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Cruz J, Gonçalves SB, Neves MC, Silva HP, Silva MT. Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:1613. [PMID: 38475148 DOI: 10.3390/s24051613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
Ensuring precise angle measurement during surgical correction of orientation-related deformities is crucial for optimal postoperative outcomes, yet there is a lack of an ideal commercial solution. Current measurement sensors and instrumentation have limitations that make their use context-specific, demanding a methodical evaluation of the field. A systematic review was carried out in March 2023. Studies reporting technologies and validation methods for intraoperative angular measurement of anatomical structures were analyzed. A total of 32 studies were included, 17 focused on image-based technologies (6 fluoroscopy, 4 camera-based tracking, and 7 CT-based), while 15 explored non-image-based technologies (6 manual instruments and 9 inertial sensor-based instruments). Image-based technologies offer better accuracy and 3D capabilities but pose challenges like additional equipment, increased radiation exposure, time, and cost. Non-image-based technologies are cost-effective but may be influenced by the surgeon's perception and require careful calibration. Nevertheless, the choice of the proper technology should take into consideration the influence of the expected error in the surgery, surgery type, and radiation dose limit. This comprehensive review serves as a valuable guide for surgeons seeking precise angle measurements intraoperatively. It not only explores the performance and application of existing technologies but also aids in the future development of innovative solutions.
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Affiliation(s)
- João Cruz
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Sérgio B Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | | | - Hugo Plácido Silva
- IT-Instituto de Telecomunicações, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Miguel Tavares Silva
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
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Schindele S, Oyewale M, Marks M, Brodbeck M, Herren DB. Three-Dimensionally Planned and Printed Patient-Tailored Plates for Corrective Osteotomies of the Distal Radius and Forearm. J Hand Surg Am 2024; 49:277.e1-277.e8. [PMID: 35985863 DOI: 10.1016/j.jhsa.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/10/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We evaluated the 1-year postoperative clinical and patient-reported outcomes in patients who had a 3-dimensional planned corrective osteotomy of their distal radius, radial shaft, or ulnar shaft using a printed, anatomical, patient-tailored plate to determine the feasibility and effectiveness of this methodology. METHODS Simulations in computer-assisted preoperative planning of corrective osteotomies resulted in 3-dimensionally printed surgical guides, surgical models, and anatomically customized plates for application at the distal radius and forearm. Patients with malunions of the distal radius or forearm who underwent fixation with the custom-made plates were documented in our registry. Grip strength and range of motion assessments were made before surgery (baseline), as well as at 6 weeks and 3 and 12 months. Additionally, patients rated their wrist-related pain and disability using the Patient-Rated Wrist Evaluation. RESULTS Fifteen patients underwent corrective surgery, and the 1-year follow-up data of 14 patients with a median age of 56 years (interquartile range, 24-64 years) were available for analysis. The median baseline Patient-Rated Wrist Evaluation score improved from 47 to 7 after 1 year. The flexion-extension arc of motion of the wrist increased from 90° at baseline to 130° at 1 year and the pronation-supination arc of motion of the wrist increased from 135° to 160° in the same time period. Differences in radiological measurements for palmar and radial inclinations, as well as for ulnar variance between the affected and contralateral wrists, were reduced with the osteotomy. In 1 case, the plate was removed 11 months after the osteotomy. No severe adverse events were reported. CONCLUSIONS Three-dimensionally planned and printed patient-tailored plates offer a reliable method for correcting even complex malunions of the distal radius and forearm. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Michael Oyewale
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Michael Brodbeck
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland; Department of Hand and Elbow Surgery, Orthopädie Rosenberg, St. Gallen, Switzerland (present affiliation)
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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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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Accuracy of 3D Corrective Osteotomy for Pediatric Malunited Both-Bone Forearm Fractures. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010021. [PMID: 36670572 PMCID: PMC9856311 DOI: 10.3390/children10010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Re-displacement of a pediatric diaphyseal forearm fracture can lead to a malunion with symptomatic impairment in forearm rotation, which may require a corrective osteotomy. Corrective osteotomy with two-dimensional (2D) radiographic planning for malunited pediatric forearm fractures can be a complex procedure due to multiplanar deformities. Three-dimensional (3D) corrective osteotomy can aid the surgeon in planning and obtaining a more accurate correction and better forearm rotation. This prospective study aimed to assess the accuracy of correction after 3D corrective osteotomy for pediatric forearm malunion and if anatomic correction influences the functional outcome. Our primary outcome measures were the residual maximum deformity angle (MDA) and malrotation after 3D corrective osteotomy. Post-operative MDA > 5° or residual malrotation > 15° were defined as non-anatomic corrections. Our secondary outcome measure was the gain in pro-supination. Between 2016−2018, fifteen patients underwent 3D corrective osteotomies for pediatric malunited diaphyseal both-bone fractures. Three-dimensional corrective osteotomies provided anatomic correction in 10 out of 15 patients. Anatomic corrections resulted in a greater gain in pro-supination than non-anatomic corrections: 70° versus 46° (p = 0.04, ANOVA). Residual malrotation of the radius was associated with inferior gain in pro-supination (p = 0.03, multi-variate linear regression). Three-dimensional corrective osteotomy for pediatric forearm malunion reliably provided an accurate correction, which led to a close-to-normal forearm rotation. Non-anatomic correction, especially residual malrotation of the radius, leads to inferior functional outcomes.
