Complex Osteotomies of Tibial Plateau Malunions Using Computer-Assisted Planning and Patient-Specific Surgical Guides

Abstract

The accurate reduction of tibial plateau malunions can be challenging without guidance. In this work, we report on a novel technique that combines 3-dimensional computer-assisted planning with patient-specific surgical guides for improving reliability and accuracy of complex intraarticular corrective osteotomies. Preoperative planning based on 3-dimensional bone models was performed to simulate fragment mobilization and reduction in 3 cases. Surgical implementation of the preoperative plan using patient-specific cutting and reduction guides was evaluated; benefits and limitations of the approach were identified and discussed. The preliminary results are encouraging and show that complex, intraarticular corrective osteotomies can be accurately performed with this technique. For selective patients with complex malunions around the tibia plateau, this method might be an attractive option, with the potential to facilitate achieving the most accurate correction possible.

A 3‐dimensional‐printed patient‐specific guide system for minimally invasive plate osteosynthesis of a comminuted mid‐diaphyseal humeral fracture in a cat

“…Avoiding intraoperative imaging is a key advantage of the reduction guide system described here as well as similar CAD‐designed, 3D‐printed patient‐specific guide systems recently described in the treatment of human radial, tibial, and scaphoid fracture malunions. In those reports, advantages also included accurate restoration of bone conformation, simplified surgical technique, and potentially reduced surgical time . Good guide fit is a key determinant of the overall accuracy of such systems.…”

“…Recent reports describe the use of a 3D‐printed patient‐specific drill guide for placement of bicortical pedicle screws in a canine cervical vertebra . Reports in the human literature detail the use of 3D‐printed patient‐specific osteotomy and reduction guides in the treatment of radial, tibial, and scaphoid fracture malunions . These techniques may facilitate closed, indirect fracture reduction and fracture alignment during MIPO but are as yet unreported in veterinary or human literature.…”

Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis

“…The majority of studies reported satisfactory immediate surgical results (60-100%). Complication reporting was sparse with two exceptions: (i) van Steenberghe et al who reported 6/27 cases of bruxism (involuntary grinding of the teeth), a complication known to be associated with immediate loading of implants in fully endentulous maxillae [50], and (ii) F€ urnstahl et al [10] who describe severe pain postoperatively due to incomplete procedure [medial compartment of the knee not repaired in theatre, despite having achieved repair during rehearsal]. The number of participants was too small (n ¼ 3) to embark on further analysis ( Table 2).…”

“…fusion of 2D-into 3D-images using computed tomography (CT) slides), and rapid prototyping (building a physical model using computer aided design (CAD) software, e.g. 3D printing) facilitate the effective and accurate construction of patient-specific anatomical models, surgical guides and implants [7][8][9][10], thus opening new avenues for pre-operative rehearsals.…”

Accuracy of patient‐specific three‐dimensional‐printed osteotomy and reduction guides for distal femoral osteotomy in dogs with medial patella luxation

“…The clinical use of patient‐specific three‐dimensional (3D)‐printed osteotomy and reduction guide systems has been reported in human surgery in the correction of fracture malunions and other deformities . These guide systems are easier to use and less expensive than computer navigation systems, provide flexibility because of their custom‐design, reduce surgical time, and are significantly more accurate in terms of residual angulation and rotation compared with computer navigation systems or conventional freehand techniques .…”