3D-print in the planning of surgical treatment in the case of extraarticular deformity of lower limbs

Abstract

An adequate planning of the curative measures is an important factor providing good functional results in the treatment of consequences of long bones injuries, in particular, malunions (post traumatic deformities). 3D-modeling in the preoperative planing gives an opportunity to assess both deformity itself and joint status. Visua­lization of injured segment with three-dimensional model manufactured using 3D-print in actual size (1:1 scale) provides additional capacities. Objective. To analyze the capacity provided by the usage of three-dimensional models of damaged segments in scale 1:1 while the planning of corrective surgery. Methods. Practicability of the usage of 3D-models, that was worked out on the base of CT-scanning, was studied in the treatment of 52 patients with different post traumatic extraarticular deformities of femur and tibia, after the fractures with intraarticular extension. Clinical results were evaluated using SF-36 and AOFAS scales. Results. Calculation for 3D-modeling was performed mostly virtually using standard computer programs with 3D-reconstruction, but 3D-print technology was used for 5 patients with the most severe and sophisticated deformities of the lower extremities. Changes in functional outcomes, according to SF-36 and AOFAS, for the patients undergone opera- tive treatment, were positive at 12 month of follow-up. Fore­ign colleagues expose analogous results of the investigations and suggest that the modeling with 3D-print provides mostly more safe, reliable and standardized clinical decisions for every particular patient. Conclusions. Preoperative usage of 3D-print on the stage of preoperative planing allows the surgeons to simulate different stages of operative intervention on the physical model, thus, help him to realize possible technical problems, choose adequate fixation device and proper instrumentation. It facilitates the shortening of surgery time, elimination of possible complications rate and achievement, in sum, good functional results in the treatment of this kind of patients.

Modern Treatment of Post-Traumatic Extra-Articular Deformity of the Femur

“…Methods for evaluating the intraoperative and postoperative rotational profile have been developed. Many of them are based on comparison with the intact contralateral femur [16,40]. Prevention of deformation in the coronal plane is possible with the help of correct restoration of the mechanical axis [41].…”

“…Calculation of 3D models was carried out mostly virtually using standard computer software with 3D reconstruction, but 3D printing technology was used in 12 patients with the most complex cases of post-traumatic deformities of the lower extremities. Preoperative planning was carried out using models of the damaged and contralateral segment made by 3D printing on a scale of 1:1 [16,17].…”

“…For 3D printing of her damaged segment, its image was virtually superimposed on the impression of the contralateral one, rotated by 180°, followed by evaluation of the combined image. It has been established that such a technique provides additional information that facilitates surgical intervention planning [16]. Even conducting an adequate X-ray examination and CT scan with calculation of deformation angles in different planes may sometimes not provide all the necessary information (Fig.…”

“…During the study of deformation, the evaluation of curvature using 3D modeling based on the results of CT studies is informative. Modern diagnostic preoperative technologies make it possible not only to compare the deformed and intact limb, but also to superimpose two images one on top of the other and in this way establish the peak of the deformation and its true appearance, choose the place of the osteotomy, and plan the fixation of the fragments [16,17].…”