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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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Liu Q, Liu Y, Li H, Fu X, Zhang X, Liu S, Zhang J, Zhang T. Marker- three dimensional measurement versus traditional radiographic measurement in the treatment of tibial fracture using Taylor spatial frame. BMC Musculoskelet Disord 2022; 23:155. [PMID: 35172802 PMCID: PMC8849035 DOI: 10.1186/s12891-022-05112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Taylor Spatial Frame (TSF) has been widely used for tibial fracture. However, traditional radiographic measurement method is complicated and the reduction accuracy is affected by various factors. The purpose of this study was to propose a new marker- three dimensional (3D) measurement method and determine the differences of reduction outcomes, if any, between marker-3D measurement method and traditional radiographic measurement in the TSF treatment. Methods Forty-one patients with tibial fracture treated by TSF in our institution were retrospectively analyzed from January 2016 to June 2019, including 21 patients in the marker-3D measurement group (experimental group) and 20 patients in the traditional radiographic measurement group (control group). In the experimental group, 3D reconstruction with 6 markers installed on the TSF was performed to determine the electronic prescription. In the control group, the anteroposterior (AP) and lateral radiographs were performed for the traditional parameter measurements. The effectiveness was evaluated by the residual displacement deformity (RDD) and residual angle deformity (RAD) in the coronal and sagittal plane, according to the AP and lateral X-rays after reduction. Results All patients achieved functional reduction. The residual RDD in AP view was 0.5 (0, 1.72) mm in experimental group and 1.74 (0.43, 3.67) mm in control group. The residual RAD in AP view was 0 (0, 1.25) ° in experimental group and 1.25 (0.62, 1.95) °in control group. As for the lateral view, the RDD was 0 (0, 1.22) mm in experimental group and 2.02 (0, 3.74) mm in control group, the RAD was 0 (0, 0) ° in experimental group and 1.42 (0, 1.93) ° in control group. Significant differences in all above comparisons were observed between the two groups (AP view RDD: P = 0.024, RAD: P = 0.020; Lateral view RDD: P = 0.016, RAD: P = 0.004). Conclusions The present study introduced a marker-3D measurement method to complement the current TSF treatment. This method avoids the manual measurement error and improves the accuracy of fracture reduction, providing potential advantages of bone healing and function rehabilitation.
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Affiliation(s)
- Qixin Liu
- Graduate College of Tianjin Medical University, Tianjin, China
| | - Yanshi Liu
- Department of Trauma and Microreconstructive surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hong Li
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Xuefei Fu
- Department of Orthopedics, Anhui No.2 Provincial People's Hospital, Hefei, Anhui, China
| | - Xingpeng Zhang
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Sida Liu
- College of Mechanical Engineering, Tianjin University, Tianjin, China
| | - Jinli Zhang
- Department of Orthopedics and Trauma, Tianjin Hospital, Tianjin, China.
| | - Tao Zhang
- Department of Orthopedics and Trauma, Tianjin Hospital, Tianjin, China.
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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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Dobbe JGG, Kloen P, Strackee SD, Streekstra GJ. Comparison of an oblique single cut rotation osteotomy with a novel 3D computer-assisted oblique double cut alignment approach. Sci Rep 2021; 11:14731. [PMID: 34282242 PMCID: PMC8290026 DOI: 10.1038/s41598-021-94141-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/06/2021] [Indexed: 11/09/2022] Open
Abstract
An oblique double-cut rotation osteotomy (ODCRO) enables correcting a complex bone deformation by aligning, in 3D, the distal, middle and proximal bone segments with a target bone, without intersegmental gaps. We propose virtual preoperative planning of an ODCRO. To minimize a residual translation error, we use an optimization algorithm and optimize towards bone length, alignment in the transverse direction, or a balanced reconstruction. We compare the residual alignment error with an oblique single-cut rotation osteotomy using 15 complex bone deformations. The single-cut approach was not feasible in 5 cases, whereas the ODCRO procedure was feasible in all cases. The residual alignment error was smaller for the ODCRO than for the single-cut approach except for one case. In a subset for length reconstruction, the length error of 7.3-21.3 mm was restored to 0.0 mm in 4 of 5 cases, although at the cost of an increased transverse translation. The proposed method renders planning an ODCRO feasible and helps restoring bone alignment and lengthening better than an oblique single-cut rotation osteotomy. Awareness of the challenges and possibilities in preoperative planning of an ODCRO will be of value for future alignment surgery and for patients.
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Affiliation(s)
- Johannes G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room no L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Peter Kloen
- Department of Orthopedic Trauma Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room no L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Yoshii Y, Ogawa T, Hara Y, Totoki Y, Ishii T. An image fusion system for corrective osteotomy of distal radius malunion. Biomed Eng Online 2021; 20:66. [PMID: 34193171 PMCID: PMC8244167 DOI: 10.1186/s12938-021-00901-8] [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: 12/14/2020] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background To provide surgical support for corrective osteotomy, we developed an image fusion system for three-dimensional (3D) preoperative planning and fluoroscopy. To assess the utility of this image fusion system, we evaluated the reproducibility of preoperative planning for corrective osteotomy of dorsally angulated distal radius malunion using the system and compared reproducibility without using the system. Methods Ten wrists from 10 distal radius malunion patients who underwent corrective osteotomy were evaluated. 3D preoperative planning and the image fusion system were used for the image fusion group (n = 5). Only 3D preoperative planning was used for the control group (n = 5). 3D preoperative planning was performed for both groups in order to assess reduction, placement, and the choice of implants. In the image fusion group, the outline of the planned image was displayed on a monitor and overlapped with fluoroscopy images during surgery. Reproducibility was evaluated using preoperative plan and postoperative 3D images. Images were compared with the 3D coordinates of the radial styloid process (1), the volar and dorsal edges of the sigmoid notch (2) (3), and the barycentric coordinates of the three reference points. The reproducibility of the preoperative plan was evaluated by the distance of the coordinates between the plan and postoperative images for the reference points. Results The distances between preoperative planning and postoperative reduction in the image fusion group were 2.1 ± 1.1 mm, 1.8 ± 0.7 mm, 1.9 ± 0.9 mm, and 1.4 ± 0.7 mm for reference points (1), (2), (3), and the barycenter, respectively. The distances between preoperative planning and postoperative reduction in the control group were 3.7 ± 1.0 mm, 2.8 ± 2.0 mm, 1.7 ± 0.8 mm, and 1.8 ± 1.2 mm for reference points (1), (2), (3), and the barycenter, respectively. The difference in reference point (1) was significantly smaller in the image fusion group than in the control group (P < 0.05). Conclusion Corrective osteotomy using an image fusion system will become a new surgical support method for fracture malunion. Trial registration Registered as NCT03764501 at ClinicalTrials.gov.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Yasukazu Totoki
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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Auer JA, Lischer C, Haab M. Displacement osteotomies/ostectomies in the horse. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. A. Auer
