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Meesters AML, Assink N, IJpma FFA. Functional outcome of 2-D- and 3-D-guided corrective forearm osteotomies: a systematic review. J Hand Surg Eur Vol 2024; 49:843-851. [PMID: 37747738 DOI: 10.1177/17531934231201962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
We performed a systematic review to compare conventional (2-D) versus 3-D-guided corrective osteotomies regarding intraoperative results, patient-reported outcome measures, range of motion, incidence of complications and pain score. PubMed (MEDLINE), Embase and Cochrane CENTRAL were searched, and 53 articles were included, reporting 1257 patients undergoing forearm corrective osteotomies between 2010 and 2022. 3-D-guided surgery resulted in a greater improvement in median Disabilities of the Arm, Shoulder and Hand (DASH) score (28, SD 7 vs. 35, SD 5) and fewer complications (12% vs. 6%). Pain scores and range of motion were similar between 3-D-guided and conventional surgery. 3-D-guided corrective osteotomy surgery appears to improve patient-reported outcomes and reduce complications compared to conventional methods. However, due to the limited number of comparative studies and the heterogeneity of the studies, a large randomized controlled trial is needed to draw definitive conclusions.Level of evidence: III.
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Affiliation(s)
- Anne M L Meesters
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- 3D Lab, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Nick Assink
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- 3D Lab, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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2
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Tetsworth KD, Welyczko ZH, Quinnan SM. Indications for Nonbiological Reconstruction of Posttraumatic Bone Defects About the Knee. J Orthop Trauma 2024; 38:S23-S29. [PMID: 38502600 DOI: 10.1097/bot.0000000000002764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 03/21/2024]
Abstract
SUMMARY 3D printing and modeling has continued to grow in popularity over the past decade because the technology has matured and become more affordable and widely available. The main indications for nonbiological reconstruction of large bone defects are principally those patients where the candidate is unlikely to be successful if reconstructed by other means. Bespoke, custom, patient-specific implants can be designed to very effectively address bone loss, incorporating design elements that are particular to the needs of any given unique clinical condition. These implants are generally designed as titanium scaffolds that encourage bony incorporation at the host implant junction both proximal and distal. These scaffolds are typically considered a cellular solid, with high porosity that also promotes bone ingrowth directly into the substance of the body of the implant. Titanium scaffolds of this type have become a useful treatment alternative for large segmental bone defects around the knee, especially distal femoral defects. These are often adult patients with local or systemic compromise, or instead they may be too young to be considered candidates for reconstruction using a megaprosthesis. The process requires careful evaluation of individual patients, then matching that patient with the best treatment option, while recognizing the expectations and demands specific to that particular patient. Several cases are presented here to illustrate the variety of indications that can be successfully addressed with this technology, highlighting the quality of the clinical outcome that can be achieved despite the complexity of the pathology encountered.
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Affiliation(s)
- Kevin D Tetsworth
- Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Australia
- Orthopaedic Research Centre of Australia, Brisbane, Australia
- Herston Biofabrication Institute, Brisbane, Australia
| | - Zhenya H Welyczko
- Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Australia
- Department of Orthopaedic Surgery, The Princess Alexandra Hospital, Brisbane, Australia; and
| | - Stephen M Quinnan
- The Paley Orthopedic and Spine Institute, St. Mary's Medical Center, West Palm Beach, FL
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3
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Haandrikman S, Schröder FF, de Graaff F, olde Heuvel J, Vochteloo AJH. Three cases of posttraumatic wrist problems solved with 3D-printed patient-specific guides. Case Reports Plast Surg Hand Surg 2024; 11:2311730. [PMID: 38328682 PMCID: PMC10849004 DOI: 10.1080/23320885.2024.2311730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
Symptomatic malunion of the wrist is one of the most common posttraumatic wrist problems. This study demonstrates three patients with complex malunions of the wrist who benefited from a corrective osteotomy using preplanned 3D-printed patient-specific guides, by experiencing improvement in their wrist function, grip strength and a reduction in pain.
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Affiliation(s)
| | | | - Feike de Graaff
- Centre for Orthopaedic Surgery OCON, Hengelo, The Netherlands
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4
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Ray S, Manske MC. Pediatric Forearm Malunions. Hand Clin 2024; 40:35-48. [PMID: 37979989 DOI: 10.1016/j.hcl.2023.08.016] [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] [Indexed: 11/20/2023]
Abstract
The aim of this article is to review the evaluation and management of pediatric forearm malunions. Acceptable parameters for nonoperative management of pediatric forearm fractures are reviewed, followed by clinical and imaging workups of malunions and decision-making points for treatment. The landscape of available technology for planning and execution of corrective osteotomy is discussed. Several cases of pediatric forearm malunion are presented, along with surgical and functional outcomes. Recommendations are given regarding the authors' preferred approach for management of pediatric forearm malunions.
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Affiliation(s)
- Shea Ray
- Department of Orthopedic Surgery, Shriners Hospital for Children Northern California, Sacramento, CA, USA
| | - M Claire Manske
- Department of Orthopedic Surgery, Shriners Hospital for Children Northern California, Sacramento, CA, USA; Department of Orthopedic Surgery, University of California Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA.
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5
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Oldhoff MGE, Assink N, Kraeima J, de Vries JPPM, Ten Duis K, Meesters AML, IJpma FFA. 3D-assisted corrective osteotomies of the distal radius: a comparison of pre-contoured conventional implants versus patient-specific implants. Eur J Trauma Emerg Surg 2024; 50:37-47. [PMID: 38261077 PMCID: PMC10924012 DOI: 10.1007/s00068-023-02415-5] [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: 09/29/2023] [Accepted: 11/25/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE There is a debate whether corrective osteotomies of the distal radius should be performed using a 3D work-up with pre-contoured conventional implants (i.e., of-the-shelf) or patient-specific implants (i.e., custom-made). This study aims to assess the postoperative accuracy of 3D-assisted correction osteotomy of the distal radius using either implant. METHODS Twenty corrective osteotomies of the distal radius were planned using 3D technologies and performed on Thiel embalmed human cadavers. Our workflow consisted of virtual surgical planning and 3D printed guides for osteotomy and repositioning. Subsequently, left radii were fixated with patient-specific implants, and right radii were fixated with pre-contoured conventional implants. The accuracy of the corrections was assessed through measurement of rotation, dorsal and radial angulation and translations with postoperative CT scans in comparison to their preoperative virtual plan. RESULTS Twenty corrective osteotomies were executed according to their plan. The median differences between the preoperative plan and postoperative results were 2.6° (IQR: 1.6-3.9°) for rotation, 1.4° (IQR: 0.6-2.9°) for dorsal angulation, 4.7° (IQR: 2.9-5.7°) for radial angulation, and 2.4 mm (IQR: 1.3-2.9 mm) for translation of the distal radius, thus sufficient for application in clinical practice. There was no significant difference in accuracy of correction when comparing pre-contoured conventional implants with patient-specific implants. CONCLUSION 3D-assisted corrective osteotomy of the distal radius with either pre-contoured conventional implants or patient-specific implants results in accurate corrections. The choice of implant type should not solely depend on accuracy of the correction, but also be based on other considerations like the availability of resources and the preoperative assessment of implant fitting.
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Affiliation(s)
- Miriam G E Oldhoff
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joep Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anne M L Meesters
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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6
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Ackermann J, Hoch A, Snedeker JG, Zingg PO, Esfandiari H, Fürnstahl P. Automatic 3D Postoperative Evaluation of Complex Orthopaedic Interventions. J Imaging 2023; 9:180. [PMID: 37754944 PMCID: PMC10532700 DOI: 10.3390/jimaging9090180] [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: 07/19/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023] Open
Abstract
In clinical practice, image-based postoperative evaluation is still performed without state-of-the-art computer methods, as these are not sufficiently automated. In this study we propose a fully automatic 3D postoperative outcome quantification method for the relevant steps of orthopaedic interventions on the example of Periacetabular Osteotomy of Ganz (PAO). A typical orthopaedic intervention involves cutting bone, anatomy manipulation and repositioning as well as implant placement. Our method includes a segmentation based deep learning approach for detection and quantification of the cuts. Furthermore, anatomy repositioning was quantified through a multi-step registration method, which entailed a coarse alignment of the pre- and postoperative CT images followed by a fine fragment alignment of the repositioned anatomy. Implant (i.e., screw) position was identified by 3D Hough transform for line detection combined with fast voxel traversal based on ray tracing. The feasibility of our approach was investigated on 27 interventions and compared against manually performed 3D outcome evaluations. The results show that our method can accurately assess the quality and accuracy of the surgery. Our evaluation of the fragment repositioning showed a cumulative error for the coarse and fine alignment of 2.1 mm. Our evaluation of screw placement accuracy resulted in a distance error of 1.32 mm for screw head location and an angular deviation of 1.1° for screw axis. As a next step we will explore generalisation capabilities by applying the method to different interventions.
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Affiliation(s)
- Joëlle Ackermann
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, 8093 Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jess Gerrit Snedeker
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, 8093 Zurich, Switzerland
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Patrick Oliver Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Hooman Esfandiari
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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7
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Mania S, Zindel C, Götschi T, Carrillo F, Fürnstahl P, Schweizer A. Malunion deformity of the forearm: Three-dimensional length variation of interosseous membrane and bone collision. J Orthop Res 2023; 41:727-736. [PMID: 35953296 DOI: 10.1002/jor.25428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 06/27/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
It remains unclear to what extent the interosseous membrane (IOM) is affected through the whole range of motion (ROM) in posttraumatic deformities of the forearm. The purpose of this study is to describe the ligament- and bone-related factors involved in rotational deficit of the forearm. Through three-dimensional (3D) kinematic simulations on one cadaveric forearm, angular deformities of 5° in four directions (flexion, extension, valgus, varus) were produced at two locations of the radius and the ulna (proximal and distal third). The occurrence of bone collision in pronation and the linear length variation of six parts of the IOM through the whole ROM were compared between the 32 types of forearm deformities. Similar patterns could be observed among four groups: 12 types of deformity presented increased bone collision in pronation, 8 presented an improvement of bone collision with an increase of the mean linear lengthening of the IOM in neutral rotation, 6 had an increased linear lengthening of the IOM in supination with nearly unchanged bone collision in pronation and 6 types presented nearly unchanged bone collision in pronation with a shortening of the mean linear length of IOM in supination or neutral rotation. This kinematic analysis provides a better understanding of the ligament- and bone-related factors expected to cause rotational deficit in forearm deformity and may help to refine the surgical indications of patient-specific corrective osteotomy.
