH, Sands AK, Sivananthan S. Finding NEEMO: towards organizing smart digital solutions in orthopaedic trauma surgery. EFORT Open Rev 2020; 5:408-420. [PMID: 32818068 PMCID: PMC7407868 DOI: 10.1302/2058-5241.5.200021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
There are many digital solutions which assist the orthopaedic trauma surgeon. This already broad field is rapidly expanding, making a complete overview of the existing solutions difficult.The AO Foundation has established a task force to address the need for an overview of digital solutions in the field of orthopaedic trauma surgery.Areas of new technology which will help the surgeon gain a greater understanding of these possible solutions are reviewed.We propose a categorization of the current needs in orthopaedic trauma surgery matched with available or potential digital solutions, and provide a narrative overview of this broad topic, including the needs, solutions and basic rules to ensure adequate use in orthopaedic trauma surgery. We seek to make this field more accessible, allowing for technological solutions to be clearly matched to trauma surgeons' needs. Cite this article: EFORT Open Rev 2020;5:408-420. DOI: 10.1302/2058-5241.5.200021.
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Affiliation(s)
- Benedikt J Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | | | | | - Meir T Marmor
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
| | - Peter H Richter
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Andrew K Sands
- Weill Cornell Medical College, Foot and Ankle Surgery, Downtown Orthopedic Associates, New York Presbyterian Lower Manhattan Hospital, New York, USA
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Sallent A, Ramírez M, Catalá J, Rodríguez-Baeza A, Bagó J, de Albert M, Vélez R. Precision and safety of Multilevel Cervical Transpedicular Screw Fixation with 3D Patient-Specific Guides; A Cadaveric Study. Sci Rep 2019; 9:15686. [PMID: 31666550 PMCID: PMC6821841 DOI: 10.1038/s41598-019-51936-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 10/02/2019] [Indexed: 11/09/2022] Open
Abstract
The aim is to design a patient-specific instrument (PSI) for multilevel cervical pedicle screw placement from C2 to C7, as well as verifying reliability and reproducibility. Computed tomography (CT) scans were obtained from 7 cadaveric cervical spines. Using Mimics software, semiautomatic segmentation was performed for each cervical spine, designing a 3D cervical spine bone model in order to plan transpedicular screw fixation. A PSI was designed according to the previously cited with two cannulated chimneys to guide the drill. The guides were 3D printed and surgeries performed at the laboratory. Postoperative scans were obtained to study screw placement. Sixty-eight transpedicular screws were available for study. 61.8% of all screws were within the pedicle or partially breached <4 mm. No differences were observed between cervical levels. None of these screws had neurovascular injury. Of the 27 screws with a grade 3 (screw outside the pedicle; 39.7%), only 2 had perforation of the transverse foramen and none of them would have caused a neural injury. In conclusion, multilevel PSI for cervical pedicle screw is a promising technology that despite showing improvements regarding free-hand technique requires further studies to improve the positioning of the PSI and their accuracy.
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Affiliation(s)
- Andrea Sallent
- Orthopaedic Department, Hospital Vall d'Hebron. Universitat Autónoma de Barcelona, Barcelona, Spain. .,Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain.
| | - Manuel Ramírez
- Orthopaedic Department, Hospital Vall d'Hebron. Universitat Autónoma de Barcelona, Barcelona, Spain.,Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain
| | - Jordi Catalá
- Radiology Department, Institut Guirado, Barcelona, Spain
| | | | - Joan Bagó
- Orthopaedic Department, Hospital Vall d'Hebron. Universitat Autónoma de Barcelona, Barcelona, Spain.,Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain
| | - Matías de Albert
- Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Roberto Vélez
- Orthopaedic Department, Hospital Vall d'Hebron. Universitat Autónoma de Barcelona, Barcelona, Spain.,Institut de Recerca Vall d'Hebron (VHIR), Barcelona, Spain
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15
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[3D printing in orthopedic and trauma surgery education and training : Possibilities and fields of application]. Unfallchirurg 2019; 122:444-451. [PMID: 31053925 DOI: 10.1007/s00113-019-0650-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The 3D printing technology enables precise fracture models to be generated from volumetric digital imaging and communications in medicine (DICOM) computed tomography (CT) data. Apart from patient treatment, in the future this technology could potentially play a significant role in education and training in the field of orthopedic and trauma surgery. Preliminary results show that the understanding and classification of fractures can be improved when teaching medical students. The use of life-size and haptic models of real fractures for education is particularly interesting. Even experienced surgeons show an improved classification and treatment planning with the help of 3D printed models when compared to plain CT data. Especially for complex articular fractures, such as those of the acetabulum and tibial plateau, initial evidence shows patient benefits in terms of reduced surgery time and blood loss with the help of 3D models. The use of 3D printing on-site at the hospital is of particular interest in orthopedic and trauma surgery as it promises to provide products within a short time. The low investment and running costs and the increasing availability of convenient software solutions will spur increasing dissemination of this technology in the coming years.