- Department of the University Zürich Veterinary Medicine College Lenzburg Switzerland
| | - C. Lischer
- Clinic for Horses, General Surgery and Radiology Free University of Berlin Berlin Germany
| | - M. Haab
- Department of the University Zürich Veterinary Medicine College Felbach Switzerland
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Lindt B, Fürst AE, Del Chicca F, Malbon A, Jackson MA. Closing wedge ostectomy and medial distal tibia plate application for treatment of severe bilateral angular limb deformities in the hindlimbs of an 8‐month‐old foal. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- B. Lindt
- Equine Department Vetsuisse Faculty University of Zurich ZurichSwitzerland
| | - A. E. Fürst
- Equine Department Vetsuisse Faculty University of Zurich ZurichSwitzerland
| | - F. Del Chicca
- Clinic of Diagnostic Imaging Department of Small Animals Vetsuisse Faculty University of Zurich ZurichSwitzerland
| | - A. Malbon
- Institute of Veterinary Pathology Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - M. A. Jackson
- Equine Department Vetsuisse Faculty University of Zurich ZurichSwitzerland
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Dobbe JGG, Peymani A, Roos HAL, Beerens M, Streekstra GJ, Strackee SD. Patient-specific plate for navigation and fixation of the distal radius: a case series. Int J Comput Assist Radiol Surg 2021; 16:515-524. [PMID: 33575933 PMCID: PMC7946677 DOI: 10.1007/s11548-021-02320-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
Purpose Corrective osteotomy of a malunited distal radius conventionally relies on 2D imaging techniques for alignment planning and evaluation. However, this approach results in suboptimal bone repositioning, which is associated with poor patient outcomes. In this case series, we evaluate the use of novel patient-specific plates (PSPs), which feature navigation and fixation of bone segments as preoperatively planned in 3D. Methods Ten participants with distal radius malunion underwent CT scans for preoperative alignment planning. Patient-specific guides and plates were designed, 3D-printed, and sterilized for use in corrective surgery of the distal radius. Pre- and postoperative results were compared in regard to clinical, functional, and radiographic outcomes. Results The application of a PSP was successful in 7 of the 10 cases. After treatment, the residual alignment error was reduced by approximately 50% compared with conventional treatment. The use of PSPs reduced pain significantly. Pre- and postoperative results were pooled and demonstrated significant correlations between: (1) pain and malpositioning, (2) the range of pro- and supination motion, the MHOQ score, the EQ-5D-5L score and dorsovolar angulation, and (3) MHOQ score and proximodistal translation. Conclusion The correlation between malalignment and MHOQ score, EQ-5D-5L score, pain, and range of motion shows that alignment should be restored as well as possible. Compared to the conventional approach, which relies on 2D imaging techniques, corrective osteotomy based on 3D preoperative planning and intraoperative fixation with a PSP has been shown to improve bone alignment and reduce pain. Level of evidence IV.
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Affiliation(s)
- Johannes G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room No L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Abbas Peymani
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hendrika A L Roos
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maikel Beerens
- Xilloc Medical, Urmonderbaan 22, Sittard-Geleen, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room No L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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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: 2] [Impact Index Per Article: 0.7] [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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Biedrzycki AH, Kistler HC, Perez-Jimenez EE, Morton AJ. Use of Hausdorff Distance and Computer Modelling to Evaluate Virtual Surgical Plans with Three-Dimensional Printed Guides against Freehand Techniques for Navicular Bone Repair in Equine Orthopaedics. Vet Comp Orthop Traumatol 2021; 34:9-16. [PMID: 33440435 DOI: 10.1055/s-0040-1721846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the surgical execution of a virtual surgical plan (VSP) with three-dimensional (3D) guides against a freehand approach in the equine navicular bone using an automated in silico computer analysis technique. STUDY DESIGN Eight pairs of cadaveric forelimb specimens of adult horses were used in an ex vivo experimental study design with in silico modelling. Limbs received either a 3.5 mm cortical screw according to a VSP or using an aiming device. Using computed tomography and computer segmentation, a comparison was made between the executed screw and the planned screw using the Hausdorff distance (HD). RESULTS Navicular bone mean HD registration error was -0.06 ± 0.29 mm. The VSP with 3D printing demonstrated significantly superior accuracy with a mean deviation of 1.19 ± 0.42 mm compared with aiming device group (3.53 ± 1.24 mm, p = 0.0018). The VSP group was 5.0 times more likely to result in a mean aberration of less than 1.0 mm (95% confidence interval, 0.62-33.4). A 3.5 mm screw with an optimal entry point can have a maximum deviation angle of 3.23 ± 0.07, 2.70 ± 0.06 and 2.37 ± 0.10 degrees in a proximal, dorsal and palmar direction respectively, prior to violating one of the cortical surfaces. CONCLUSION Procedures performed using the 3D guides have a high degree of accuracy, with minimal mean deviations (<1 mm and <1 degree) of a VSP compared with those using the conventional aiming device. The use of VSP and the HD for evaluation of orthopaedic surgeries and outcome measures shows promise for simplifying and improving surgical accuracy.
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Affiliation(s)
- Adam H Biedrzycki
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States
| | - Hannah C Kistler
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States
| | | | - Alison J Morton
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States
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Athlani L, Chenel A, Detammaecker R, De Almeida YK, Dautel G. Computer-assisted 3D preoperative planning of corrective osteotomy for extra-articular distal radius malunion: A 16-patient case series. HAND SURGERY & REHABILITATION 2020; 39:275-283. [PMID: 32244068 DOI: 10.1016/j.hansur.2020.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/27/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
The aim of this prospective study was to describe the surgical procedure and to report outcomes of computer-assisted 3D preoperative planning of corrective osteotomy for extra-articular distal radius malunions. Sixteen consecutive patients were enrolled. CT scans of both wrists were performed, and 3D bone surface models of the radii were created. Software was used to simulate the osteotomy and the reorientation of the distal radial articular surface. Patient-specific cutting and drilling guides for intraoperative guidance of the osteotomy as well as bone graft templates were also simulated. At a mean follow-up of 12 months (range 6-27) after surgery, pain was reduced from 3 to 0.3 at rest and 6.8 to 1.5 during effort according to a visual analog scale. The average wrist flexion-extension was 145° and pronation-supination was 155°. Grip strength was 91% of the contralateral side. All patients achieved primary bone union in a mean of 10 weeks (range, 7-18). Using our 3D analysis method, preoperative 3D values showed no significant difference with radiographic measurement. Moreover, there was no significant difference between the postoperative radiographic values in term of correction. This procedure provides satisfactory clinical and radiological results with minimal residual malalignment. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- L Athlani
- Service de chirurgie de la main, Chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre Chirurgical Emile Gall, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| | - A Chenel
- Newclip Technics, PSI Radius, 45, rue des Garottières, 44115 Haute-Goulaine, France.