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Affiliation(s)
- Sylvano Mania
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christoph Zindel
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Tobias Götschi
- Research in Orthopaedic Computer Science Group, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Fabio Carrillo
- Research in Orthopaedic Computer Science Group, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science Group, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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8
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The Flipping-Wedge Osteotomy: How 3D Virtual Surgical Planning (VSP) Suggested a Simple and Promising Type of Osteotomy in Pediatric Post-Traumatic Forearm Deformity. J Pers Med 2023; 13:jpm13030549. [PMID: 36983730 PMCID: PMC10058750 DOI: 10.3390/jpm13030549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
(1) Background: The application of computer-aided planning in the surgical treatment of post-traumatic forearm deformities has been increasingly widening the range of techniques over the last two decades. We present the “flipping-wedge osteotomy”, a promising geometrical approach to correct uniapical deformities defined during our experience with virtual surgical planning (VSP); (2) Methods: a case of post-traumatic distal radius deformity (magnitude 43°) treated with a flipping-wedge osteotomy in an 11-year-old girl is reported, presenting the planning rationale, its geometrical demonstration, and the outcome of the procedure; (3) Results: surgery achieved correction of both the angular and rotational deformities with a neutral ulnar variance; (4) Conclusions: flipping-wedge osteotomy may be a viable option to achieve correction in forearm deformities, and it deserves further clinical investigation.
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9
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3D accuracy and clinical outcomes of corrective osteotomies with patient-specific instruments in complex upper extremity deformities: an approach for investigation and correlation. Eur J Med Res 2022; 27:197. [PMID: 36209123 PMCID: PMC9548141 DOI: 10.1186/s40001-022-00830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Corrective osteotomies of the upper extremities with patient-specific instruments (PSIs) are increasingly used. In this context, the concordance between planning and postoperative 3D radiographs as well as the association between 3D accuracy and clinical outcome has rarely been evaluated. In this pilot study, we aimed to investigate our clinical mid-term outcome and 3D accuracy as well as their possible correlation, including identifying aspects critical to reaching optimal correction results. Methods From October 2018 to January 2020, we used PSIs for 12 corrective osteotomies of the upper extremity in 11 bones of 8 patients (congenital or posttraumatic deformities in 2 elbows, 3 forearms, 3 distal radii). In follow-up examination (10–25 months postoperatively), patient satisfaction, grip strength, ROM, VAS, and DASH were evaluated. Three-dimensional radiological accuracy was determined with 3D-reconstructed postoperative CT scans. With the software tool “Part Comparison” of Mimics® Innovation Suite Software/Materialise, surface differences of pre-planned and postoperative 3D models were compared. Results Compared to the preoperative situation pain and function were better at follow-up: The average VAS score significantly decreased from 6.5 ± 4.1 cm preoperatively to 2.3 ± 2.6 cm at the follow-up time point (p = 0.008). The average DASH score significantly improved, from 48.4 ± 30.9 to 27.0 ± 25.2 (p = 0.015). In the part comparison analysis “planned vs postoperative comparison”, significantly more points in percent (= 3D accuracy) were in a −3 mm to 3 mm interval than in the “preoperative vs planned comparison” (87.3 ± 13.8% vs 48.9 ± 16.6%, p = 0.004). After surgery, the maximum deviation value over all cases was 4.5 ± 1.1 mm, and the minimum deviation value was − 4.5 ± 1.2 mm vs preoperatively 12.9 ± 6.2 mm (p = 0.004) and − 7.2 ± 2.1 mm (p = 0.02), respectively. Clinically, in all cases with higher accuracy (> 90%), an improvement of either DASH or VAS or both of > 60% to the preoperative values occurred. There was a significant correlation between accuracy (%) and ΔVAS (p = 0.004). There were no method-related complications. Conclusions Our data after PSI-based corrective osteotomy in complex deformities of the upper extremity in a limited number of cases indicate a positive correlation between 3D accuracy and clinical outcomes. Examination of 3D accuracy to analyse sources of error in the hole procedure from initial CT scan to end of surgery even in patients with not fully satisfactory clinical results is required for further development of the method to achieve optimal correction results with nearly 100% congruence between the planned and postoperative 3D bone position. Trial registration This retrospective study was registered in the Center for Translational & Clinical Research Aachen (CTC-A) with the number 20-514 on November 20, 2021
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10
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SHIM BJ, LEE JH, GONG HS. Preoperative Three-Dimensional Simulation of Osteotomy for Correction of Malunion of Both Bones of Forearm: A Case Report. J Hand Surg Asian Pac Vol 2022; 27:726-731. [DOI: 10.1142/s2424835522720341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Corrective osteotomy of malunion of both forearm bones is a challenging procedure because it needs accurate angular and rotational correction of both bones. Recent advances in three-dimensional (3D) printing techniques have shown promising results in the correction of complex deformities. We report a patient with malunion of both bones of the forearm in whom we determined site and degree of correction required based on the computed tomography images of the affected side and mirrored images of the contralateral healthy side. We then created 3D printed sawbones and simulated osteotomy to confirm stable dynamic forearm rotation. This method enabled satisfactory restoration of anatomical and functional outcomes. Preoperative dynamic motion simulation using 3D printed anatomic bone model is helpful for complex corrective osteotomy of forearm fracture malunion. Level of Evidence: Level V (Therapeutic)
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Affiliation(s)
- Bum J. SHIM
- Department of Orthopedic Surgery, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jeong H. LEE
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun S. GONG
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Li TP, Wollstein A, Sabharwal S, Nayar SK, Sabharwal S. Malunion of Pediatric Forearm Shaft Fractures: Management Principles and Techniques. Curr Rev Musculoskelet Med 2022; 15:427-437. [PMID: 35876970 PMCID: PMC9789287 DOI: 10.1007/s12178-022-09783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Clinically significant malunion of forearm diaphyseal fractures is an uncommon but potentially disabling condition amongst children and adolescents. We present the preoperative evaluation, including imaging, and discuss surgical indications and contemporary approaches to manage such patients, including an illustrative case. RECENT FINDINGS While advances in three-dimensional (3D) simulation, modeling, and patient-specific instrumentation have expanded the surgical armamentarium, their impact on long-term outcomes compared to traditional methods remains unknown. Successful outcome following surgical correction of malunion following a both-bone forearm fracture can be achieved with careful patient selection, appropriate indications, and a well-planned surgical execution.
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Affiliation(s)
- T. Peter Li
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Adi Wollstein
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Samir Sabharwal
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Suresh K. Nayar
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Sanjeev Sabharwal
- Department of Orthopaedic Surgery, University of California San Francisco, Benioff Children’s Hospital, Oakland, CA USA
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12
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Moreta J, Gayoso Ó, Donaire-Hoyas D, Roces-García J, Gómez-Vallejo J, Moya-Gómez E, Raya-Roldán D, Albert-Ullibarri A, Marqués-López F, Albareda J. Orthopedic Surgeons’ Accuracy When Orienting an Acetabular Cup. A Comparison with Untrained Individuals. Medicina (B Aires) 2022; 58:medicina58070973. [PMID: 35888692 PMCID: PMC9317603 DOI: 10.3390/medicina58070973] [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: 06/20/2022] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives: Previous studies demonstrated a huge variability among surgeons when it comes to reproducing the position of an acetabular cup in total hip arthroplasty. Our main objective is to determine if orthopedic surgeons can replicate a given orientation on a pelvic model better than untrained individuals. Our secondary objective is to determine if experience has any influence on their ability for this task. Materials and Methods: A group of specialist orthopedic hip surgeons and a group of volunteers with no medical training were asked to reproduce three given (randomly generated) acetabular cup orientations (inclination and anteversion) on a pelvic model. Error was measured by means of a hip navigation system and comparisons between groups were made using the appropriate statistical methods. Results: The study included 107 individuals, 36 orthopedic surgeons and 71 untrained volunteers. The mean error among surgeons was slightly greater as regards both inclination (7.84 ± 5.53 vs. 6.70 ± 4.03) and anteversion (5.85 ± 4.52 vs. 5.48 ± 3.44), although statistical significance was not reached (p = 0.226 and p = 0.639, respectively). Similarly, although surgeons with more than 100 procedures a year obtained better results than those with less surgical experience (8.01 vs. 7.67 degrees of error in inclination and 5.83 vs. 5.87 in anteversion), this difference was not statistically significant, either (p = 0.852 and p = 0.981). Conclusions: No differences were found in the average error made by orthopedic surgeons and untrained individuals. Furthermore, the surgeons’ cup orientation accuracy was not seen to improve significantly with experience.
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Affiliation(s)
- Jesús Moreta
- Department of Orthopedic Surgery and Traumatology, Hospital Galdakao-Usansolo, 48960 Galdakao, Spain
- Correspondence:
| | - Óscar Gayoso
- Department of Orthopedic Surgery and Traumatology, Hospital San Rafael, 15006 A Coruña, Spain;
| | - Daniel Donaire-Hoyas
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Jorge Roces-García
- Department of Construction and Manufacturing Engineering, Polytechnic School of Engineering of Gijón, University of Oviedo, 33204 Gijón, Spain;
| | - Jesús Gómez-Vallejo
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (J.G.-V.); (J.A.)
| | - Esther Moya-Gómez
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Cruz y San Pablo, 08025 Barcelona, Spain;
| | - David Raya-Roldán
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Alberto Albert-Ullibarri
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Fernando Marqués-López
- Department of Orthopedic Surgery and Traumatology, Parc de Salut Mar, 08003 Barcelona, Spain;
| | - Jorge Albareda
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (J.G.-V.); (J.A.)
