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

Abstract

Background: Cubitus varus deformity is a common sequela of elbow fractures in children. Cubitus varus deformity treatment is tending toward 3D correction, which is challenging for orthopedic surgeons. This study aims to explore whether individualized 3D-printed navigation templates can assist with accurate and effective corrective treatment of children with cubitus varus deformity. Methods: Thirty-five patients were treated for cubitus varus deformity from June 2015 to April 2017, including 21 boys and 14 girls, aged 4.6-13.2 years (average, 7.5 years). Of these cases, 17 deformities were on the left side and 18 were on the right side. All were treated with wedge osteotomy of the lateral distal humerus. 3D-printed navigation templates were used in 16 cases, while traditional surgery was used in 19 cases. All patients underwent computed tomography scans before surgery. Computer software was used to analyze the measurements and design and print individualized navigation templates. The navigation templates were matched, and surgery was initially simulated. Intraoperative individualized navigation templates were used to assist with accurate osteotomy and Kirschner wire fixation. Operation times were recorded in all cases, the carrying angles before and after surgery were assessed by computer, and postoperative elbow joint function was evaluated using Bellemore criteria. All measurement data were presented as means ± SD, and Student's t test was used to examine differences between groups. All count data between both groups were compared using the chi-square test or Fisher's exact test analysis. Results: All individualized navigation templates matched well with the corresponding anatomical markers and were consistent with preoperative planning, simulated surgery, and intraoperative procedures. Average operation times from clear exposure to fixed Kirschner wire were 11.69 min (9.6-13.5 min) for the individualized navigation template group and 22.89 min (17.7-26.8 min) for the traditional operation group (p < 0.001). Average differences in postoperation carrying angles between affected and healthy sides were 1.13°(0-2.0°) and 4.21°(0-7.5°), respectively (p < 0.001). Follow-up 6-12 months postoperation showed that elbow function did not differ significantly between groups using the Bellemore criteria (p > 0.05). Conclusions: Individualized navigation templates simplify procedures, reduce operation time, and improve accuracy when used in orthopedic surgery to treat children with cubitus varus deformity.

The effect of three-dimensional (3D) printing on quantitative and qualitative outcomes in paediatric orthopaedic osteotomies: a systematic review

“…Quantitative outcome measures included surgical operation time, fluoroscopic exposure (number of radiographs), intra-operative blood loss volume, radiographic angular correction measurements and range of motion assessments. There was a statistically significant reduction in operative time, 17 , 25 , 26 , 37 fluoroscopic exposure 25 , 26 and intra-operative blood loss, 37 with significant improvements found in angular correction 27 , 28 and range of motion. 29 , 30 …”

“…The total number of patients across all studies was 212, with the largest individual study patient number equalling 35. 17 The mean age across the studies was 11.2 years (range 3 to 21 years).…”

“…Fifteen studies utilized 3D printing for PSI in operations involving the proximal femur (four), 25 – 28 forearm (five), 29 – 33 foot (one), 34 and distal humerus (five). 17 , 35 – 38 …”

“… 25 , 26 By applying individualized templates which closely correlate to the patient’s bony anatomy, there is no requirement to perform repeated adjustments which arguably saves time, blood loss and reduces the requirement for repeated fluoroscopy exposures. 17 , 37 …”

Using 3D Printing Technology for Corrective Biplanar Chevron Osteotomy with Customized Osteotomy Guide and Patient-Matched Monoblock Crosslink Plate in Treatment of Cubitus Varus Deformity: A Case Report and Technical Note

“…Then, the closed-wedge osteotomy was performed by cutting through a slit on the template and using the reduction guide to align the bone [15]. Since then, many researchers have tried to develop an individualized navigation template for the lateral closed-wedge osteotomy for the CVD [9,16,17] and showed the advantages of this technique with respect to determining the osteotomy angle, osteotomy plane, and rotational angle. In this study, we innovatively designed the customized osteotomy guide to place on the posterior surface of the distal humerus due to the need for a posterior slit for the biplanar Chevron osteotomy.…”