| | - R Detammaecker
- Service de chirurgie de la main, Chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre Chirurgical Emile Gall, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| | - Y-K De Almeida
- Service de chirurgie de la main, Chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre Chirurgical Emile Gall, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| | - G Dautel
- Service de chirurgie de la main, Chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre Chirurgical Emile Gall, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
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16
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Caiti G, Dobbe JGG, Strackee SD, Strijkers GJ, Streekstra GJ. Computer-Assisted Techniques in Corrective Distal Radius Osteotomy Procedures. IEEE Rev Biomed Eng 2020; 13:233-247. [DOI: 10.1109/rbme.2019.2928424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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17
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Caiti G, Dobbe JGG, Bervoets E, Beerens M, Strackee SD, Strijkers GJ, Streekstra GJ. Biomechanical considerations in the design of patient-specific fixation plates for the distal radius. Med Biol Eng Comput 2018; 57:1099-1107. [PMID: 30588576 PMCID: PMC6477011 DOI: 10.1007/s11517-018-1945-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/10/2018] [Indexed: 01/08/2023]
Abstract
Use of patient-specific fixation plates is promising in corrective osteotomy of the distal radius. So far, custom plates were mostly shaped to closely fit onto the bone surface and ensure accurate positioning of bone segments, however, without considering the biomechanical needs for bone healing. In this study, we investigated how custom plates can be optimized to stimulate callus formation under daily loading conditions. We calculated implant stress distributions, axial screw forces, and interfragmentary strains via finite element analysis (FEA) and compared these parameters for a corrective distal radius osteotomy model fixated by standard and custom plates. We then evaluated these parameters in a modified custom plate design with alternative screw configuration, plate size, and thickness on 5 radii models. Compared to initial design, in the modified custom plate, the maximum stress was reduced, especially under torsional load (- 31%). Under bending load, implants with 1.9-mm thickness induced an average strain (median = 2.14%, IQR = 0.2) in the recommended range (2-10%) to promote callus formation. Optimizing the plate shape, width, and thickness in order to keep the fixation stable while guaranteeing sufficient strain to enhance callus formation can be considered as a design criteria for future, less invasive, custom distal radius plates. Graphical abstract ᅟ.
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Affiliation(s)
- G Caiti
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands.
| | - J G G Dobbe
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - E Bervoets
- Metrotech Engineering & Physics, Begtrupvej 75, Sporup, Denmark
| | - M Beerens
- Xilloc Medical B. V., Urmonderbaan 22, Geleen, Netherlands
| | - S D Strackee
- Amsterdam UMC, University of Amsterdam, Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - G J Strijkers
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - G J Streekstra
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
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18
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Implementation of a semiautomatic method to design patient-specific instruments for corrective osteotomy of the radius. Int J Comput Assist Radiol Surg 2018; 14:829-840. [PMID: 30535827 DOI: 10.1007/s11548-018-1896-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE 3D-printed patient-specific instruments (PSIs), such as surgical guides and implants, show great promise for accurate navigation in surgical correction of post-traumatic deformities of the distal radius. However, existing costs of computer-aided design and manufacturing process prevent everyday surgical use. In this paper, we propose an innovative semiautomatic methodology to streamline the PSIs design. METHODS The new method was implemented as an extension of our existing 3D planning software. It facilitates the design of a regular and smooth implant and a companion guide starting from a user-selected surface on the affected bone. We evaluated the software by designing PSIs starting from preoperative virtual 3D plans of five patients previously treated at our institute for corrective osteotomy. We repeated the design for the same cases also with commercially available software, with and without dedicated customization. We measured design time and tracked user activity during the design process of implants, guides and subsequent modifications. RESULTS All the designed shapes were considered valid. Median design times ([Formula: see text]) were reduced for implants (([Formula: see text]) = 2.2 min) and guides (([Formula: see text]) = 1.0 min) compared to the standard (([Formula: see text]) = 13 min and ([Formula: see text]) = 8 min) and the partially customized (([Formula: see text]) = 6.5 min and ([Formula: see text]) = 6.0 min) commercially available alternatives. Mouse and keyboard activities were reduced (median count of strokes and clicks during implant design (([Formula: see text]) = 53, and guide design (([Formula: see text]) = 27) compared to using standard software (([Formula: see text]) = 559 and ([Formula: see text]) = 380) and customized commercial software (([Formula: see text]) = 217 and ([Formula: see text]) = 180). CONCLUSION Our software solution efficiently streamlines the design of PSIs for distal radius malunion. It represents a first step in making 3D-printed PSIs technology more accessible.
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Hirsiger S, Schweizer A, Miyake J, Nagy L, Fürnstahl P. Corrective Osteotomies of Phalangeal and Metacarpal Malunions Using Patient-Specific Guides: CT-Based Evaluation of the Reduction Accuracy. Hand (N Y) 2018; 13:627-636. [PMID: 28895433 PMCID: PMC6300182 DOI: 10.1177/1558944717726135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical planning of corrective osteotomies is traditionally based on conventional radiographs and clinical findings. In the past 10 years, 3-dimensional (3D) preoperative planning approaches with patient-specific guides have been developed. However, the application of this technology to posttraumatic deformities of the metacarpals and phalangeal bones has not yet been investigated. Our goal was to evaluate the feasibility of the surgical application to the latter and to evaluate the extent and precision of correction. METHODS We present results of 6 patients (8 osteotomies) treated with phalangeal or metacarpal corrective osteotomy. Deformities were located in the third ray in 1, fourth ray in 3, and fifth ray in 4 cases. Six malunited metacarpal bones (1 intra-articular) and 2 deformed proximal phalanges were treated. Computer-based 3D preoperative planning using the contralateral hand as a template allowed the production of 3D-printed patient-specific guides that were used intraoperatively for navigation. The precision of the reduction was assessed using pre- and postoperative computed tomography by comparing the postoperative bone model with the preoperatively simulated osteotomy. Range of motion and grip strength were documented pre- and postoperatively. RESULTS The mean follow-up time was 6 months (range: 5-11 months). Rotational deformity was reduced from a mean of 10.0° (range: 7.2°-19.3°) preoperatively to 2.3° (range: 0.7°-3.7°) postoperatively, and translational incongruency decreased from a mean of 1.4 mm (range: 0.7-2.8 mm) to 0.4 mm (range: 0.1-0.9 mm). CONCLUSION Preliminary results indicate that a precise reduction for corrective osteotomies of metacarpal and phalangeal bones can be achieved by using 3D planning and patient-specific guides.