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13
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De Armond CC, Lewis DD, Kim SE, Biedrzycki AH. Accuracy of virtual surgical planning and custom three-dimensionally printed osteotomy and reduction guides for acute uni- and biapical correction of antebrachial deformities in dogs. J Am Vet Med Assoc 2022; 260:1-9. [PMID: 35460550 DOI: 10.2460/javma.21.09.0419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report clinical experience using virtual surgical planning (VSP) and surgical application of 3D printed custom surgical guides to facilitate uni- and biapical correction of antebrachial deformities in dogs. ANIMALS 11 dogs (13 antebrachial deformity corrections). PROCEDURES Using CT-based bone models, VSP was performed, and surgical guides were designed and 3D printed. The guides were used to execute osteotomies and align bone segments. Postoperative CTs were obtained to compare limb alignment with the VSP. Long-term assessment of lameness and cosmesis were compared with preoperative status. RESULTS Guides were successfully utilized and postoperative analysis was available for 10 of 13 deformities. Guides were abandoned in 2 deformities due to soft tissue tension. Evaluation of postoperative frontal, sagittal, axial, and translational limb alignment revealed that over 90% of parameters were within the acceptable range of ≤ 5° angulation and rotation or ≤ 5 mm of translation from the VSP. Lameness scores were improved in 7/8 deformities with associated preoperative lameness, and posture was improved in 10/10 deformities in which guides were deployed. Complications included reduced range of carpal motion (n = 2), implant sensitivity (n = 2), fracture (n = 1), and tendon laceration (n = 1). CLINICAL RELEVANCE VSP and customized surgical guide application facilitated accurate antebrachial limb deformity correction in the majority of deformities in this case series. The use of VSP and 3D printed guides would appear to be a viable and accurate approach for correction of both uni- and biapical antebrachial deformities in dogs.
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Affiliation(s)
- Christina C De Armond
- 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Daniel D Lewis
- 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Stanley E Kim
- 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Adam H Biedrzycki
- 2Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
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Cornejo J, Cornejo-Aguilar JA, Vargas M, Helguero CG, Milanezi de Andrade R, Torres-Montoya S, Asensio-Salazar J, Rivero Calle A, Martínez Santos J, Damon A, Quiñones-Hinojosa A, Quintero-Consuegra MD, Umaña JP, Gallo-Bernal S, Briceño M, Tripodi P, Sebastian R, Perales-Villarroel P, De la Cruz-Ku G, Mckenzie T, Arruarana VS, Ji J, Zuluaga L, Haehn DA, Paoli A, Villa JC, Martinez R, Gonzalez C, Grossmann RJ, Escalona G, Cinelli I, Russomano T. Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6797745. [PMID: 35372574 PMCID: PMC8970887 DOI: 10.1155/2022/6797745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system. Finally, the integration with augmented, mixed, virtual reality is analyzed to show the advantages of personalized treatments, taking into account the improvements for preoperative, intraoperative planning, and medical training. Also, this article explores the creation of devices and tools for space surgery to get better outcomes under changing gravity conditions.
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Affiliation(s)
- José Cornejo
- Facultad de Ingeniería, Universidad San Ignacio de Loyola, La Molina, Lima 15024, Peru
- Department of Medicine and Biology & Department of Physics and Engineering, Bioastronautics and Space Mechatronics Research Group, Lima 15024, Peru
| | | | | | | | - Rafhael Milanezi de Andrade
- Robotics and Biomechanics Laboratory, Department of Mechanical Engineering, Universidade Federal do Espírito Santo, Brazil
| | | | | | - Alvaro Rivero Calle
- Department of Oral and Maxillofacial Surgery, Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Martínez Santos
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Aaron Damon
- Department of Neurosurgery, Mayo Clinic, FL, USA
| | | | | | - Juan Pablo Umaña
- Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotá DC, Colombia
| | | | - Manolo Briceño
- Villamedic Group, Lima, Peru
- Clínica Internacional, Lima, Peru
| | | | - Raul Sebastian
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
| | | | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Peru
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jiakai Ji
- Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, NY, USA
| | - Laura Zuluaga
- Department of Urology, Fundación Santa Fe de Bogotá, Colombia
| | | | - Albit Paoli
- Howard University Hospital, Washington, DC, USA
| | | | | | - Cristians Gonzalez
- Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut of Image-Guided Surgery (IHU-Strasbourg), Strasbourg, France
| | | | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ilaria Cinelli
- Aerospace Human Factors Association, Aerospace Medical Association, VA, USA
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15
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Roth KC, van Es EM, Kraan GA, Verhaar JAN, Stockmans F, Colaris JW. Outcomes of 3-D corrective osteotomies for paediatric malunited both-bone forearm fractures. J Hand Surg Eur Vol 2022; 47:164-171. [PMID: 34260312 PMCID: PMC8801669 DOI: 10.1177/17531934211029511] [Citation(s) in RCA: 2] [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: 02/03/2023]
Abstract
Closed treatment of paediatric diaphyseal forearm fractures carries the risk of re-displacement, which can lead to symptomatic malunions. This is because growth will not correct angulation deformity as it does in metaphyseal fractures. The purpose of this prospective cohort study was to evaluate the outcomes after 3-D-planned corrective osteotomy with patient-specific surgical guides for paediatric malunited forearm fractures causing impaired pro-supination. Our primary outcome measure was the gain in pro-supination at 12 months follow-up. Fifteen patients with a mean age at trauma of 9.6 years and time until osteotomy of 5.9 years were included. Preoperatively, patients displayed a mean pro-supination of 67° corresponding to 44% of the contralateral forearm. At final follow-up, this improved to 128°, achieving 85% of the contralateral side. Multivariate linear regression analysis revealed that predictors of greater functional gain after 3-D corrective osteotomy are severe preoperative impairment in pro-supination, shorter interval until 3-D corrective osteotomy and greater angulation of the radius.Level of evidence: III.
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Affiliation(s)
- Kasper C. Roth
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands,Kasper C. Roth, Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Eline M. van Es
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerald A. Kraan
- Department of Orthopaedics, Reinier HAGA Orthopaedic Centre, Zoetermeer, The Netherlands
| | - Jan A. N. Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Joost W. Colaris
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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16
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Three-Dimensional Printing in Hand Surgery. J Hand Surg Am 2021; 46:1016-1022. [PMID: 34274209 DOI: 10.1016/j.jhsa.2021.05.028] [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: 01/21/2021] [Revised: 05/05/2021] [Accepted: 05/14/2021] [Indexed: 02/02/2023]
Abstract
The medical application of 3-dimensional printing technology has evolved in the last decade, with an increasing variety of uses in hand surgery. The ability for patient-specific design, rapid prototyping, and low cost of production of 3-dimensional printed materials has led to this rise in clinical applications, both for common procedures and complex reconstructions. Within hand surgery, 3-dimensional printing can be applied in several broad categories: to construct patient-specific models for preoperative planning, to design orthotics and prosthetics to meet specific patient demands, to create patient-specific aids for intraoperative use, to generate patient-specific hardware and prostheses for implantation, and for applications for trainee education.
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17
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Patient-Specific Guided Osteotomy to Correct a Symptomatic Malunion of the Left Forearm. CHILDREN-BASEL 2021; 8:children8080707. [PMID: 34438598 PMCID: PMC8394506 DOI: 10.3390/children8080707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 12/02/2022]
Abstract
We present a case report of a 12-year old female with a midshaft forearm fracture. Initial conservative treatment with a cast failed, resulting in a malunion. The malunion resulted in functional impairment for which surgery was indicated. A corrective osteotomy was planned using 3D analyses of the preoperative CT-scan. Subsequently, patient-specific guides were printed and used during the procedure to precisely correct the malunion. Three months after surgery, the radiographs showed full consolidation and the patient was pain-free with full range of motion and comparable strength in both forearms. The current case report shows that a corrective osteotomy with patient-specific guides based on preoperative 3D analyses can help surgeons to plan and precisely correct complex malunions resulting in improved functional outcomes.
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18
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Menor Fusaro F, Di Felice Ardente P, Pérez Abad M, Yanguas Muns C. Three-dimensional imaging, modeling, and printing in the correction of a complex clavicle malunion. JSES Int 2021; 5:729-733. [PMID: 34223422 PMCID: PMC8246001 DOI: 10.1016/j.jseint.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Park KM, Marcellin-Little DJ, Garcia TC. Evaluation of computer-aided design software methods for assessment of the three-dimensional geometry of the canine radius. Am J Vet Res 2021; 82:435-448. [PMID: 34032484 DOI: 10.2460/ajvr.82.6.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe methods to measure the 3-D orientation of the proximal, diaphyseal, and distal segments of the canine radius by use of computer-aided design software (CADS) and to compare the repeatability and reliability of measurements derived by those methods. SAMPLE 31 canine radii with biapical deformities and 24 clinically normal (control) canine radii. PROCEDURES Select CT scans of radii were imported into a CADS program. Cartesian coordinate systems for the humerus and proximal, diaphyseal, and distal radial segments were developed. The orientation of each radial segment in the frontal, sagittal, and transverse planes was measured in triplicate by 3 methods. The repeatability and reliability of those measurements were calculated and compared among the 3 measurement methods. RESULTS The mean ± SD within-subject repeatability of radial angular measurements for all 3 methods was 1.40 ± 0.67° in the frontal plane, 3.17 ± 2.21° in the sagittal plane, and 3.01 ± 1.11° in the transverse plane for control radii and 2.56 ± 1.95° in the frontal plane, 3.59 ± 2.39° in the sagittal plane, and 3.47 ± 1.19° in the transverse plane for abnormal radii. Mean ± SD bias between radial measurement methods was 1.88 ± 2.07° in the frontal plane, 6.44 ± 6.80° in the sagittal plane, and 2.27 ± 2.81° in the transverse plane. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that use of CADS to assess the 3-D orientation of the proximal, diaphyseal, and distal segments of normal and abnormal canine radii yielded highly repeatable and reliable measurements.