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16
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Krettek C, Bruns N. [Current concepts and new developments of 3D printing in trauma surgery]. Unfallchirurg 2019; 122:256-269. [PMID: 30903248 DOI: 10.1007/s00113-019-0636-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The use of 3D printing (synonyms "rapid prototyping" and "additive manufacturing") has played an increasing role in the industry for many years and finds more and more interest and application in musculoskeletal surgery, especially orthopedic trauma surgery.In this article the current literature is systematically reviewed, presented and evaluated in a condensed and comprehensive way according to anatomical (upper and lower extremities) and functional aspects. As many of the publications analyzed were feasibility studies, the degree of evidence is low and methodological weaknesses are obvious and numerous; however, this pioneering work is extremely stimulating and important for further development because the technical, medical and economic potential of this technology is huge and interesting for all those involved in the treatment of musculoskeletal problems.
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Affiliation(s)
- C Krettek
- Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - N Bruns
- Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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17
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Foo GL, Kwek EBK. Are Three-Dimensional Printed Models Useful for Preoperative Planning of Tibial Plafond Fractures? J Foot Ankle Surg 2019; 58:723-729. [PMID: 31079980 DOI: 10.1053/j.jfas.2018.12.005] [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: 01/24/2018] [Indexed: 02/03/2023]
Abstract
Computed tomography (CT) scans with 3-dimensional (3D) reconstruction are the gold standard of imaging for complex fractures. However, visualising CT imaging can be challenging. With increasing access to 3D printing, we postulate that life-sized 3D models can better assist in visualising CT images, aiding preoperative planning of tibial plafond fractures. 3D models of 3 tibial plafond fractures of differing complexities were printed. We approached surgeons in our institution who manage tibial plafond fractures to complete a questionnaire on preoperative planning of the cases based on CT scans. We then examined whether analysing the 3D models after that changed the plan. This included ratings on the usefulness, accuracy, and ease of use of the models. Six surgeons participated in the study. In the simple fracture model, median usefulness was graded as 4.5 (range minimum to maximum: 0 to 7), accuracy 8 (4 to 10), and ease of use 9 (7 to 10) with 0 being the lowest and 10 being the upper limit of how useful, accurate, or easy to use the models were. For the intermediate fracture, median usefulness was 6.5 (2 to 8), accuracy 7.5 (3 to 10), and ease of use 8.5 (7 to 10). For the complex fracture, median usefulness was 6 (1 to 9), accuracy 7.5 (1 to 9), and ease of use 8.5 (0 to 9). We attribute these poorer scores to difficulty in processing the scans, resulting in less accurate printing of the many fragments in complex impacted fractures. In conclusion, 3D-printed models are easy to use and accurate in preoperative planning of tibial plafond fractures. Most surgeons believe that 3D models and CT scans combined were more useful than CT scans alone.
