Developing a Three-Dimensional (3D) Assessment Method for Clubfoot-A Study Protocol

Recent approaches in clinical applications of 3D printing in neonates and pediatrics

Neonates and pediatric populations are vulnerable subjects in terms of health. Proper screening and early optimal treatment would reduce infant and child mortality, improving the quality of life. Researchers and clinicians all over the world are in pursuit of innovations to improve the medical care delivery system. Infant morphometrics changes drastically due to the rapid somatic growth in infancy and childhood, demanding for patient-specific customization of treatment intervention accordingly. 3D printing is a radical technology that allows the generation of physical 3D products from digital images and addresses the patient-specific requirement. The combination of cost-effective and on-demand customization offers a boundless opportunity for the enhancement of neonates and pediatric health.Conclusion: The advanced technology of 3D printing proposes a pioneering breakthrough in bringing physiologically and anatomically appropriate treatment strategies addressing the unmet needs of child health problems. What is Known: • The potential application of 3D printing is observed across a multitude of fields within medicine and surgery. • The unprecedented effect of this technology on pediatric healthcare is still very much a work in progress. What is New: • The recent clinical applications of 3D printing provide better treatment modalities to infants and children. • The review provides an overview of the comparison between conventional treatment methods and 3DP regarding specific applications.

Finite-element-based 3D computer modeling for personalized treatment planning in clubfoot deformity: Case report with technique description

RATIONALE

In clubfoot deformity, planning of corrective treatment requires a complex understanding of the foot anatomy, as well as of the geometry and distribution of altered mechanical forces acting at the level of the deformed foot. At the same time, treatment success depends largely on the selection of the most appropriate shape and angles of the customized orthesis developed for foot correction. Therefore, a complex assessment of the intensity and distribution of the mechanical forces at this site is mandatory prior to initiation of any corrective therapy.

PATIENT CONCERNS

We present here the case of a 3-year-old male child with clubfoot deformity, weighting 20 kg, with no other congenital malformations, in whom finite element modeling (FEM) technology associated with a newly developed technique of three-dimensional (3D) computational simulation was applied for personalized treatment planning.

INTERVENTIONS

The FEM-based computational 3D simulation technique allowed selection of the corrective treatment associated with the most physiologic pattern of force distribution at the level of the foot.

OUTCOMES

The proposed technique led to selection of the most appropriate therapy that successfully corrected the foot deformity. After 3D computer simulations, the elongations recorded were 2.71 cm for Achilles tendon, 1.69 cm for anterior tibialis tendon, 1.35 cm for the long flexor of the toes, and 1.69 cm for the long flexor of the hallux. The Von Mises equivalent stress distribution was σ = 4.26 MPa, not exceeding the elastic capacity of the bones, therefore the residual deformations were minimal. The customized treatment selected in this way was highly appropriate for the child, and led to complete recovery of the deformity in three months.

LESSONS

This case is the first one in which FEM-based computational 3D modeling was applied for selection of treatment strategy in a child with clubfoot. The case reported here illustrates the role of advanced medical computer technology, based on complex image processing, FEM and 3D simulations, in providing an effective clinical decision support tool for personalized treatment selection in children with clubfoot deformity.