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20
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Frizziero L, Santi GM, Leon-Cardenas C, Donnici G, Liverani A, Papaleo P, Napolitano F, Pagliari C, Di Gennaro GL, Stallone S, Stilli S, Trisolino G, Zarantonello P. In-House, Fast FDM Prototyping of a Custom Cutting Guide for a Lower-Risk Pediatric Femoral Osteotomy. Bioengineering (Basel) 2021; 8:bioengineering8060071. [PMID: 34073324 PMCID: PMC8230284 DOI: 10.3390/bioengineering8060071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 12/01/2022] Open
Abstract
Three-dimensional printed custom cutting guides (CCGs) are becoming more and more investigated in medical literature, as a patient-specific approach is often desired and very much needed in today’s surgical practice. Three-dimensional printing applications and computer-aided surgical simulations (CASS) allow for meticulous preoperatory planning and substantial reductions of operating time and risk of human error. However, several limitations seem to slow the large-scale adoption of 3D printed CCGs. CAD designing and 3D printing skills are inevitably needed to develop workflow and address the study; therefore, hospitals are pushed to include third-party collaboration, from highly specialized medical centers to industrial engineering companies, thus increasing the time and cost of labor. The aim of this study was to move towards the feasibility of an in-house, low-cost CCG 3D printing methodology for pediatric orthopedic (PO) surgery. The prototype of a femoral cutting guide was developed for its application at the IOR—Rizzoli Orthopedic Institute of Bologna. The element was printed with an entry-level 3D printer with a high-temperature PLA fiber, whose thermomechanical properties can withstand common steam heat sterilization without bending or losing the original geometry. This methodology allowed for extensive preoperatory planning that would likewise reduce the overall surgery time, whilst reducing the risks related to the intervention.
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Affiliation(s)
- Leonardo Frizziero
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
- Correspondence:
| | - Gian Maria Santi
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Christian Leon-Cardenas
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Giampiero Donnici
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Alfredo Liverani
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Paola Papaleo
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Francesca Napolitano
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Curzio Pagliari
- Department of Industrial Engineering, Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy; (G.M.S.); (C.L.-C.); (G.D.); (A.L.); (P.P.); (F.N.); (C.P.)
| | - Giovanni Luigi Di Gennaro
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
| | - Stefano Stallone
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
| | - Stefano Stilli
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
| | - Giovanni Trisolino
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
| | - Paola Zarantonello
- IRCCS—Istituto Ortopedico Rizzoli (Rizzoli Orthopaedic Institute), Paediatric Orthopaedics and Traumatology, 40136 Bologna, Italy; (G.L.D.G.); (S.S.); (S.S.); (G.T.); (P.Z.)
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21
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Shigi A, Oka K, Tanaka H, Shiode R, Murase T. Utility of a 3-dimensionally printed color-coded bone model to visualize impinging osteophytes for arthroscopic débridement arthroplasty in elbow osteoarthritis. J Shoulder Elbow Surg 2021; 30:1152-1158. [PMID: 33486060 DOI: 10.1016/j.jse.2020.12.002] [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: 03/30/2020] [Revised: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The identification and precise removal of bony impingement lesions during arthroscopic débridement arthroplasty for elbow osteoarthritis require a high level of experience and surgical skill. We have developed a new technique to identify impinging osteophytes on a computer display by simulating elbow motion using the multiple positions of 3-dimensional (3D) elbow models created from computed tomography data. Moreover, an actual color-coded 3D model indicating the impinging osteophytes was created with a 3D printer and was used as an intraoperative reference tool. This study aimed to verify the efficacy of these new technologies in arthroscopic débridement for elbow osteoarthritis. METHODS We retrospectively studied 16 patients treated with arthroscopic débridement for elbow osteoarthritis after a preoperative computer simulation. Patients who underwent surgery with only the preoperative simulation were assigned to group 1 (n = 8), whereas those on whom we operated using a color-coded 3D bone model created from the preoperative simulation were assigned to group 2 (n = 8). Elbow extension and flexion range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the severity of osteoarthritis were compared between the groups. RESULTS Although preoperative elbow flexion and MEPS values were not significantly different between the groups, preoperative extension was significantly more restricted in group 2 than in group 1 (P = .0131). Group 2 tended to include more severe cases according to the Hastings-Rettig classification (P = .0693). ROM and MEPS values were improved in all cases. No significant differences in postoperative ROM or MEPS values were observed between the groups. There were no significant differences in the improvement in ROM or MEPS values between the 2 groups. CONCLUSIONS The use of preoperative simulation and a color-coded bone model could help to achieve as good postoperative ROM and MEPS values for advanced elbow osteoarthritis as those for early and intermediate stages.
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Affiliation(s)
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryoya Shiode
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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De Armond CC, Kim SE, Lewis DD, Biedryzcki AH, Banks SA, Cook JL, Keister JD. Three-dimensional-printed custom guides for bipolar coxofemoral osteochondral allograft in dogs. PLoS One 2021; 16:e0244208. [PMID: 33561146 PMCID: PMC7872253 DOI: 10.1371/journal.pone.0244208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/04/2020] [Indexed: 12/03/2022] Open
Abstract
The objective of this experimental study was to develop and evaluate a three-dimensionally printed custom surgical guide system for performing bipolar coxofemoral osteochondral allograft transplantation in dogs. Five cadaver dogs, weighing 20–38 kg were used in the study. Custom surgical guides were designed and three-dimensionally printed to facilitate accurate execution of a surgical plan for bipolar coxofemoral osteochondral allograft transplantation. Guide-assisted technique was compared to freehand technique in each cadaver. Surgical time was recorded and postoperative computed tomography and three-dimensional segmentation was performed. Femoral version and inclination angles, femoral neck length, and gap present at the femoral and acetabular donor-recipient interface was compared between the virtual surgical plan and postoperative outcome for both techniques. One-tailed paired t-test (P < .05) was used for statistical analysis. When compared to free-hand preparation, mean donor femoral preparation time was 10 minutes longer and mean recipient preparation time was 2 minutes longer when using guides (p = 0.011 and p = 0.001, respectively). No difference in acetabular preparation time was noted between groups. Gap volume at the acetabular and femoral donor-recipient interface was not different between groups. Mean difference between the planned and postoperative version angle was 6.2° lower for the guide group when compared to the freehand group (p = 0.025). Mean femoral neck length was 2 mm closer to the plan when using guides than when performing surgery freehand (p = 0.037). Accuracy for femoral angle of inclination was not different between groups. Custom surgical guides warrants consideration in developing bipolar coxofemoral osteochondral allograft transplantation as an alternative surgical technique for managing hip disorders in dogs.
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Affiliation(s)
- Christina C. De Armond
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, United States of America
| | - Stanley E. Kim
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, United States of America
- * E-mail:
| | - Daniel D. Lewis
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, United States of America
| | - Adam H. Biedryzcki
- Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, United States of America
| | - Scott A. Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, United States of America
| | - James L. Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics & Mizzou BioJoint Center, University of Missouri, Columbia, Missouri, United States of America
| | - Justin D. Keister
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, United States of America
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23
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Saravi B, Lang G, Steger R, Vollmer A, Zwingmann J. Corrective Osteotomy of Upper Extremity Malunions Using Three-Dimensional Planning and Patient-Specific Surgical Guides: Recent Advances and Perspectives. Front Surg 2021; 8:615026. [PMID: 33614702 PMCID: PMC7887308 DOI: 10.3389/fsurg.2021.615026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
Malunions of the upper extremity can result in severe functional problems and increase the risk of osteoarthritis. The surgical reconstruction of complex malunions can be technically challenging. Recent advances in computer-assisted orthopedic surgery provide an innovative solution for complex three-dimensional (3-D) reconstructions. This study aims to evaluate the clinical applicability of 3-D computer-assisted planning and surgery for upper extremity malunions. Hence, we provide a summary of evidence on this topic and highlight recent advances in this field. Further, we provide a practical implementation of this therapeutic approach based on three cases of malunited forearm fractures treated with corrective osteotomy using preoperative three-dimensional simulation and patient-specific surgical guides. All three cases, one female (56 years old) and two males (18 and 26 years old), had painful restrictions in range of motion (ROM) due to forearm malunions and took part in clinical and radiologic assessments. Postoperative evaluation of patient outcomes showed a substantial increase in range of motion, reduction of preoperatively reported pain, and an overall improvement of patients' satisfaction. The therapeutic approach used in these cases resulted in an excellent anatomical and functional reconstruction and was assessed as precise, safe, and reliable. Based on current evidence and our results, the 3-D preoperative planning technique could be the new gold standard in the treatment of complex upper extremity malunions in the future.
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Affiliation(s)
- Babak Saravi
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Rebecca Steger
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jörn Zwingmann
- Department of Orthopedics and Trauma Surgery, St. Elisabeth Hospital Ravensburg, Ravensburg, Germany
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Raza M, Murphy D, Gelfer Y. The effect of three-dimensional (3D) printing on quantitative and qualitative outcomes in paediatric orthopaedic osteotomies: a systematic review. EFORT Open Rev 2021; 6:130-138. [PMID: 33828856 PMCID: PMC8022016 DOI: 10.1302/2058-5241.6.200092] [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: 12/15/2022] Open
Abstract
Three-dimensional (3D) printing technology is increasingly being utilized in various surgical specialities. In paediatric orthopaedics it has been applied in the pre-operative and intra-operative stages, allowing complex deformities to be replicated and patient-specific instrumentation to be used. This systematic review analyses the literature on the effect of 3D printing on paediatric orthopaedic osteotomy outcomes.A systematic review of several databases was conducted according to PRISMA guidelines. Studies evaluating the use of 3D printing technology in orthopaedic osteotomy procedures in children (aged ≤ 16 years) were included. Spinal and bone tumour surgery were excluded. Data extracted included demographics, disease pathology, target bone, type of technology, imaging modality used, qualitative/quantitative outcomes and follow-up. Articles were further categorized as either 'pre-operative' or 'intra-operative' applications of the technology.Twenty-two articles fitting the inclusion criteria were included. The reported studies included 212 patients. There were five articles of level of evidence 3 and 17 level 4.A large variety of outcomes were reported with the most commonly used being operating time, fluoroscopic exposure and intra-operative blood loss.A significant difference in operative time, fluoroscopic exposure, blood loss and angular correction was found in the 'intra-operative' application group. No significant difference was found in the 'pre-operative' category.Despite a relatively low evidence base pool of studies, our aggregate data demonstrate a benefit of 3D printing technology in various deformity correction applications, especially when used in the 'intra-operative' setting. Further research including paediatric-specific core outcomes is required to determine the potential benefit of this novel addition. Cite this article: EFORT Open Rev 2021;6:130-138. DOI: 10.1302/2058-5241.6.200092.
