Current Concepts in the Resection of Bone Tumors Using a Patient-Specific Three-Dimensional Printed Cutting Guide

Orthopedic meta-implants

Meta-biomaterials, engineered materials with distinctive combinations of mechanical, physical, and biological properties stemming from their micro-architecture, have emerged as a promising domain within biomedical engineering. Correspondingly, meta-implants, which serve as the device counterparts of meta-biomaterials, offer exceptional functionalities, holding great potential for addressing complex skeletal diseases. This paper presents a comprehensive overview of the various types of meta-implants, including hybrid, shape-morphing, metallic clay, and deployable meta-implants, highlighting their unprecedented properties and recent achievement in the field. This paper also delves into the potential future developments of meta-implants, addressing the exploration of multi-functionalities in meta-biomaterials and their applications in diverse biomedical fields.

Three-dimensional printed models can reduce costs and surgical time for complex proximal humeral fractures: preoperative planning, patient satisfaction, and improved resident skills

BACKGROUND

Proximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study's objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients.

MATERIALS AND METHODS

Twenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated.

RESULTS

Intraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention.

CONCLUSIONS

Fewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims.

LEVEL OF EVIDENCE

Level I, prospective randomized case-control study.

3D-printed patient specific surgical guides: Balancing accuracy with practicality

Introduction

Three-dimensional (3D) printing technology has been used in orthopaedic surgery in recent years to manufacture customized surgical cutting jigs. However, there is scarcity of literature and information regarding the optimal parameters of an ideal jig. Our study aims to determine the optimum parameters to design surgical jigs that can produce accurate cuts, and remain practical for use, to serve as a guide for jig creation in future.

Methods and materials

A biomechanical lab study was designed to investigate whether the thickness of a jig and the height of its cutting slot can significantly affect cutting accuracy. Surgical jigs were 3D printed in medical grade, and an oscillating sawblade was used to mimic intraoperative surgical cuts through the cutting slots onto wooden blocks, which were then analysed to determine the accuracy of cuts.

Results

Statistical analysis was performed on a total of 72 cuts. The cutting accuracy increased when the thickness of the jig increased, at all slot heights. The cutting accuracy also increased as the slot height decreased, at all jig thicknesses. Overall, the parameters for jig construction that yielded the most accurate cuts were a jig thickness of 15 mm, in combination with a slot height of 100 % of the width of the sawblade. Additionally, at a jig thickness of 15 mm, there was no statistically significant difference in cutting accuracy when increasing the slot height to 120 %.

Conclusion

This study is the first to propose tangible parameters that can be applied to surgical jig construction to obtain reproducible accurate cuts. Provided that a jig of 15 mm thickness can be accommodated by the size of the wound, the ideal surgical jig with a superior balance of accuracy and useability is 15 mm thick, with a cutting slot height of 120 % of the sawblade thickness.

Special Issue: "Pediatric Orthopedic Malignancy: Types, Symptoms, and Treatment"

Pediatric orthopedic malignancies are extremely rare and require appropriate diagnosis and treatment by a multidisciplinary team [...].