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Affiliation(s)
- Gen Lin Foo
- Associate Consultant, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Ernest Beng Kee Kwek
- Adjunct Assistant Professor, Head of Orthopaedic Trauma Surgery Service, and Senior Consultant, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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18
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Sallent A, Seijas R, Pérez-Bellmunt A, Oliva E, Casasayas O, Escalona C, Ares O. Feasibility of 3D-printed models of the proximal femur to real bone: a cadaveric study. Hip Int 2019; 29:452-455. [PMID: 30421629 DOI: 10.1177/1120700018811553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION 3D technology has increased popularity during the past decade due to recent advancements and has been described as a useful tool in several fields of medicine including orthopaedic surgery. Applications include preoperative planning, custom-made implants, patient-specific guides, etc. The aim of this study was to evaluate the similarity between 3D-printed models and cadaveric femoral heads, based on CT scans. METHODS Cadaveric study of 12 male hips. Computed tomography (CT) was performed and through a semi-automatic segmentation process created the 3D model. Using a 3D printer, the model was printed in ABS plastic. 1 observer performed several measurements in the cadaver, and a 2nd observer performed the same measurements in the 3D-printed model. A 3rd observer compared both measurements and performed the statistical analysis. RESULTS There were no significant differences in the measurements of bony structures between the cadaveric specimens and the 3D-printed model (p > 0.05 in all cases). We found significant differences when comparing measurements containing a soft tissue element, for example the dimensions of the cartilage covered femoral head (p < 0.0001). CONCLUSIONS 3D-printed models of the hip are accurate and feasible to the real bone and can thus be reliable for preoperative planning or other uses that may arise in orthopaedic surgery. Presence of cartilage must be considered when creating the 3D model from CT that considers bone but not cartilage.
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Affiliation(s)
- Andrea Sallent
- 1 Orthopaedic Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - Roberto Seijas
- 2 Arthroscopy GC, Garcia Cugat Foundation Hospital Quirón, Barcelona, Spain.,3 Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Eulalia Oliva
- 4 Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Oriol Casasayas
- 2 Arthroscopy GC, Garcia Cugat Foundation Hospital Quirón, Barcelona, Spain
| | - Carles Escalona
- 2 Arthroscopy GC, Garcia Cugat Foundation Hospital Quirón, Barcelona, Spain
| | - Oscar Ares
- 5 Hospital Clinic of Barcelona, University of Barcelona, Spain.,6 Centro Médico Teknon, Barcelona, Spain
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Duan XJ, Fan HQ, Wang FY, He P, Yang L. Application of 3D-printed Customized Guides in Subtalar Joint Arthrodesis. Orthop Surg 2019; 11:405-413. [PMID: 31106975 PMCID: PMC6595118 DOI: 10.1111/os.12464] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/08/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the feasibility of 3D printed customized guides assisting the precise drilling of Kirschner wires in subtalar joint arthrodesis. METHODS We retrospectively reviewed the data of 29 patients (30 subtalar joints) who underwent subtalar joint arthrodesis between 1 July 2013 and 31 December 2017. The customized guides were designed on a full-scale 3D polylactic acid model made from computed tomography (CT) data of patients by Model Intestinal Microflora in Computer Simulation (MIMICS) software, which were manufactured by 3D printing technology. A total of 14 joints used customized guides (experimental group); the remained 16 joints used the traditional method (control group). The time of drilling the Kirschner wires to the correct position, the time of subtalar fusion, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and complications were evaluated in both groups. RESULTS All customized guides were successfully manufactured. In the experimental group, it took 2.1 ± 0.7 min to drill the Kirschner wire to the satisfactory position, and 2 cases needed to be re-drilled; in the control group, it took 4.6 ± 1.9 min to drill the Kirschner wire to the satisfactory position (P < 0.05), and 8 cases needed to be re-drilled. No serious complications occurred in both groups during and after the surgery. Postoperative radiographic fusion was confirmed in all cases. No significant difference was observed in the fusion time and AOFAS scores 1 year postoperatively between the two groups (P > 0.05). CONCLUSION It is safe to apply 3D-printed customized guides for subtalar joint arthrodesis, which can assist the accurate drilling of Kirschner wires into the appropriate position according to the preoperative plan, and reduce the operation time as well as intraoperative radiation.