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Affiliation(s)
- Mohsen Raza
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Daniel Murphy
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Yael Gelfer
- Department of Trauma & Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK.,St George's, University of London, London, UK
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Shibano K, Kunugiza Y, Kawashima K, Tomita T. Total Knee Arthroplasty with Concomitant Corrective Tibial Osteotomy Using Patient-Specific Instrumentation and Computed Tomography-Based Navigation in Severe Post-High Tibial Osteotomy Valgus Collapse. Arthroplast Today 2020; 6:742-746. [PMID: 32923561 PMCID: PMC7476213 DOI: 10.1016/j.artd.2020.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 78-year-old woman with lateral knee osteoarthritis and severe valgus knee deformity after high tibial osteotomy. The patient's severe valgus tibial deformity with a valgus angle of 45° was evaluated using a 3-dimensional bone model, and a closing-wedge osteotomy was planned. Combined total knee arthroplasty and closing-wedge tibial osteotomy were performed using patient-specific instrumentation and a computed tomography–based navigation system. A semiconstrained total knee system with a long stem was implanted for fixation of the osteotomy site in the tibia. The patient was able to walk without pain 2 years postoperatively. The Knee Society Score improved from 13 to 73 points, and the functional score improved from 30 to 65 points. This preoperative planning method and the treatment procedure would be beneficial for clinical decision-making and treatment of severe valgus knee deformities.
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Affiliation(s)
- Koji Shibano
- Department of Orthopedics, Minoh City Hospital, Osaka, Japan
| | - Yasuo Kunugiza
- Department of Orthopedics, JCHO Hoshigaoka Medical Center, Osaka, Japan
| | - Kunihiko Kawashima
- Department of Orthopedics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Tetsuya Tomita
- Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
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26
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Computer-Aided Surgical Simulation for Correcting Complex Limb Deformities in Children. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10155181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This work aims to present an in-house low-cost computer-aided simulation (CASS) process that was recently implemented in the preoperative planning of complex osteotomies for limb deformities in children. Five patients admitted to the Unit of Paediatric Orthopaedics and Traumatology from April 2018 to December 2019, for correcting congenital or post-traumatic limb deformities were included in the study. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software, and the surgery was planned and simulated starting from the 3D digital model. 3D printed sterilizable models were fabricated using a low-cost 3D printer, and animations of the operation were generated with the aim to accurately explain the operation to parents. All procedures were successfully planned using our CASS method and the 3D printed models were used during the operation, improving the understanding of the severely abnormal bony anatomy. The surgery was precisely reproduced according to CASS and the deformities were successfully corrected in four cases, while in one case, the intraoperative intentional undersizing of the bone osteotomy produced an incomplete correction of a congenital forearm deformity. Our study describes the application of a safe, effective, user-friendly, and low-cost CASS process in paediatric orthopaedics (PO) surgery. We are convinced that our study will stimulate the widespread adoption of this technological innovation in routine clinical practice for the treatment of rare congenital and post-traumatic limb deformities during childhood.
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Wirth SH, Espinosa N. The Use of Virtual Planning and Patient-specific Guides to Correct Complex Deformities of the Foot and Ankle. Foot Ankle Clin 2020; 25:257-268. [PMID: 32381313 DOI: 10.1016/j.fcl.2020.02.004] [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] [Indexed: 02/02/2023]
Abstract
This article provides an overview regarding the virtual planning and precise execution of corrective osteotomies around the foot and ankle. Based on 3-dimensional data obtained from CT scans, surgeons are able to create a virtual plan of how to correct a complex deformity. This plan is transferred into the production of true patient-specific guides, designed to perform a specific surgical intervention. The authors have extensive experience with this technique and were involved in the development of the method. The current article provides an overview regarding the virtual planning and precise execution of corrective osteotomies around the foot and ankle.
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Affiliation(s)
- Stephan H Wirth
- Department of Orthopaedics, University of Zurich, The Balgrist, Forchstrasse 340, Zurich 8008, Switzerland
| | - Norman Espinosa
- Institute for Foot and Ankle Reconstruction, Fussinstitut Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
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28
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Luo TD, Nunez FA, Newman EA, Nunez FA. Early Correction of Distal Radius Partial Articular Malunion Leads to Good Long-term Functional Recovery at Mean Follow-up of 4 Years. Hand (N Y) 2020; 15:276-280. [PMID: 30095014 PMCID: PMC7076619 DOI: 10.1177/1558944718793972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Distal radius articular step-off or deformity may cause posttraumatic arthritis and poor functional outcome. The purpose of this study was to evaluate pain and functional outcomes in patients with malunited partial articular distal radius fractures who underwent corrective osteotomy. We hypothesized that anatomic restoration of distal radius articular surface after a malunited partial articular distal radius fracture results in improvement in pain and functional measures and delays the development of posttraumatic arthritis. Methods: Seven consecutive patients with mean age of 38 years underwent corrective osteotomy via either a standard dorsal approach or combined dorsal and volar approach. Mean time from injury to corrective osteotomy was 10 weeks. Patients were assessed with respect to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), forearm and wrist range of motion, pain, and grip strength. Results: At mean follow-up of 44 months, significant improvements in pain scores (7.1-0.9, P < .001), QuickDASH (38.7-11.6, P < .001), grip strength (21.4-30.0 kg, P = .01) were achieved. All range of motion measurements demonstrated significant improvements except forearm pronation. One patient demonstrated radiographic evidence of osteoarthritis but had no pain at final follow-up. No patients required secondary surgery for removal of symptomatic hardware. Conclusions: Based on these findings, we recommend that early corrective osteotomies should be considered in young patients with intra-articular distal radius malunions before considering salvage procedures such as partial or complete wrist arthrodesis.
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Affiliation(s)
- T. David Luo
- Wake Forest Baptist Medical Center,
Winston-Salem, NC, USA,T. David Luo, Wake Forest Baptist Medical
Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Fiesky A. Nunez
- Wake Forest Baptist Medical Center,
Winston-Salem, NC, USA,Cleveland Clinic, OH, USA
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29
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Gallego MDLADLR, Otero JC, Prado Tovar MD, Gutierrez HA, Sanchez Crespo MR. Unusual Forearm Deformity Solved by 3D Custom Made Guides. J Hand Surg Asian Pac Vol 2019; 24:483-487. [PMID: 31690203 DOI: 10.1142/s2424835519720184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of a symptomatic forearm deformity due to a premature distal ulnar fracture solved by 3D custom made cutting guides. Our patient is a sixteen years old girl referred to us due to a forearm deformity and a dysplasic ulnar head associated to pain at the dorsum of the distal ulna and at the radial head at the elbow. Using custom-made cutting guides on a 3D model, a both bone forearm osteotomy was performed. At 18 months of follow up, the range of motion did not improve significantly but our patient referred no pain and she was satisfied with the procedure. The accuracy of single cut osteotomies, utilizing three-dimensional planning and custom patient guides has been previously established. This technique helped with the pain in our case.
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30
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Oka K, Murase T, Okada K, Tanaka H, Yoshikawa H. Single-plane rotational osteotomy for cubitus varus deformity based on preoperative computer simulation. J Orthop Sci 2019; 24:945-951. [PMID: 28539249 DOI: 10.1016/j.jos.2017.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/07/2016] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka 565-0871, Japan.
| | - Kiyoshi Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka 565-0871, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, Osaka 565-0871, Japan
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31
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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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Roner S, Bersier P, Fürnstahl P, Vlachopoulos L, Schweizer A, Wieser K. 3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments. J Orthop Surg Res 2019; 14:115. [PMID: 31036029 PMCID: PMC6489333 DOI: 10.1186/s13018-019-1151-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/11/2019] [Indexed: 12/01/2022] Open
Abstract
Background Preoperative three-dimensional planning and intraoperative navigation by patient-specific instruments is a promising method for the exact correction of bone deformities. Nevertheless, disadvantages of current concepts are the missing options of adapting the surgical plan intraoperatively. By providing the surgeons with a controlled length adjustment through the patient-specific instruments, the application area can usefully be expanded in the treatment of clavicle osteosyntheses. Methods In three cases, preoperative three-dimensional surgical planning with the intraoperative use of patient-specific instruments was applied. The computer-assisted assessments of clavicle deformities, the preoperative plan, and the design of patient-specific instruments were created on the basis of computed tomography data. Reduction guides for restoring length and rotation according to the mirrored healthy contralateral side were enhanced with adaptable length adjustment functions. The screw thread of the reduction guides enabled temporary distraction of the clavicle fracture fragments and a controlled compression of the optionally used interposed bone block between clavicle fragments. Results Navigated clavicle osteosyntheses by enhanced patient-specific instruments was executed uneventful in all three cases. The surgeon was able to adapt clavicle length in a planned axis intraoperatively as clinically desired. Conclusion Computer-assisted planning of clavicle osteosynthesis and surgical navigation with additional adaptable patient-specific instruments can usefully expand the previous application areas. By using guided length adjustments, the fragments and optionally the graft can be compressed along a planned axis as desired to ensure optimal bone healing. Level of evidence Basic science study, Surgical technique Electronic supplementary material The online version of this article (10.1186/s13018-019-1151-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Roner
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchtrasse, 340 8008, Zurich, Switzerland.
