Custom 3D-Printed Cutting Guides for Femoral Osteotomy in Rotational Malalignment Due to Diaphyseal Fractures: Surgical Technique and Case Series

Abstract

Femoral shaft fractures are one of the most common injuries in trauma patients. The gold standard treatment consists of closed reduction and intramedullary nailing, providing a high fracture healing rate and allowing early mobilization. However, rotational malalignment is a well-known complication following this procedure, and excessive femoral anteversion or femoral retroversion can trigger functional complaints. In order to achieve the ideal degree of femoral rotation, a 3D planning and printing cutting guides procedure was developed to correct femoral malrotation. A patient series with malalignment after a femoral diaphyseal fracture was operated on with the customized guides and evaluated in this study. Computed tomography scans were performed to accurately determine the number of degrees of malrotation, allowing the design of specific and personalized surgical guides to correct these accurately. Once designed, they were produced by 3D printing. After surgery with the customized guides to correct femoral malrotation, all patients presented a normalized anteversion angle of the femur (average −10.3°, range from −5° to −15°), according to their contralateral limb. These data suggest that the use of customized cutting guides for femoral osteotomy is a safe and reproducible surgical technique that offers precise results when correcting femoral malrotation.

A novel patient-specific 3D printed guide for accurate femoral derotation osteotomies: a case report

“…Either central or eccentrical placement of the pins seems to be irrelevant to the amount of rotation needed before pins become parallel. Further, due to the compact design of the 3D guide, there was minimal need for periosteal stripping and soft tissue detachment as compared to other studies presenting 3D derotation guides (3,13). Besides fracture revision surgery, the concept of this 3D technique might be applicable for patients with excessive native ante-or retroversion of the femur too (14).…”

“…However, most axial malrotations become symptomatic in the later phase of rehabilitation because of altered gait (toeing-in/-out or abductor muscle malfunction) when fracture consolidation is almost reached (2,10). This urges the need for revision surgery in the form of a subtrochanteric or diaphyseal derotation osteotomy (1,3,4,9). Femoral derotation osteotomies are technically challenging procedures for which careful preoperative CTbased planning of FAVA correction is key to successful outcome (1,9).…”

“…The prevalence of evident rotational malalignment after intramedullary (IM) nailing for femoral fractures (pertrochanteric, subtrochanteric, diaphyseal) is broadly estimated on 2.3–35% ( 1 , 2 ). Due to the intraoperative closed reduction maneuver, it appears difficult to maintain control over the native rotation of the femur, both radiographically and clinically ( 1 , 3 ).…”

“…Relevant mechanical leg axis deviation might be expected in case of >20° side to side difference ( 6 ). However, increased femoral anteversion results in an elevated patellofemoral contract pressure, toeing-in during gait and anterior groin pain ( 1 , 3 , 7 , 8 ). This might severely impact the quality of life and the activity level of the ambulating patient (regardless of age) ( 1 ).…”

Minimally Invasive Derotational Osteotomy of Long Bones: Smartphone Application Used to Improve the Accuracy of Correction

“…A recently introduced innovative surgical technique that corrects femoral malrotation using 3D printing technology [ 27 ] has the advantage of using customized cutting guides that allow accurate estimation of the angle of correction of malrotation. Additionally, it also requires shorter operating time and less radiation exposure.…”