A Two-Step Approach for 3D-Guided Patient-Specific Corrective Limb Osteotomies

Abstract

Background: Corrective osteotomy surgery for long bone anomalies can be very challenging since deformation of the bone is often present in three dimensions. We developed a two-step approach for 3D-planned corrective osteotomies which consists of a cutting and reposition guide in combination with a conventional osteosynthesis plate. This study aimed to assess accuracy of the achieved corrections using this two-step technique. Methods: All patients (≥12 years) treated for post-traumatic malunion with a two-step 3D-planned corrective osteotomy within our center in 2021 were prospectively included. Three-dimensional virtual models of the planned outcome and the clinically achieved outcome were obtained and aligned. Postoperative evaluation of the accuracy of performed corrections was assessed by measuring the preoperative and postoperative alignment error in terms of angulation, rotation and translation. Results: A total of 10 patients were included. All corrective osteotomies were performed according to the predetermined surgical plan without any complications. The preoperative deformities ranged from 7.1 to 27.5° in terms of angulation and 5.3 to 26.1° in terms of rotation. The achieved alignment deviated on average 2.1 ± 1.0 and 3.4 ± 1.6 degrees from the planning for the angulation and rotation, respectively. Conclusions: A two-step approach for 3D-guided patient-specific corrective limb osteotomies is reliable, feasible and accurate.

Functional outcome of 2-D- and 3-D-guided corrective forearm osteotomies: a systematic review

“…In addition, the surgery can be performed using 3-D-printed patient-specific surgical cutting and reposition guides ( Lal and Patralekh, 2018 ; Tack et al., 2016 ). Various methods and techniques for corrective osteotomies of different deformed bones have been described ( Assink et al., 2022a ). In addition, 3-D corrective osteotomies for malunited paediatric forearm fractures are already being performed and 3-D osteotomies are a predictor of better functional outcome in children ( Roth et al., 2017 , 2022a , 2022b ).…”

3D-assisted corrective osteotomies of the distal radius: a comparison of pre-contoured conventional implants versus patient-specific implants

“…Corrective osteotomy surgery of the distal radius in combination with a patient-specific implant is reported in only a few studies [ 18 , 19 ]. Dobbe et al presented a case report on the application of a patient-specific distal radius locking plate [ 13 ], obtaining favorable outcomes (residual displacement of − 0.9°, 2.3°, and 1.7° for dorsal, radial, and rotational angles, respectively). Subsequently, Dobbe et al [ 19 ] presented a case series involving corrective osteotomies of the distal radius treated with patient-specific implants.…”

“…Two surgical guides were designed for each implant, according to our two-step approach for 3D-guided patient-specific corrective osteotomies [ 13 ] (Fig. 1 c5 conventional implant /Fig.…”

“…They have full plate-to-bone contact at the final preferred bone position, based on the 3D virtual models created by the patients’ computed tomography (CT) data. In our clinic, corrective limb osteotomies are currently performed using a 3D-assisted two-step approach, resulting in reliable, feasible, and accurate results [ 13 ]. Corrective osteotomies of the radius with both a patient-specific implant and a surgical guide showed high accuracy and reproducibly of positioning on artificial bone [ 14 , 15 ], in cadaveric studies [ 16 ] and in clinical reports [ 17 – 19 ].…”

Advances of 3D printing technologies in orthopaedic trauma and surgical training: a transformative approach

“…During surgery, 3D technology can offer real-time guidance to implement the preoperative plan into the actual operation. Surgical guides produced through 3D printing can be directly placed in the surgical field, aiding in osteotomy saw planes, fracture reductions, and the positioning of implants and screws [ 4 ]. Postoperatively, 3D imaging enables the assessment of surgical outcomes concerning the quality of fracture reduction and the accuracy of implant placement [ 5 ].…”