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Affiliation(s)
- Xiao-Jun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua-Quan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fu-You Wang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Peng He
- Chongqing Institute of Optics and Mechanics, Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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20
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Can Preoperative 3D Printing Change Surgeon's Operative Plan for Distal Tibia Fracture? BIOMED RESEARCH INTERNATIONAL 2019; 2019:7059413. [PMID: 30886862 PMCID: PMC6388342 DOI: 10.1155/2019/7059413] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/31/2019] [Indexed: 01/22/2023]
Abstract
This study aimed to determine if 3D printing can affect surgeon's selection of plate for distal tibia fracture surgery and to find out whether orthopedic surgeons consider this technology necessary and would use it in their practice. A total of 102 orthopedic surgeons were asked to choose anatomically contoured locking plates among 5 most commonly used types for one simple and one complex distal tibia fracture based on X-ray and CT images. Next, they were provided real-size 3D printed models of the same fractures, allowed to apply each of the 5 plates to these models, and asked if they would change their choice of plate. A 10-point numeric rating scale was provided to measure the extent of the help that 3D printing provided on preoperative planning. Finally, we asked the surgeons if they would use 3D printing in their practice. Seventy-four percent of inexperienced surgeons changed their selection of plate after using 3D printed models for the complex fracture. In contrast, only 9% of experienced surgeons changed their selection of plate for the simple fracture. Surgeons rated the extent of usefulness of the 3D models in preoperative planning as a mean of 4.84 ± 2.54 points for the simple fracture and 6.63 ± 2.54 points for the complex fracture. The difference was significant (p < 0.001). Eighty-six percent of inexperienced surgeons wanted to use 3D models for complex fractures. However, only 18% of experienced surgeons wanted to use 3D printed models for simple fractures. The use of a real-size 3D-printed model often changed surgeon's preoperative selection of locking plates, especially when inexperienced surgeons evaluated a complex fracture. However, experienced surgeons did not find 3D models very useful when assessing simple fractures. Future applications of 3D models should focus on training beginners in fracture surgery, especially when complex fractures are concerned.
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21
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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22
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Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118809050. [PMID: 30450008 PMCID: PMC6236480 DOI: 10.1177/1179544118809050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/16/2018] [Indexed: 11/15/2022]
Abstract
Avulsion fractures compromise function and movement at the affected joint. If
left untreated, it can lead to deformity, nonunion, malunion, pain, and
disability. The purpose of this review was to identify and describe the
epidemiology and available treatment options for common avulsion fractures of
the upper and lower extremities. Current evidence suggests that optimal
treatment is dependent on the severity of the fracture. Conservative efforts
generally include casting or splinting with a period of immobilization. Surgery
is typically indicated for more severe cases or if nonoperative treatments fail;
patient demographics or preferences and surgeon experience may also play a role
in decision making. Some avulsion fractures can be surgically managed with any
one of various techniques, each with their own pros and cons, and often there is
no clear consensus on choosing one technique over another; however, there is
some research suggesting that screw fixation, when possible, may offer the best
stability and compression at the fracture site and earlier mobilization and
return to function. Physicians should be mindful of the potential complications
associated with each intervention.