| | - P Bersier
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchtrasse, 340 8008, Zurich, Switzerland
| | - P Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchtrasse, 340 8008, Zurich, Switzerland
| | - L Vlachopoulos
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - A Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - K Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Oka K, Tanaka H, Okada K, Sahara W, Myoui A, Yamada T, Yamamoto M, Kurimoto S, Hirata H, Murase T. Three-Dimensional Corrective Osteotomy for Malunited Fractures of the Upper Extremity Using Patient-Matched Instruments: A Prospective, Multicenter, Open-Label, Single-Arm Trial. J Bone Joint Surg Am 2019; 101:710-721. [PMID: 30994589 DOI: 10.2106/jbjs.18.00765] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Medical image processing has facilitated simulation of 3-dimensional (3-D) corrective osteotomy, and 3-D rapid prototyping technology has further enabled the manufacturing of patient-matched surgical guides and implants (patient-matched instruments, or PMIs). However, 3-D corrective osteotomy using these technologies has not been the standard procedure. We aimed to prospectively verify the efficacy and safety of PMIs in corrective osteotomy for deformities of the upper extremity. METHODS We enrolled 16 patients with a total of 17 bone deformities in the upper extremity. Eight patients had distal radial malunion; 5, distal humeral malunion; and 3, forearm diaphyseal malunion. All cases underwent 3-D corrective osteotomy with PMIs. The primary end point was the residual maximum deformity angle (MDA), which was calculated from 2 deformity angles-1 on the anteroposterior and 1 on the lateral postoperative radiograph. Secondary end points included the deformity angle on radiographs, 3-D error between the preoperative planning model and the postoperative result, range of motion, grip strength, pain measured with a visual analog scale (VAS), patient satisfaction, and Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS The average MDA significantly improved from 25.5° preoperatively to 3.3° at the final follow-up (p < 0.001). The angular deformity was within 5° in all cases, except for 1 with distal radial malunion who had a higher angle on the anteroposterior radiograph. The error between the correction seen on the postoperative 3-D bone model and the planned correction was <1° and <1 mm. Flexion and extension of the wrist and pronation of the forearm of the patients treated for distal radial malunion improved significantly, and pronation improved for those treated for forearm diaphyseal malunion. The average VAS score, grip strength, and DASH score significantly improved as well. Of the 16 patients, 15 were very satisfied or satisfied with the outcomes. CONCLUSIONS Corrective osteotomy using PMIs achieved accurate correction and good functional recovery in the upper extremity. Although our study was limited to cases without any deformity on the contralateral side, 3-D corrective osteotomy using PMIs resolved treatment challenges for complex deformities in upper extremities. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kunihiro Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.,Health and Counseling Center, Osaka University, Toyonaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kiyoshi Okada
- Data Coordinating Center (T.Y.), Department of Medical Innovation (K. Okada and A.M.), Osaka University Hospital, Suita, Japan
| | - Wataru Sahara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Akira Myoui
- Data Coordinating Center (T.Y.), Department of Medical Innovation (K. Okada and A.M.), Osaka University Hospital, Suita, Japan
| | - Tomomi Yamada
- Data Coordinating Center (T.Y.), Department of Medical Innovation (K. Okada and A.M.), Osaka University Hospital, Suita, Japan
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeru Kurimoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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34
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Pediatric Forearm Deformity: Use of 3D Modeling to Guide Deformity Correction. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Shintani K, Kazuki K, Yoneda M, Uemura T, Okada M, Takamatsu K, Nakamura H. Computer-Assisted Three-Dimensional Corrective Osteotomy for Malunited Fractures of the Distal Radius Using Prefabricated Bone Graft Substitute. J Hand Surg Asian Pac Vol 2019; 23:479-486. [PMID: 30428808 DOI: 10.1142/s2424835518500467] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Three-dimensional computed tomography (3D-CT) imaging has enabled more accurate preoperative planning. The purpose of this study was to investigate the results of a novel, computer-assisted, 3D corrective osteotomy using prefabricated bone graft substitute to treat malunited fractures of the distal radius. METHODS We investigated 19 patients who underwent the computer-assisted 3D corrective osteotomy for a malunited fracture of the distal radius after the operation was stimulated with CT data. A prefabricated bone graft substitute corresponding to the patient's bone defect was implanted and internal fixation was performed using a plate and screws. We compared postoperative radiographic parameters of the patient's operated side with their sound side and analyzed clinical outcomes using Mayo wrist score. RESULTS All patients achieved bone union on X-ray imaging at final follow-up. The mean differences of palmar tilt, radial inclination and ulnar variance between the operation side and the sound side were 4.3°, 2.3° and 1.2 mm, respectively. The Mayo wrist score was fair in 4 patients and poor in 15 patients before surgery. At the final follow-up after surgery, the scores improved to excellent in 3 patients, good in 11 patients and fair in 5 patients. There were two patients with correction loss at the final follow-up, but no patient complained of hand joint pain. CONCLUSIONS We believe that computer-assisted 3D corrective osteotomy using prefabricated bone graft substitute achieved good results because it worked as a guide to the accurate angle.
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Affiliation(s)
- Kosuke Shintani
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | - Takuya Uemura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Mitsuhiro Okada
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kiyohito Takamatsu
- Department of Orthopedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Abe S, Murase T, Oka K, Shigi A, Tanaka H, Yoshikawa H. In Vivo Three-Dimensional Analysis of Malunited Forearm Diaphyseal Fractures with Forearm Rotational Restriction. J Bone Joint Surg Am 2018; 100:e113. [PMID: 30180062 DOI: 10.2106/jbjs.17.00934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to clarify the mechanisms of rotational restriction in malunited forearm diaphyseal fractures. METHODS We retrospectively analyzed the cases of 18 patients with malunited forearm diaphyseal fractures and rotational restriction. All patients underwent bilateral computed tomography (CT) of the forearm in maximum supination, pronation, and neutral positions. From these images, we created 3-dimensional (3-D) bone surface models. We quantified the 3-D deformities, identified instances of osseous impingement between the radius and the ulna during forearm rotation, calculated the path length of the central band (CB) of the interosseous membrane, and measured forearm range of motion. RESULTS Sixteen patients had extension deformity of the radius (the RE group) and 2 had flexion deformity (the RF group). In the RE group, extension deformity of the radius and valgus deformity of the ulna had significant negative correlation with pronation range of motion (R = -0.50, p = 0.046) and supination range of motion (R = -0.63, p = 0.027), respectively. Osseous impingement was mainly observed during pronation (15 of 16 patients). The CB path with the largest changes in length originated from the distal CB attachment area of the radius and ran toward the proximal area of the ulna (the transverse CB). The transverse CB significantly increased in length in supination compared with that in pronation (p < 0.001). Therefore, tightness of the transverse CB appeared to cause supination restriction in the RE group. In the RF group, osseous impingement caused supination restriction. The greatest increases in the transverse CB length were observed in pronation in the RF group, which appeared to cause pronation restriction. CONCLUSIONS In the RE group, pronation restriction was associated with osseous impingement that was due to extension deformity of the radius, and supination restriction was associated with CB tightness that was due to valgus deformity of the ulna. In the RF group, our results suggested that pronation restriction was caused by CB tightness and that supination restriction was caused by osseous impingement. CLINICAL RELEVANCE Three-dimensional corrective osteotomy for extension deformity of the radius in malunited forearm diaphyseal fractures would improve rotational restriction by relieving osseous impingement during pronation and CB tightness during supination.
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Affiliation(s)
- Shingo Abe
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsuo Shigi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Murase T. Morphology and kinematics studies of the upper extremity and its clinical application in deformity correction. J Orthop Sci 2018; 23:722-733. [PMID: 30054134 DOI: 10.1016/j.jos.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/10/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
Abstract
Morphological and kinetic studies using computer-generated bone models are helpful for determining normal articular movements and various pathological conditions of the wrist joints, forearms, and elbow joints. Previous studies consisted of kinetic analyses that were carried out by superimposing three-dimensional bone models created on a computer on the basis of CT data obtained by scanning the limbs in several different positions. We applied the techniques used in such studies and have discovered a method for carrying out surgical procedure simulations aimed at correcting upper limb deformities. In addition, we have developed a system aimed at assisting surgical procedures conducted in accordance with simulations by using patient-matched guides (patient-matched instruments, PMI) and custom-made osteosynthesis plates. Our system has allowed for accurate anatomical corrections to be carried out three-dimensionally during a simple surgical procedure. The system was clinically used in the treatment of cubitus varus as well as malunited distal radial fractures and forearm fractures. As a result, accurate correction and favorable clinical outcomes have been achieved. Together with the development of therapeutic techniques, we have also simultaneously developed the related technological system, which consists of imaging protocols aimed at reducing the amount of radiation exposure and creating statistical shape models, as well as web-based tools for communication between physicians and engineers.
