Application of computer simulation in the treatment of traumatic cubitus varus deformity in children

Abstract

Cubitus varus deformity is common in children. The purpose of this study was to assess the usefulness of computer simulation based on three-dimensional computed tomography (3D-CT) reconstruction with regard to preoperative planning and surgical treatment in children with traumatic cubitus varus deformity.The study included 13 patients with traumatic cubitus varus deformity between January 2012 and January 2015. The original 3D-CT data were transferred to Mimics 10.01 software. Special tools were used for simulation of supracondylar lateral wedge osteotomy of the humerus. Intraoperative elbow arthrography was used to identify the articular surface of the elbow joint for assisting the judgment of the osteotomy site. Kirschner wires were used to determine the osteotomy plane and angle. The osteotomy site was fixed by crossing Kirschner wires and steel wire tension band.Of the 13 patients, 11 were male and 2 were female. The left side was affected in 8 patients, and the right side was affected in 5 patients. The patient age ranged from 2 years to 14 years (mean age, 6 years and 7 months). The varus angle ranged from 12° to 35° (mean angle, 20°). The carrying angle on the contralateral side ranged from 5° to 18° (mean angle, 10°). The varus deformities showed good correction. The 13 patients were followed up for 24 to 60 months (mean follow-up, 38 months). According to the Flynn score of elbow joint function after surgery: 10 patients had excellent function, 2 had good function, and 1 had fair function. The excellent rate was 92.3%. At the final follow-up, the ipsilateral carrying angle ranged from 4° to 15° (mean angle, 11°).Computer simulation based on 3D-CT reconstruction can provide good information on the right humeral osteotomy position and osteotomy angle. It can guide the actual operation and provide better results after surgery. Intraoperative elbow arthrography is useful to determine the level of elbow joint osteotomy, and it can assist in the operation.Level of evidence: Level IV-retrospective case, treatment study.

Clinical application of individualized 3D-printed navigation template to children with cubitus varus deformity

“…This poses a challenge for orthopedic surgeons. Accurately controlling the correction angle in each dimension during the operation is difficult, and the adjustment must often be repeated during surgery or the degree of correction must be determined based on general appearance [27]. Medical 3D-printing technology is based on computer-aided design (CAD) and rapid prototyping technology [28,29], using medically specific materials to print products that can be applied in the medical field and have individualized 3D structures or functions [30].…”

Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity

“…Although the 3D printing guide plate has been widely used in various fields such as the spine, trauma, and arthroplasty currently [14, 23, 24], the applications in adolescent deformity correction have been rarely reported. Previously, Zhang et al [18] and Jiang et al [25], respectively, applied the computer navigation templates to correct adolescent cubitus varus deformity and achieved satisfactory short-term effects, but there is still a lack of comparison of the long-term prognosis with conventional surgery group. In this study, there was no significant difference in the total postoperative complication rate between two groups (14.3% versus 18.2%, P = 0.371).…”

Computer-Aided Surgical Simulation for Correcting Complex Limb Deformities in Children

“…Despite the fact that computer-aided surgical planning and simulation is increasingly used in reconstructive surgery and trauma, the use of this technology in PO surgery is at the beginning. Several advantages have been reported in terms of the use of CASS in orthopaedic surgery [3][4][5][6][7]21,25]. The visuospatial understanding of the bony anatomy is enhanced by physical models, maybe because of the combination of both a tactile and an optic experience, which has been demonstrated to improve the execution of surgical procedures, especially in complex cases.…”

“…This type of surgery usually requires extensive preoperative planning, because of the complex 3D anatomy of the axial and appendicular skeleton. Growing evidence has proven that CASS may increase performance, precision, and efficiency of surgeons, thus, decreasing complications and adverse outcomes, and driving down costs for both patients/families and health care system [3][4][5][6][7]. However, CASS is often considered as costly, time consuming, and the prerogative of a few specialized centers that have facilities and trained staff for it, thus, discouraging its use among surgeons.…”