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Affiliation(s)
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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Lal H, Patralekh MK. 3D printing and its applications in orthopaedic trauma: A technological marvel. J Clin Orthop Trauma 2018; 9:260-268. [PMID: 30202159 PMCID: PMC6128305 DOI: 10.1016/j.jcot.2018.07.022] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND With rapid emergence of 3D printing technology, surgeons have recently started to apply this for nearly all areas of orthopaedic trauma surgery. Computed tomography or magnetic resonance images of trauma patients can be utilized for making graspable objects from 3D reconstructed images. Patient specific anatomical models can thereby be created. They enhance surgeon's knowledge of their patients' precise patho-anatomy, regarding both traumatized bones and soft tissue as well as normal areas, and therefore help in accurate preoperative planning. 3D printed patient specific instrumentation can help to achieve precise implant placement, and better surgical results. Most importantly, customized implants, casts, orthoses and prosthetics can be manufactured to match an individual's anatomy. Three dimensional (3D) printing, also called as 'additive manufacturing' and 'rapid prototyping' is considered as the "second industrial revolution", and this appears to be especially true for orthopaedic trauma surgery. METHODS A literature search was performed for extracting all papers related to 3D Printing applications in orthopaedics and allied sciences on the Pubmed, and SCOPUS; using suitable key terms and Boolean operators ("3D Printing" OR "3 dimensional printing" OR "3D printed" OR "additive manufacturing" OR "rapid prototyping") AND (''Orthopaedics" OR "Orthopaedics'') AND ("Trauma" OR "Injury")in June 2018. Search was also performed in Web of Science, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. No limits were set on the time period or evidence level, as 3D printing in orthopaedics is relatively recent and mainly low level evidence is available. Titles and abstracts were screened and all duplicate and unrelated papers were excluded. Papers related to orthopaedic trauma were manually selected for this review. RESULTS The search on Pubmed retrieved 144 Papers and similar search on SCOPUS retrieved 94 papers. Additional searches did not reveal more relevant papers. After excluding duplicates and unrelated papers, and on screening of titles and abstracts, 59 papers were considered for review. Papers related to spine fractures only were not included, as they have been covered in another paper in this journal issue. CONCLUSION All over the world, orthopaedic Surgeon's and allied professionals and scientists are enthusiastically using 3D printing technology for designing patient specific models, instrumentation, implants, orthosis and prosthesis, besides 3D bioprinting of bone and cartilage scaffolding, and the same has been applied for nearly all areas of orthopaedic trauma surgery, from head to foot.
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Affiliation(s)
| | - Mohit Kumar Patralekh
- Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, 110029, India
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24
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Park HJ, Wang C, Choi KH, Kim HN. Use of a life-size three-dimensional-printed spine model for pedicle screw instrumentation training. J Orthop Surg Res 2018; 13:86. [PMID: 29661210 PMCID: PMC5902859 DOI: 10.1186/s13018-018-0788-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/28/2018] [Indexed: 11/30/2022] Open
Abstract
Background Training beginners of the pedicle screw instrumentation technique in the operating room is limited because of issues related to patient safety and surgical efficiency. Three-dimensional (3D) printing enables training or simulation surgery on a real-size replica of deformed spine, which is difficult to perform in the usual cadaver or surrogate plastic models. The purpose of this study was to evaluate the educational effect of using a real-size 3D-printed spine model for training beginners of the free-hand pedicle screw instrumentation technique. We asked whether the use of a 3D spine model can improve (1) screw instrumentation accuracy and (2) length of procedure. Methods Twenty life-size 3D-printed lumbar spine models were made from 10 volunteers (two models for each volunteer). Two novice surgeons who had no experience of free-hand pedicle screw instrumentation technique were instructed by an experienced surgeon, and each surgeon inserted 10 pedicle screws for each lumbar spine model. Computed tomography scans of the spine models were obtained to evaluate screw instrumentation accuracy. The length of time in completing the procedure was recorded. The results of the latter 10 spine models were compared with those of the former 10 models to evaluate learning effect. Results A total of 37/200 screws (18.5%) perforated the pedicle cortex with a mean of 1.7 mm (range, 1.2–3.3 mm). However, the latter half of the models had significantly less violation than the former half (10/100 vs. 27/100, p < 0.001). The mean length of time to complete 10 pedicle screw instrumentations in a spine model was 42.8 ± 5.3 min for the former 10 spine models and 35.6 ± 2.9 min for the latter 10 spine models. The latter 10 spine models had significantly less time than the former 10 models (p < 0.001). Conclusion A life-size 3D-printed spine model can be an excellent tool for training beginners of the free-hand pedicle screw instrumentation.
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Affiliation(s)
- Hyun Jin Park
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Dalim-1dong, Youngdeungpo-gu, Seoul, 150-950, South Korea
| | - Chenyu Wang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Dalim-1dong, Youngdeungpo-gu, Seoul, 150-950, South Korea
| | - Kyung Ho Choi
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Dalim-1dong, Youngdeungpo-gu, Seoul, 150-950, South Korea
| | - Hyong Nyun Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Dalim-1dong, Youngdeungpo-gu, Seoul, 150-950, South Korea.