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Affiliation(s)
| | | | | | | | - Philipp Fürnstahl
- University of Zurich, Switzerland,Philipp Fürnstahl, Department of
Orthopedics, University Hospital Balgrist, University of Zurich, Forchstrasse
340, Zürich 8008, Switzerland.
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20
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Roner S, Carrillo F, Vlachopoulos L, Schweizer A, Nagy L, Fuernstahl P. Improving accuracy of opening-wedge osteotomies of distal radius using a patient-specific ramp-guide technique. BMC Musculoskelet Disord 2018; 19:374. [PMID: 30322393 PMCID: PMC6190568 DOI: 10.1186/s12891-018-2279-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Opening-wedge osteotomies of the distal radius, performed with three-dimensional printed patient-specific instruments, are a promising technique for accurate correction of malunions. Nevertheless, reports of residual malalignments and discrepancies in the plate and screw position from the planned fixation exist. Consequently, we developed a patient-specific ramp-guide technique, combining navigation of plate positioning, osteotomy cutting, and reduction. The aim of this study is to compare the accuracy of navigation of three-dimensional planned opening-wedge osteotomies, using a ramp-guide, over state-of-the-art guide techniques relying solely on pre-drilled holes. METHODS A retrospective analysis was carried out on opening-wedge osteotomies of the distal radius, performed between May 2016 and April 2017, with patient-specific instruments. Eight patients were identified in which a ramp-guide for the distal plate fixation was used. We compared the reduction accuracy with a control group of seven patients, where the reduction was performed with pre-drilled screw holes placed with the patient-specific instruments. The navigation accuracy was assessed by comparing the preoperative plans with the postoperative segmented, computed tomography scans. The accuracy was expressed using a 3D angle and in measurements of all six degrees of freedom (3 translations, 3 rotations), with respect to an anatomical coordinate system. RESULTS The duration of the surgery of the ramp-guide group was significantly shorter compared to the control group. Significantly less rotational and translational residual malalignment error was observed in the open-wedged osteotomies, where patient-specific instruments with ramp-guides were used. On average, a residual rotational malalignment error of 2.0° (± 2.2°) and a translational malalignment error of 0.6 mm (± 0.2 mm) was observed in the ramp-guide group, as compared to the 4.2° (± 15.0°) and 1.0 mm (± 0.4 mm) error in the control group. The used plate was not significantly positioned more accurately, but significantly fewer screws (15.6%) were misaligned in the distal fragment compared to the control group (51.9%). CONCLUSION The use of the presented ramp-guide technique in opening-wedge osteotomies is improving reduction accuracy, screw position, and surgical duration, compared to the existing patient-specific instrument based navigation methods.
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Affiliation(s)
- Simon Roner
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Fabio Carrillo
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ladislav Nagy
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fuernstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
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21
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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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Buijze GA, Leong NL, Stockmans F, Axelsson P, Moreno R, Ibsen Sörensen A, Jupiter JB. Three-Dimensional Compared with Two-Dimensional Preoperative Planning of Corrective Osteotomy for Extra-Articular Distal Radial Malunion: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:1191-1202. [PMID: 30020124 DOI: 10.2106/jbjs.17.00544] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malunion is the most frequent complication seen after a fracture of the distal end of the radius. The primary aim of this study was to compare patient-reported outcome measures (PROMs) after corrective osteotomy for malunited distal radial fractures with and without 3-dimensional (3D) planning and use of patient-specific surgical guides. METHODS From September 2010 to May 2015, 40 adult patients with a symptomatic extra-articular malunited distal radial fracture were randomized to 3D computer-assisted planning or conventional 2-dimensional (2D) planning for corrective osteotomy. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist Evaluation (PRWE) score, pain and satisfaction scores, grip strength, and radiographic measurements at 3, 6, and 12 months postoperatively. RESULTS From baseline to 12 months of follow-up, the reduction in the mean DASH score was -30.7 ± 18.7 points for the 3D planning group compared with -20.1 ± 17.8 points for 2D planning (p = 0.103). Secondary functional outcome by means of the PRWE resulted in a similar reduction of -34.4 ± 22.9 points for the 3D planning group compared with -26.6 ± 18.3 points for the 2D planning group (p = 0.226). There were no significant differences in pain, satisfaction, range of motion, and grip strength. Radiographic analysis showed significant differences in the mean residual volar angulation (by 3.3°; p = 0.04) and radial inclination (by 2.7°; p = 0.028) compared with the templated side, in favor of 3D planning and guidance. The duration of preoperative planning and surgery as well as complication rates were comparable. CONCLUSIONS Although there was a trend toward a minimal clinically important difference in PROMs in favor of 3D computer-assisted guidance for corrective osteotomy of extra-articular distal radial malunion, it did not attain significance because of (post hoc) insufficient power. Despite the challenge of feasibility, a trial of large magnitude is warranted to draw definitive conclusions regarding clinical advantages of this advanced, more expensive technology. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Geert A Buijze
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Natalie L Leong
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Filip Stockmans
- Handgroep Groeninge, AZ Groeninge, Kortrijk, Belgium.,KU Leuven Campus Kortrijk, Kortrijk, Belgium
| | - Peter Axelsson
- Department of Hand Surgery, Institute of Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rodrigo Moreno
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky
| | - Allan Ibsen Sörensen
- Department of Hand Surgery, Institute of Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Dobbe JGG, Caiti G, Schreurs AW, Strackee SD, Beerens M, Streekstra GJ. Positioning accuracy of a patient-tailored rimmed wedge implant for corrective osteotomy of the distal radius. Med Eng Phys 2018; 58:S1350-4533(18)30084-5. [PMID: 29802013 DOI: 10.1016/j.medengphy.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/24/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
Conventional corrective osteotomy surgery is based on 2-D imaging for planning and evaluation of bone positioning. In this feasibility study we propose and evaluate the use of 3-D preoperative planning and design of a custom rimmed wedge to be inserted into the osteotomy gap. The shape of the wedge provides 3-D bone positioning as planned, while the rims keep the bone segments in place. The method is evaluated experimentally using 3-D printed radii specimens of five different malunion patients, as well as in a human cadaver specimen. Positioning was accurate and reproducible showing residual displacements along the x-, y- and z-axes of (mean ± SD): (-0.19 ± 0.75, 0.38 ± 1.09, and 0.47 ± 0.48) mm and residual rotations about these axes of (mean ± SD): (-1.22 ± 1.66, -0.40 ± 0.93, and -0.33 ± 1.50)° for artificial bone specimens. The cadaver experiment showed similar displacements along the x-, y- and z-axes (-0.17, 1.11, and -0.35) mm and residual rotations about these axes (-2.93, -1.53, and 2.31)°. Positioning by inserting a rimmed wedge in corrective osteotomy surgery is accurate with residual errors comparable to bilateral differences. The method seems promising for future utilization in corrective osteotomy surgery and may ultimately render the procedure minimally invasive.