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Affiliation(s)
- Tsuyoshi Murase
- Department of Orthopedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
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Schenk P, Vlachopoulos L, Hingsammer A, Fucentese SF, Fürnstahl P. Is the contralateral tibia a reliable template for reconstruction: a three-dimensional anatomy cadaveric study. Knee Surg Sports Traumatol Arthrosc 2018; 26:2324-2331. [PMID: 27872989 DOI: 10.1007/s00167-016-4378-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The contralateral anatomy is regularly used as a reconstruction template for corrective osteotomies of several deformities and pathological conditions. However, there is lack of evidence that the intra-individual differences between both tibiae are sufficiently small to use the contralateral tibia as a 3D reconstruction template for complex osteotomies. The aim of this study was to evaluate the intra-individual side differences of the tibia in length, torsion, angulation, and translation using 3D measurement techniques. METHODS 3D surface models of both tibiae were created from computed tomography data of 51 cadavers. The (mirrored) models of the right tibiae were divided into two halves at the centre of the shaft. Thereafter, the proximal and distal segments were aligned to the left (contralateral) tibia in an automated fashion. The relative 3D transformation between both aligned segments was measured to quantify the side difference in 6° of freedom (3D translation vector, 3 angles of rotation). RESULTS The mean side difference in tibia length was 2.1 mm (SD 1.3 mm; range 0.2-5.9 mm). The mean side difference in torsion was 4.9° (SD 4.1°; range 0.2°-17.6°). The mean side difference in the coronal and sagittal planes was 1.1° (SD 0.9°; range 0.0°-4.6°) and 1.0° (SD 0.8°; range 0.1°-2.9°), respectively. CONCLUSION The present study confirms small side differences in torsion between the left and right tibia, while the side differences in the coronal and sagittal plane are probably negligible. The contralateral tibia seems to be a reliable reconstruction template for the 3D preoperative planning of complex corrective osteotomies of the tibia. However, torsional differences should be interpreted with caution, as a single cut-off value of a clinically relevant torsional side difference cannot be defined. The presented results are relevant to surgeons considering the contralateral tibia as a 3D reconstruction template for corrective osteotomies of the tibia. LEVEL OF EVIDENCE Basic science.
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Affiliation(s)
- Pascal Schenk
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Lazaros Vlachopoulos
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.,Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Andreas Hingsammer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Weigelt L, Fürnstahl P, Hirsiger S, Vlachopoulos L, Espinosa N, Wirth SH. Three-Dimensional Correction of Complex Ankle Deformities With Computer-Assisted Planning and Patient-Specific Surgical Guides. J Foot Ankle Surg 2018; 56:1158-1164. [PMID: 28668219 DOI: 10.1053/j.jfas.2017.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Indexed: 02/03/2023]
Abstract
Three-dimensional computer-assisted preoperative planning, combined with patient-specific surgical guides, has become an effective technique for treating complex extra- and intraarticular bone malunions by corrective osteotomy. The feasibility and accuracy of such a technique has not yet been evaluated for ankle deformities. Four surgical cases of varying complexity and location were selected for evaluation. Three-dimensional bone models of the affected and contralateral healthy lower limb were generated from computed tomography scans. The preoperative planning software permitted quantification of the deformity in 3 dimensions and subsequent simulation of reduction, yielding a precise surgical plan. Patient-specific surgical guides were designed, manufactured, and finally applied during surgery to reproduce the preoperative plan. Evaluation of the postoperative computed tomography scans indicated adequate reduction accuracy with residual translational and rotational errors of <3 mm and <6°, respectively. Two patients required revision surgery owing to anterior osseous impingement or delayed union of the osteotomy. All patients were satisfied with the postoperative course and were pain free at a mean follow-up period of 2.5 (range 1 to 4) years. These promising results require confirmation in a clinical study with a larger sample size.
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Affiliation(s)
- Lizzy Weigelt
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefanie Hirsiger
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Norman Espinosa
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan H Wirth
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Grewal S, Dobbe JGG, Kloen P. Corrective osteotomy in symptomatic clavicular malunion using computer-assisted 3-D planning and patient-specific surgical guides. J Orthop 2018; 15:438-441. [PMID: 29881172 DOI: 10.1016/j.jor.2018.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/18/2018] [Indexed: 11/29/2022] Open
Abstract
Surgical correction of a symptomatic clavicular malunion requires simultaneous adjustment of the translation as well as the rotation in multiple planes. We describe a corrective osteotomy for a clavicle malunion using 3-D computer assisted preoperative-planning combined with patient-specific surgical guides, along with the benefits and disadvantages of this approach. This method enabled quantifying the malunion by comparing the malunited bone with the normal contralateral clavicle as a template. The postoperative results were encouraging with symmetrical shoulder anatomy and functional improvement. Therefore, we recommend this technique in patients with a symptomatic clavicle malunion, as it allows successful correction of the deformity.
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Affiliation(s)
- Simran Grewal
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Johannes G G Dobbe
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Peter Kloen
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Kataoka T, Oka K, Murase T. Rotational Corrective Osteotomy for Malunited Distal Diaphyseal Radius Fractures in Children and Adolescents. J Hand Surg Am 2018; 43:286.e1-286.e8. [PMID: 29032874 DOI: 10.1016/j.jhsa.2017.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 08/02/2017] [Accepted: 09/06/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To report our method of computer-planned rotational corrective osteotomy for malunited distal diaphyseal radius fractures in children and adolescents using a custom jig and to review the results of 4 cases. METHODS Four patients (mean age, 13 years; range, 11-16 years) underwent computer-planned rotational corrective osteotomy for malunited distal diaphyseal radius fracture using a custom jig. We retrospectively evaluated their radiographic and clinical data. RESULTS In patients who had marked restriction of forearm supination before osteotomy, the mean arc of forearm supination improved from 5° before surgery to 79° after surgery. Angular deformity on x-ray, range of forearm rotation, and grip strength all improved after surgery. Mild and moderate pain reported by 1 and 2 patients, respectively, was resolved after surgery. CONCLUSIONS Computer-planned rotational corrective osteotomy for malunited distal diaphyseal radius fracture in children and adolescents using a custom jig is a strategy that facilitates the surgical procedure by accurately correcting both rotational and angular deformities on 1 plane in a single procedure. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Toshiyuki Kataoka
- Department of Orthopedic Surgery, Hoshigaoka Medical Center, Osaka, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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Oxley B. A 3-dimensional-printed patient-specific guide system for minimally invasive plate osteosynthesis of a comminuted mid-diaphyseal humeral fracture in a cat. Vet Surg 2018; 47:445-453. [DOI: 10.1111/vsu.12776] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/14/2017] [Accepted: 07/31/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Bill Oxley
- Willows Referral Service; Solihull United Kingdom
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Preoperative Computer Simulation and Patient-specific Guides are Safe and Effective to Correct Forearm Deformity in Children. J Pediatr Orthop 2018; 37:504-510. [PMID: 26491911 DOI: 10.1097/bpo.0000000000000673] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posttraumatic and congenital forearm deformities in children can be difficult to appreciate in all planes. In cases of distal radioulnar joint instability and loss of forearm rotation, surgical correction is challenging. Advances in 3-dimensional printing allow creation of custom guides at a reasonable cost, enabling precise correction of the deformity in all planes. METHODS Nineteen children with deformity of the forearm had corrective osteotomies performed using preoperative 3-dimensional computer modeling and patient-specific surgical guides. Surgicase software was used for 3-dimensional planning of the corrective osteotomy, by superimposing a mirror image of the unaffected side as a template. Based upon this planning, patient-specific surgical guides were manufactured. Radiographic and clinical outcomes were assessed. RESULTS Three patients had a diagnosis of multiple hereditary exostoses, and one of Madelung's deformity. The remaining 15 patients had a diagnosis of fracture malunion. Average preoperative angulation of both the radius and ulna was 23 degrees. For the patients with fracture malunions, the time from injury to surgery ranged from 6 months to 8 years. Twelve patients underwent osteotomies of both the radius and ulna, 5 had osteotomies of the radius alone, and 2 had a single osteotomy of the ulna only. All osteotomies went on to unite and no patient lost range of motion. Preoperative arc of forearm rotation averaged 101 degrees (range 0 to 180 degrees). Postoperatively, this improved to 133 degrees (range 85 to 180 degrees). Eight patients had distal radioulnar instability preoperatively, all of which normalized after surgery. There were 4 complications: 1 hypertrophic scar, 1 subject with extensor pollicis longus weakness, and 2 transient sensory losses in the superficial radial nerve distribution. CONCLUSIONS This case series demonstrates that 3-dimensional computer modeling permits complex and multiple osteotomies to be done safely to achieve deformity correction in children. Limitations in forearm rotation and distal radioulnar malalignment can be reliably improved using this technique. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Miyamura S, Oka K, Abe S, Shigi A, Tanaka H, Sugamoto K, Yoshikawa H, Murase T. Altered bone density and stress distribution patterns in long-standing cubitus varus deformity and their effect during early osteoarthritis of the elbow. Osteoarthritis Cartilage 2018; 26:72-83. [PMID: 29037846 DOI: 10.1016/j.joca.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 08/29/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the bone density and stress distribution patterns in long-standing cubitus varus and clarify the effects of the deformity on bone density. DESIGN We created three-dimensional computed tomography (CT) elbow models from 21 patients with long-standing cubitus varus deformities without advanced osteoarthritis (OA) and assessed the deformity by superimposing the affected humerus onto a mirror-image of the contralateral normal. Elbows were divided into 13 regions before measuring the bone density of each region and comparing the percentage of high-density volume (%HDV) between affected and normal sides. We constructed finite element models and quantitatively analyzed stress distribution. RESULTS Average degrees of deformities were 20.1° of varus, 6.4° of extension, and 12.7° of internal rotation. The medial side of the affected humerus and ulna, Anteromedial trochlea (P < 0.001), Medial coronoid (P = 0.004), and Medial olecranon (P = 0.049) had significantly higher %HDVs than their normal counterparts. Conversely, %HDVs on the affected lateral side, Capitellum (P < 0.001), Anterolateral trochlea (P = 0.010), Posterolateral trochlea (P < 0.001), Lateral coronoid (P = 0.007), and Lateral olecranon (P < 0.001) were significantly lower than the normal side. The affected radial head %HDVs at Anterolateral and Posteromedial quadrants were high (P = 0.007) and low (P = 0.007), respectively. The bone density distribution coincided with stress distribution patterns revealed by finite element analysis (FEA), except in the lateral region influenced by forearm rotation. CONCLUSIONS Repetitive stress on the medial elbow may alter bone density distribution patterns, probably presenting from early stage of OA.