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25
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Kim JW, Lee Y, Seo J, Park JH, Seo YM, Kim SS, Shon HC. Clinical experience with three-dimensional printing techniques in orthopedic trauma. J Orthop Sci 2018; 23:383-388. [PMID: 29325763 DOI: 10.1016/j.jos.2017.12.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 12/10/2017] [Accepted: 12/19/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND To report our experiences with the use of three-dimensional (3D) printing in the field of orthopedic trauma. METHODS This retrospective study enrolled 24 patients from three university teaching hospitals in whom 3D printing technique was applied: 14 patients with acetabular fractures and 10 patients with clavicular shaft fractures. We summarized our experiences with 3D printed bone models. RESULTS Three-dimensional printed acetabular models improved understanding of complex acetabular anatomy and fracture pattern to plan the optimal positioning of a reduction clamp and the trajectory of screws. Pre-bending of a reconstruction plate could reduce operative time. We also recorded fluoroscopic images of a simulated surgery for percutaneous screw fixation of the acetabular posterior column, with the optimal positioning of the guide wire determined during the simulation used as a reference during the actual operation. This surgical simulation was performed by a resident and served as a helpful training method. For fractures of the clavicle, we identified the optimal position of anatomical plates using 3D printed clavicle models. CONCLUSION In our experience, 3D printing technique provided surgeons with improved understanding of the fracture pattern and anatomy and was effectively used for preoperative planning, education of surgical trainees, and performing simulations to improve intra-operative technical outcomes.
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Affiliation(s)
- Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
| | - Yongkoo Lee
- Korea Institute of Machinery & Materials, Daegu, Republic of Korea
| | - Joonho Seo
- Korea Institute of Machinery & Materials, Daegu, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Yong Min Seo
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Sung Soo Kim
- Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Hyun Chul Shon
- Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheong-Ju, Republic of Korea.
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Papagelopoulos PJ, Savvidou OD, Koutsouradis P, Chloros GD, Bolia IK, Sakellariou VI, Kontogeorgakos VA, Mavrodontis II, Mavrogenis AF, Diamantopoulos P. Three-dimensional Technologies in Orthopedics. Orthopedics 2018; 41:12-20. [PMID: 29401368 DOI: 10.3928/01477447-20180109-04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
New 3-dimensional digital technologies are revolutionizing orthopedic clinical practice, allowing structures of any complexity to be manufactured in just hours. Such technologies can make surgery for complex cases more precise, more cost-effective, and possibly easier to perform. Applications include pre-operative planning, surgical simulation, patient-specific instrumentation and implants, bioprinting, prosthetics, and orthotics. The basic principles of 3- dimensional technologies, including imaging, design, numerical simulation, and printing, and their current applications in orthopedics are reviewed. [Orthopedics. 2018; 41(1):12-20.].
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27
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Bannon R, Parihar S, Skarparis Y, Varsou O, Cezayirli E. 3D printing the pterygopalatine fossa: a negative space model of a complex structure. Surg Radiol Anat 2017; 40:185-191. [PMID: 28856438 PMCID: PMC5846833 DOI: 10.1007/s00276-017-1916-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/23/2017] [Indexed: 02/01/2023]
Abstract
PURPOSE The pterygopalatine fossa is one of the most complex anatomical regions to understand. It is poorly visualized in cadaveric dissection and most textbooks rely on schematic depictions. We describe our approach to creating a low-cost, 3D model of the pterygopalatine fossa, including its associated canals and foramina, using an affordable "desktop" 3D printer. METHODS We used open source software to create a volume render of the pterygopalatine fossa from axial slices of a head computerised tomography scan. These data were then exported to a 3D printer to produce an anatomically accurate model. RESULTS The resulting 'negative space' model of the pterygopalatine fossa provides a useful and innovative aid for understanding the complex anatomical relationships of the pterygopalatine fossa. CONCLUSION This model was designed primarily for medical students; however, it will also be of interest to postgraduates in ENT, ophthalmology, neurosurgery, and radiology. The technical process described may be replicated by other departments wishing to develop their own anatomical models whilst incurring minimal costs.