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Affiliation(s)
- Johannes G G Dobbe
- Department of Biomedical Engineering and Physics, Medical Imaging Section, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Room no. L0-113-3, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Giuliana Caiti
- Department of Biomedical Engineering and Physics, Medical Imaging Section, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Room no. L0-113-3, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Albert W Schreurs
- Department of Biomedical Engineering and Physics, Medical Imaging Section, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Room no. L0-113-3, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, 1105 AZ Amsterdam The Netherlands
| | - Maikel Beerens
- Xilloc Medical, Urmonderbaan 22, Gate 2, Building 110, 6167 RD Sittard-Geleen, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics, Medical Imaging Section, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Room no. L0-113-3, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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24
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Roner S, Vlachopoulos L, Nagy L, Schweizer A, Fürnstahl P. Accuracy and Early Clinical Outcome of 3-Dimensional Planned and Guided Single-Cut Osteotomies of Malunited Forearm Bones. J Hand Surg Am 2017; 42:1031.e1-1031.e8. [PMID: 28888571 DOI: 10.1016/j.jhsa.2017.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the reduction accuracy of 3-dimensional planned single-cut osteotomies (SCOTs) of the forearm that were performed using patient-specific guides. METHODS A retrospective analysis of SCOTs performed between 2012 and 2014 was performed. Ten patients (age, 15-59 years) with 6 malunions of the ulna and 6 malunions of the radius were identified. The reduction accuracy was assessed by comparing the 3-dimensional preoperative plan of each osteotomy with the superimposed bone model extracted from postoperative computed tomography data. The difference was assessed by 3-dimensional angle and in all 6 degrees of freedom (3 translations, 3 rotations) with respect to an anatomical coordinate system. Wrist range of motion and grip strength was assessed after a mean of 16.7 months and compared with the preoperative measurements. RESULTS On average, the 12 SCOTs demonstrated excellent accuracy of the reduction with respect to rotation (ie, pronation/supination, 4.9°; flexion/extension, 1.7°; ulnar/radial angulation, 2.0°) and translation (ie, proximal/distal, 0.8 mm; radial/ulnar, 0.8 mm; dorsal/palmar, 0.8 mm). A mean residual 3-dimensional angle of 5.8° (SD, 3.6°) was measured after surgery. All 6 patients operated on for reasons of a reduced range of motion demonstrated improved symptoms and increased movement (from 20° to 80°). In the patients with unstable/painful distal radioulnar joint, 3 were totally free of complaints and 1 patient showed residual pain during sports. CONCLUSIONS A SCOT combined with patient-specific guides is an accurate and reliable technique to restore normal anatomy in multiplanar deformities of the forearm. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Simon Roner
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Lazaros Vlachopoulos
- Computer Assisted Research and Development Team, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ladislav Nagy
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Team, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Caiti G, Dobbe JGG, Strijkers GJ, Strackee SD, Streekstra GJ. Positioning error of custom 3D-printed surgical guides for the radius: influence of fitting location and guide design. Int J Comput Assist Radiol Surg 2017; 13:507-518. [PMID: 29110185 PMCID: PMC5880872 DOI: 10.1007/s11548-017-1682-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Utilization of 3D-printed patient-specific surgical guides is a promising navigation approach for orthopedic surgery. However, navigation errors can arise if the guide is not correctly positioned at the planned bone location, compromising the surgical outcome. Quantitative measurements of guide positioning errors are rarely reported and have never been related to guide design and underlying bone anatomy. In this study, the positioning accuracy of a standard and an extended guide design with lateral extension is evaluated at different fitting locations (distal, mid-shaft and proximal) on the volar side of the radius. METHODS Four operators placed the surgical guides on 3D-printed radius models obtained from the CT scans of six patients. For each radius model, every operator positioned two guide designs on the three fitting locations. The residual positioning error was quantified with a CT-based image analysis method in terms of the mean target registration error (mTRE), total translation error ([Formula: see text]) and total rotation error ([Formula: see text]) by comparing the actual guide position with the preoperatively planned position. Three generalized linear regression models were constructed to evaluate if the fitting location and the guide design affected mTRE, [Formula: see text] and [Formula: see text]. RESULTS mTRE, [Formula: see text] and [Formula: see text] were significantly higher for mid-shaft guides ([Formula: see text]) compared to distal guides. The guide extension significantly improved the target registration and translational accuracy in all the volar radius locations ([Formula: see text]). However, in the mid-shaft region, the guide extension yielded an increased total rotational error ([Formula: see text]). CONCLUSION Our study demonstrates that positioning accuracy depends on the fitting location and on the guide design. In distal and proximal radial regions, the accuracy of guides with lateral extension is higher than standard guides and is therefore recommended for future use.