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Affiliation(s)
- S Miyamura
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - K Oka
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan; Osaka University Healthcare Center, 17-1 Machikaneyama-cho, Toyonaka, Osaka 560-0043, Japan.
| | - S Abe
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - A Shigi
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - H Tanaka
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - K Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - H Yoshikawa
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | - T Murase
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
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Miyamura S, Tanaka H, Oka K, Shigi A, Abe S, Yoshikawa H, Murase T. Physeal bar resection using a patient-specific guide with intramedullary endoscopic assistance for partial physeal arrest of the distal radius. Arch Orthop Trauma Surg 2018; 138:1179-1188. [PMID: 29955969 PMCID: PMC6060782 DOI: 10.1007/s00402-018-2985-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Indexed: 12/01/2022]
Abstract
The partial physeal arrest of the distal radius could result in progressive deformities and functional problems of the wrist. Despite being the most preferred surgical intervention, physeal bar resection (Langenskiöld procedure) is technically demanding. This manuscript aims to illustrate the technical tricks and present an illustrative case of premature physeal arrest of the distal radius managed with a novel method for the Langenskiöld procedure, involving complete removal of the bar using a patient-specific guide in combination with an intramedullary endoscopy technique that facilitated direct observation.
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Affiliation(s)
- Satoshi Miyamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hiroyuki Tanaka
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kunihiro Oka
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
- Osaka University Healthcare Center, 17-1 Machikaneyama-cho, Toyonaka, Osaka, 560-0043, Japan
| | - Atsuo Shigi
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Shingo Abe
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
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Computer-Assisted Corrective Osteotomy of Malunited Pediatric Radial Neck Fractures-Three-Dimensional Postoperative Accuracy and Clinical Outcome. J Orthop Trauma 2017; 31:e436-e441. [PMID: 28742788 DOI: 10.1097/bot.0000000000000970] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Neglected or incorrect treatment of pediatric radial neck fractures may lead to symptomatic malunions. Computer-assisted corrective osteotomies with patient-specific guides have been proposed as a promising technique for the reconstruction of malunited long bone deformities. The aim of this study was to evaluate the accuracy and clinical outcome of this technique in children with malunited fractures of the radial neck. Four children [2 boys, 2 girls; mean age 12 (10-16) years] underwent computer-assisted closing wedge osteotomy of the radial neck. The contralateral uninjured side was used as a reconstruction template. Computed tomography were performed 8 weeks postoperatively to confirm bony consolidation and to quantify residual 3D rotational and translational displacement error. Clinical outcome [pain, range of motion (ROM)] and overall satisfaction were documented. Preoperative subluxation of the radial head could be corrected in 2 of 3 patients. One patient had to be revised because of secondary traumatic loss of reduction. At the last follow-up [mean 16 (range, 12-24) months], all patients were pain free for activities of daily living (preoperative pain: visual analog scale 6). Pain during sport activities could be substantially reduced (visual analog scale 8→2). Although the procedure failed to improve ROM, none of the patients had limitations regarding work, daily, or sports activities. Yet, restricted ROM was considered as a cosmetic problem in 1 patient. Full consolidation of the osteotomy site, with no signs of avascular necrosis of the radial head, was achieved in all patients. The deformity could be substantially reduced, from a 3D angle of 13-40 degrees to 3-7 degrees (58%-89% deformity correction). Computer-assisted corrective osteotomy is a novel technique for the treatment of radial neck malunions that led to adequate pain reduction and 3D accuracy of deformity correction in our small case series. Despite the lack of improved ROM, all patients were satisfied and would undergo the same procedure again.
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Three-Dimensional Deformities of Nonoperative Midshaft Clavicle Fractures: A Surface Matching Analysis. J Orthop Trauma 2017; 31:e385-e389. [PMID: 29053545 DOI: 10.1097/bot.0000000000000931] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the 3-dimensional deformities of midshaft clavicle fractures, which had been treated nonoperatively, using computed tomography (CT) surface matching. METHODS Twenty-one patients with unilateral midshaft clavicle fracture, who had been treated nonoperatively, were enrolled and evaluated retrospectively. The 3-dimensional deformity of the fractured clavicle was evaluated by CT surface matching. CT scans of 21 age- and sex-matched patients with initial traumatic shoulder dislocation or proximal humeral fracture were enrolled as a control group, and the differences in 3-dimensional deformities and lengths of the clavicles between the fracture group and the control group were evaluated. A correlation analysis was also performed between rotational deformities and clavicular length shortening. RESULTS The affected clavicle showed 1.3 ± 6.9 degrees of downward angular deformity, 2.1 ± 8.0 degrees of anterior angular deformity, and 5.0 ± 4.9 degrees of anterior rotational deformity. Compared with the control group, the fractured clavicle showed larger anterior rotational deformity (P = 0.021). Shortening of the clavicle demonstrated negative correlation with anterior axial rotation (R = -0.534, P = 0.013), but no correlation was found between clavicular shortening and the other 2 rotational deformities. CONCLUSION In cases of midshaft clavicle fracture, the distal fragment usually rotates anteriorly because of its anatomical relationships. Shortening deformity after clavicle fracture was reported to change shoulder kinematics, and anterior rotational deformity might adversely affect scapular motion.
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Roth KC, Walenkamp MMJ, van Geenen RCI, Reijman M, Verhaar JAN, Colaris JW. Factors determining outcome of corrective osteotomy for malunited paediatric forearm fractures: a systematic review and meta-analysis. J Hand Surg Eur Vol 2017; 42:810-816. [PMID: 28891765 PMCID: PMC5598749 DOI: 10.1177/1753193417711684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of this study was to identify predictors of a superior functional outcome after corrective osteotomy for paediatric malunited radius and both-bone forearm fractures. We performed a systematic review and meta-analysis of individual participant data, searching databases up to 1 October 2016. Our primary outcome was the gain in pronosupination seen after corrective osteotomy. Individual participant data of 11 cohort studies were included, concerning 71 participants with a median age of 11 years at trauma. Corrective osteotomy was performed after a median of 12 months after trauma, leading to a mean gain of 77° in pronosupination after a median follow-up of 29 months. Analysis of variance and multiple regression analysis revealed that predictors of superior functional outcome after corrective osteotomy are: an interval between trauma and corrective osteotomy of less than 1 year, an angular deformity of greater than 20° and the use of three-dimensional computer-assisted techniques. LEVEL OF EVIDENCE II.
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Affiliation(s)
- K. C. Roth
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands,Department of Orthopaedics, Amphia Hospital, Breda, The Netherlands,K. C. Roth, Department of Orthopaedics, Erasmus University Medical Centre, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - M. M. J. Walenkamp
- Trauma Unit, Department of Surgery, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
| | | | - M. Reijman
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J. A. N. Verhaar
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J. W. Colaris
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures Using Preoperative 3-Dimensional Planning and Patient-Specific Surgical Guides and Implants. J Hand Surg Am 2017; 42:836.e1-836.e12. [PMID: 28709790 DOI: 10.1016/j.jhsa.2017.06.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Three-dimensional planning based on computed tomography images of the malunited and the mirrored contralateral forearm allows preoperative simulations of corrective osteotomies, the fabrication of patient-specific osteotomy guides, and custom-made 3-dimensional printed titanium plates. This study aims to assess the precision and clinical outcome of this technique. METHODS This was a prospective pilot study with 5 consecutive patients. The mean age at initial injury was 11 years (range, 4-16 years), and the mean interval from the time of injury to the time of corrective surgery was 32 months (range, 7-107 months). Patient-specific osteotomy guides and custom-made plates were used for multiplanar corrective osteotomies of both forearm bones at the distal level in 1 patient and at the middle-third level in 4 patients. Patients were assessed before and after surgery after a mean follow-up of 42 months (range, 29-51 months). RESULTS The mean planned angular corrections of the ulna and radius before surgery were 9.9° and 10.0°, respectively. The mean postoperative corrections obtained were 10.1° and 10.8° with corresponding mean errors in correction of 1.8° (range, 0.3°-5.2°) for the ulna and 1.4° (range, 0.2°-3.3°) for the radius. Forearm supination improved significantly from 47° (range, 25°-75°) before surgery to 89° (range, 85°-90°) at final review. Forearm pronation improved from 68° (range, 45°-84°) to 87° (range, 82°-90°). In addition, there was a statistically significant improvement in pain and grip strength. CONCLUSIONS This study demonstrates that 3-dimensional planned patient-specific guides and implants allow the surgeon to perform precise corrective osteotomies of complex multiplanar forearm deformities with satisfactory preliminary results. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Jeuken RM, Hendrickx RPM, Schotanus MGM, Jansen EJ. Near-anatomical correction using a CT-guided technique of a forearm malunion in a 15-year-old girl: A case report including surgical technique. Orthop Traumatol Surg Res 2017; 103:783-790. [PMID: 28428034 DOI: 10.1016/j.otsr.2017.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/08/2017] [Accepted: 03/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND In this case report, we describe a left-arm both-bone forearm fracture in a 15-year-old girl who fell off a swing. Conservative treatment with an above-elbow cast failed, resulting in a malunion with functional impairment. The pro- and supination were 90/0/10, respectively. The patient complained of difficulties performing daily activities. For this pediatric case, a corrective osteotomy was proposed using a CT-guided technique aiming for maximum anatomical and functional outcome. It was the first time this technique was used in our hospital. METHODS A corrective osteotomy of the patient's left arm was performed using 3D printed templates to guide the osteotomy orientation. These templates were produced using specialized software in which CT images of her malunited left forearm were overlaid with the mirrored images of her healthy right forearm. RESULTS The postoperative CT-scan showed a near-anatomical reduction with close to 1° correction in all three planes, as compared to the preoperative planning. Three months after surgery, the patient had regained full function of her left forearm. CONCLUSION Although this was the first time this technique was used in our hospital, it resulted in excellent anatomical and functional outcomes making it a safe, reliable and precise treatment option that may be useful for even more complex corrections. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- R M Jeuken
- Department of Orthopedic Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, Netherlands; Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen-Sittard, Netherlands.
| | - R P M Hendrickx
- Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen-Sittard, Netherlands
| | - M G M Schotanus
- Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen-Sittard, Netherlands
| | - E J Jansen
- Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen-Sittard, Netherlands
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