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Affiliation(s)
- Ross Bannon
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, Scotland.
| | - Shivani Parihar
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, Scotland
| | - Yiannis Skarparis
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, Scotland
| | - Ourania Varsou
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, Scotland
| | - Enis Cezayirli
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, Scotland
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Lou Y, Cai L, Wang C, Tang Q, Pan T, Guo X, Wang J. Comparison of traditional surgery and surgery assisted by three dimensional printing technology in the treatment of tibial plateau fractures. INTERNATIONAL ORTHOPAEDICS 2017; 41:1875-1880. [DOI: 10.1007/s00264-017-3445-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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Volumetric Analysis of Alveolar Bone Defect Using Three-Dimensional-Printed Models Versus Computer-Aided Engineering. J Craniofac Surg 2017; 28:383-386. [DOI: 10.1097/scs.0000000000003301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Application of 3D Printing in the Surgical Planning of Trimalleolar Fracture and Doctor-Patient Communication. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2482086. [PMID: 27446944 PMCID: PMC4947492 DOI: 10.1155/2016/2482086] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/08/2016] [Indexed: 12/15/2022]
Abstract
To evaluate the effect of 3D printing in treating trimalleolar fractures and its roles in physician-patient communication, thirty patients with trimalleolar fractures were randomly divided into the 3D printing assisted-design operation group (Group A) and the no-3D printing assisted-design group (Group B). In Group A, 3D printing was used by the surgeons to produce a prototype of the actual fracture to guide the surgical treatment. All patients underwent open reduction and internal fixation. A questionnaire was designed for doctors and patients to verify the verisimilitude and effectiveness of the 3D-printed prototype. Meanwhile, the operation time and the intraoperative blood loss were compared between the two groups. The fracture prototypes were accurately printed, and the average overall score of the verisimilitude and effectiveness of the 3D-printed prototypes was relatively high. Both the operation time and the intraoperative blood loss in Group A were less than those in Group B (P < 0.05). Patient satisfaction using the 3D-printed prototype and the communication score were 9.3 ± 0.6 points. A 3D-printed prototype can faithfully reflect the anatomy of the fracture site; it can effectively help the doctors plan the operation and represent an effective tool for physician-patient communication.
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Naftulin JS, Kimchi EY, Cash SS. Streamlined, Inexpensive 3D Printing of the Brain and Skull. PLoS One 2015; 10:e0136198. [PMID: 26295459 PMCID: PMC4546422 DOI: 10.1371/journal.pone.0136198] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/31/2015] [Indexed: 12/12/2022] Open
Abstract
Neuroimaging technologies such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) collect three-dimensional data (3D) that is typically viewed on two-dimensional (2D) screens. Actual 3D models, however, allow interaction with real objects such as implantable electrode grids, potentially improving patient specific neurosurgical planning and personalized clinical education. Desktop 3D printers can now produce relatively inexpensive, good quality prints. We describe our process for reliably generating life-sized 3D brain prints from MRIs and 3D skull prints from CTs. We have integrated a standardized, primarily open-source process for 3D printing brains and skulls. We describe how to convert clinical neuroimaging Digital Imaging and Communications in Medicine (DICOM) images to stereolithography (STL) files, a common 3D object file format that can be sent to 3D printing services. We additionally share how to convert these STL files to machine instruction gcode files, for reliable in-house printing on desktop, open-source 3D printers. We have successfully printed over 19 patient brain hemispheres from 7 patients on two different open-source desktop 3D printers. Each brain hemisphere costs approximately $3–4 in consumable plastic filament as described, and the total process takes 14–17 hours, almost all of which is unsupervised (preprocessing = 4–6 hr; printing = 9–11 hr, post-processing = <30 min). Printing a matching portion of a skull costs $1–5 in consumable plastic filament and takes less than 14 hr, in total. We have developed a streamlined, cost-effective process for 3D printing brain and skull models. We surveyed healthcare providers and patients who confirmed that rapid-prototype patient specific 3D models may help interdisciplinary surgical planning and patient education. The methods we describe can be applied for other clinical, research, and educational purposes.
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Affiliation(s)
- Jason S. Naftulin
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eyal Y. Kimchi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Sydney S. Cash
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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