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Affiliation(s)
- G Caiti
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G J Strijkers
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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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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Dobbe JGG, Strackee SD, Streekstra GJ. Minimizing the Translation Error in the Application of an Oblique Single-Cut Rotation Osteotomy: Where to Cut? IEEE Trans Biomed Eng 2017; 65:821-827. [PMID: 28682244 DOI: 10.1109/tbme.2017.2721498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE An oblique single cut rotation osteotomy enables correcting angular bone alignment in the coronal, sagittal, and transverse planes, with just a single oblique osteotomy, and by rotating one bone segment in the osteotomy plane. However, translational malalignment is likely to exist if the bone is curved or deformed and the location of the oblique osteotomy is not obvious. METHODS In this paper, we investigate how translational malalignment depends on the osteotomy location. We further propose and evaluate by simulation in 3-D, a method that minimizes translational malalignment by varying the osteotomy location and by sliding the distal bone segment with respect to the proximal bone segment within the oblique osteotomy plane. The method is finally compared to what three surgeons achieve by manually selecting the osteotomy location in 3-D virtual space without planning in-plane translations. RESULTS The minimization method optimized for length better than the surgeons did, by 3.2 mm on average, range (0.1, 9.4) mm, in 82% of the cases. A better translation in the axial plane was achieved by 4.1 mm on average, range (0.3, 14.4) mm, in 77% of the cases. CONCLUSION The proposed method generally performs better than subjectively choosing an osteotomy position along the bone axis. SIGNIFICANCE The proposed method is considered a valuable tool for future alignment planning of an oblique single-cut rotation osteotomy since it helps minimizing translational malalignment.
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Schweizer A, Mauler F, Vlachopoulos L, Nagy L, Fürnstahl P. Computer-Assisted 3-Dimensional Reconstructions of Scaphoid Fractures and Nonunions With and Without the Use of Patient-Specific Guides: Early Clinical Outcomes and Postoperative Assessments of Reconstruction Accuracy. J Hand Surg Am 2016; 41:59-69. [PMID: 26710736 DOI: 10.1016/j.jhsa.2015.10.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 10/03/2015] [Accepted: 10/04/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To present results regarding the accuracy of the reduction of surgically reconstructed scaphoid nonunions or fractures using 3-dimensional computer-based planning with and without patient-specific guides. METHODS Computer-based surgical planning was performed with computed tomography (CT) data on 22 patients comparing models of the pathological and the opposite uninjured scaphoid in 3 dimensions. For group 1 (9 patients), patient-specific guides were designed and manufactured using additive manufacturing technology. During surgery, the guides were used to define the orientation of the reduced fragments. The scaphoids in group 2 (13 patients) were reduced with the conventional freehand technique. All scaphoids in both groups were fixed with a headless compression screw or K-wires, and all bone defects (except one) were filled with autologous bone grafts or vascularized grafts. Postoperative CT scans were acquired 2 or more months after the operations to monitor consolidation and compare the final result with the preoperative plan. The clinical results and accuracy of the reconstructions were compared. RESULTS In group 1, 8 of 9 scaphoids healed after 2 to 6 months, and partial nonunion after 9 months was observed in one patient. In group 2, 11 of 13 scaphoids healed between 2 and 34 months whereas 2 scaphoids did not consolidate. Comparison of the preoperative and postoperative 3-dimensional data revealed an average residual displacement of 7° (4° in flexion-extension, 4° in ulnar-radial deviation, and 3° in pronation-supination) in group 1. In group 2, residual displacement after surgery was 26° (22° in flexion-extension, 12° in ulnar-radial deviation, and 7° in pronation-supination). The difference in the accuracy of reconstruction was significant. CONCLUSIONS Although the scaphoid is small, patient-specific guides can be used to perform scaphoid reconstructions. When the guides were used, the reconstructions were significantly more anatomic compared with those resulting from the freehand technique. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Andreas Schweizer
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Flavien Mauler
- 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
| | - Ladislav Nagy
- 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.
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Vlachopoulos L, Schweizer A, Graf M, Nagy L, Fürnstahl P. Three-dimensional postoperative accuracy of extra-articular forearm osteotomies using CT-scan based patient-specific surgical guides. BMC Musculoskelet Disord 2015; 16:336. [PMID: 26537949 PMCID: PMC4634814 DOI: 10.1186/s12891-015-0793-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/28/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Computer assisted corrective osteotomy of the diaphyseal forearm and the distal radius based on computer simulation and patient-specific guides has been described as a promising technique for accurate reconstruction of forearm deformities. Thereby, the intraoperative use of patient-specific drill and cutting guides facilitate the transfer of the preoperative plan to the surgery. However, the difference between planned and performed reduction is difficult to assess with conventional radiographs. The aim of this study was to evaluate the accuracy of this surgical technique based on postoperative three-dimensional (3D) computed tomography (CT) data. METHODS Fourteen patients (mean age 23.2 (range, 12-58) years) with an extra-articular deformity of the forearm had undergone computer assisted corrective osteotomy with the healthy anatomy of the contralateral uninjured side as a reconstruction template. 3D bone surface models of the pathological and contralateral side were created from CT data for the computer simulation. Patient-specific drill and cutting guides including the preoperative planned screw direction of the angular-stable locking plates and the osteotomy planes were used for the intraoperative realization of the preoperative plan. There were seven opening wedge osteotomies and nine closing wedge (or single-cut) osteotomies performed. Eight-ten weeks postoperatively CT scans were obtained to assess bony consolidation and additionally used to generate a 3D model of the forearm. The simulated osteotomies- preoperative bone models with simulated correction - and the performed osteotomies - postoperative bone models - were analyzed for residual differences in 3D alignment. RESULTS On average, a significant higher residual rotational deformity was observed in opening wedge osteotomies (8.30° ± 5.35°) compared to closing wedge osteotomies (3.47° ± 1.09°). The average residual translation was comparable small in both groups, i.e., below 1.5 mm and 1.1 mm for opening and closing wedge osteotomies, respectively. CONCLUSIONS The technique demonstrated high accuracy in performing closing wedge (or single-cut) osteotomies. However, for opening wedge osteotomies with extensive lengthening, probably due to the fact that precise reduction was difficult to achieve or maintain, the final corrections were less accurate.
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Affiliation(s)
- Lazaros Vlachopoulos
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Matthias Graf
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Ladislav Nagy
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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Walenkamp MMJ, de Muinck Keizer RJO, Dobbe JGG, Streekstra GJ, Goslings JC, Kloen P, Strackee SD, Schep NWL. Computer-assisted 3D planned corrective osteotomies in eight malunited radius fractures. Strategies Trauma Limb Reconstr 2015; 10:109-16. [PMID: 26350551 PMCID: PMC4570883 DOI: 10.1007/s11751-015-0234-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022] Open
Abstract
In corrective osteotomy of the radius, detailed preoperative planning is essential to optimising functional outcome. However, complex malunions are not completely addressed with conventional preoperative planning. Computer-assisted preoperative planning may optimise the results of corrective osteotomy of the radius. We analysed the pre- and postoperative radiological result of computer-assisted 3D planned corrective osteotomy in a series of patients with a malunited radius and assessed postoperative function. We included eight patients aged 13–64 who underwent a computer-assisted 3D planned corrective osteotomy of the radius for the treatment of a symptomatic radius malunion. We evaluated pre- and postoperative residual malpositioning on 3D reconstructions as expressed in six positioning parameters (three displacements along and three rotations about the axes of a 3D anatomical coordinate system) and assessed postoperative wrist range of motion. In this small case series, dorsopalmar tilt was significantly improved (p = 0.05). Ulnoradial shift, however, increased by the correction osteotomy (6 of 8 cases, 75 %). Postoperative 3D evaluation revealed improved positioning parameters for patients in axial rotational alignment (62.5 %), radial inclination (75 %), proximodistal shift (83 %) and volodorsal shift (88 %), although the cohort was not large enough to confirm this by statistical significance. All but one patient experienced improved range of motion (88 %). Computer-assisted 3D planning ameliorates alignment of radial malunions and improves functional results in patients with a symptomatic malunion of the radius. Further development is required to improve transfer of the planned position to the intra-operative bone. Level of evidence IV.
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Affiliation(s)
- M M J Walenkamp
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, room G4-137, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R J O de Muinck Keizer
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, room G4-137, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - J G G Dobbe
- Biomedical Engineering and Physics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - G J Streekstra
- Biomedical Engineering and Physics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, room G4-137, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P Kloen
- Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Precision of image-based registration for intraoperative navigation in the presence of metal artifacts: Application to corrective osteotomy surgery. Med Eng Phys 2015; 37:524-30. [PMID: 25906944 DOI: 10.1016/j.medengphy.2015.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 02/06/2015] [Accepted: 03/22/2015] [Indexed: 11/20/2022]
Abstract
Navigation for corrective osteotomy surgery requires patient-to-image registration. When registration is based on intraoperative 3-D cone-beam CT (CBCT) imaging, metal landmarks may be used that deteriorate image quality. This study investigates whether metal artifacts influence the precision of image-to-patient registration, either with or without intermediate user intervention during the registration procedure, in an application for corrective osteotomy of the distal radius. A series of 3-D CBCT scans is made of a cadaver arm with and without metal landmarks. Metal artifact reduction (MAR) based on inpainting techniques is used to improve 3-D CBCT images hampered by metal artifacts. This provides three sets of images (with metal, with MAR, and without metal), which enable investigating the differences in precision of intraoperative registration. Gray-level based point-to-image registration showed a better correlation coefficient if intraoperative images with MAR are used, indicating a better image similarity. The precision of registration without intermediate user intervention during the registration procedure, expressed as the residual angulation and displacement error after repetitive registration was very low and showed no improvement when MAR was used. By adding intermediate user intervention to the registration procedure however, precision was very high but was not affected by the presence of metal artifacts in the specific application.
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Patient-specific distal radius locking plate for fixation and accurate 3D positioning in corrective osteotomy. Strategies Trauma Limb Reconstr 2014; 9:179-83. [PMID: 25362548 PMCID: PMC4278965 DOI: 10.1007/s11751-014-0203-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/25/2014] [Indexed: 11/26/2022] Open
Abstract
Preoperative three-dimensional planning methods have been described extensively. However, transferring the virtual plan to the patient is often challenging. In this report, we describe the management of a severely malunited distal radius fracture using a patient-specific plate for accurate spatial positioning and fixation. Twenty months postoperatively the patient shows almost painless reconstruction and a nearly normal range of motion.
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Ma B, Kunz M, Gammon B, Ellis RE, Pichora DR. A laboratory comparison of computer navigation and individualized guides for distal radius osteotomy. Int J Comput Assist Radiol Surg 2013; 9:713-24. [PMID: 24323402 DOI: 10.1007/s11548-013-0966-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/19/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE This article presents the results of a multiuser, randomized laboratory trial comparing the accuracy and precision of image-based navigation against individualized guides for distal radius osteotomy (DRO). METHODS Six surgeons each performed four DROs using image-based navigation and four DROs using individualized guides in a laboratory setting with plastic phantom replicas of radii from patients who had received DRO as treatment for radial deformity. Time required and correction errors of ulnar variance, radial inclination, and volar tilt were measured. RESULTS There were no statistically significant differences in the average correction errors. There was a statistically significant difference in the standard deviation of ulnar variance error (2.0 mm for navigation vs. 0.6 mm for guides). There was a statistically significant difference in the standard deviation of radial inclination error ([Formula: see text] for navigation vs. [Formula: see text] for guides). There were statistically significant differences in the times required (705 s for navigation vs. 214 s for guides) and their standard deviations (144 s for navigation vs. 98 s for guides). CONCLUSIONS Compared to navigated DRO, individualized guides were easier to use, faster, and produced more precise correction of ulnar variance and radial inclination. The combination of true three-dimensional planning, ease of use, and accurate and precise corrective guidance makes the individualized guide technique a promising approach for performing corrective osteotomy of the distal radius.
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Affiliation(s)
- Burton Ma
- Department of Electrical Engineering and Computing Science, York University, Toronto, ON, Canada,
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