Efficacy of two reduction methods in conjunction with 3-D–printed patient-specific pin guides for aligning simulated comminuted tibial fractures in cadaveric dogs

Johnson, Matthew; Lewis, Daniel D.; Sutton, William A.; Scheuermann, Logan M.; Armond, Christina C De; Kim, Stanley E.; Biedrzycki, Adam H.

doi:10.2460/ajvr.21.12.0215

Cited by 8 publications

(40 citation statements)

References 39 publications

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“…In the development of this technique, we realized that guide placement was more difficult at the proximal femur and distal tibia due to the more cylindrical shape of the bone. This has been discussed for the canine tibia by Johnson et al [14]. We mainly solved the problem with a three-point support as outlined in the methods section (Figs.…”

Section: Chaouche Et Al Presented Excellent Results Of 100mentioning

confidence: 99%

“…Applied to a veterinary fracture setting, Johnson et al compared two techniques very similar to ours in canine tibiae. Both of their techniques showed minor alignment discrepancies compared to the intact tibia within clinically acceptable standards (0.8/2.3 mm for length, 1.7/2.9° for coronal plane alignment, 5.0/5.4° for sagittal plane alignment, 3.6/3.5° for torsional alignment) [14]. Despite a more accurate length restoration, the observed changes after reduction are slightly higher than the ones we reported for porcine tibiae.…”

Section: Discussionmentioning

confidence: 99%

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3D printed fracture reduction guides planned and printed at the point of care show high accuracy – a porcine feasibility study

Hecker

Eberlein

2022

J EXP ORTOP

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Purpose After surgical treatment of comminuted diaphyseal femoral and tibial fractures, relevant malalignment, especially rotational errors occur in up to 40–50%. This either results in a poor clinical outcome or requires revision surgery. This study aims to evaluate the accuracy of reduction if surgery is supported by 3D guides planned and printed at the point of care. Methods Ten porcine legs underwent computed tomography (CT) and 3D models of femur and tibia were built. Reduction guides were virtually constructed and fitted to the proximal and distal metaphysis. The guides were 3D printed using medically approved resin. Femoral and tibial comminuted diaphyseal fractures were simulated and subsequently reduced using the 3D guides. Postoperative 3D bone models were reconstructed to compare the accuracy to the preoperative planning. Results Femoral reduction showed a mean deviation ± SD from the plan of 1.0 mm ± 0.9 mm for length, 0.9° ± 0.7° for varus/valgus, 1.2° ± 0.9° for procurvatum/recurvatum and 2.0° ± 1.7° for rotation. Analysis of the tibial reduction revealed a mean deviation ± SD of 2.4 mm ± 1.6 mm for length, 1.0° ± 0.6° for varus/valgus, 1.3° ± 1.4° for procurvatum/recurvatum and 2.9° ± 2.2° for rotation. Conclusions This study shows high accuracy of reduction with 3D guides planned and printed at the point of care. Applied to a clinical setting, this technique has the potential to avoid malreduction and consecutive revision surgery in comminuted diaphyseal fractures. Level of Evidence Basic Science.

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Section: Chaouche Et Al Presented Excellent Results Of 100mentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

3D printed fracture reduction guides planned and printed at the point of care show high accuracy – a porcine feasibility study

Hecker

Eberlein

2022

J EXP ORTOP

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“…11 Similarly, a custom 3D printed reduction system resulted in excellent reduction in dog cadavers with simulated tibial fractures. 12 The objectives of this study were to (1) develop and describe a fracture reduction system (FRS) designed to mitigate the challenges of indirect femoral fracture reduction and (2) assess the efficiency and accuracy of reduction using accurately precontoured plates and either the FRS or placement of an intramedullary pin (IMP). We hypothesized that FRS would reduce the duration of surgery, require fewer fluoroscopic images, and produce superior alignment when compared to IMP.…”

Section: Introductionmentioning

confidence: 99%

“…Virtual surgical planning and 3-dimensional (3D) printing are gaining interest in veterinary orthopedic surgery and the application of custom surgical guides to facilitate indirect fracture reduction during MIPO has been described. 11,12 One case report described utilizing MIPO with 2 custom surgical guides and an alignment jig for a cat with a comminuted mid-diaphyseal humeral fracture, and near-anatomic alignment was achieved. 11 Similarly, a custom 3D printed reduction system resulted in excellent reduction in dog cadavers with simulated tibial fractures.…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive plate osteosynthesis of femoral fractures with 3D‐printed bone models and custom surgical guides: A cadaveric study in dogs

et al. 2022

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ObjectiveAssess the accuracy and efficiency of reduction provided by application of plates precontoured to 3‐dimensional (3D)‐printed femoral bone models using a custom fracture reduction system (FRS) or intramedullary pin (IMP) to facilitate femoral minimally invasive plate osteosynthesis (MIPO) in dogs.Study designExperimental cadaveric study.Sample populationSeven dog cadavers.MethodsVirtual 3D femoral models were created using computed tomographic images. Simulated, virtual mid‐diaphyseal femoral fractures were created and reduced. Reduced femoral models were 3D‐printed and a plate was contoured. Custom drill guides for plate screw placement were designed and 3D‐printed for the FRS. Mid‐diaphyseal simulated comminuted fractures were created in cadavers, and fractures were aligned using FRS or IMP and stabilized with the precontoured plates. Number of fluoroscopic images acquired per procedure and surgical duration were recorded. Computed tomographic scans were repeated to assess femoral length and alignment.ResultsCompared to the preoperative virtual plan, median change in femoral length and frontal, sagittal, and axial alignment was less than 3 mm, 2°, 3°, and 3° postoperatively, respectively, in both reduction groups. There was no difference in length or alignment between reduction groups (P > .05). During FRS, fewer fluoroscopic images were taken (P = .001), however, surgical duration was longer than IMP procedures (P = .011).ConclusionFemoral alignment was accurate when using plates precontoured to 3D printed models, regardless of reduction method.Clinical significanceAccurate plate contouring using anatomically accurate models may improve fracture reduction accuracy during MIPO applications. Custom surgical guides may reduce fluoroscopy use associated with MIPO.

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Three‐dimensionally printed osteotomy and reaming guides for correction of a multiplanar femoral deformity stabilized with an interlocking nail in a dog

Scheuermann,

Kim

2024

Veterinary Surgery

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ObjectiveTo describe the use of virtual surgical planning (VSP) and three‐dimensionally (3D) printed surgical guides for corrective osteotomies stabilized with an interlocking nail in a dog with a multiplanar femoral deformity.Study designCase report.AnimalsAn 8‐year‐old male neutered mixed breed dog weighing 44 kg.MethodsA dog was presented for a right grade 3 lateral patellar luxation secondary to a multiplanar femoral deformity due to a suspected femoral malunion. A computed tomography (CT) scan was obtained to create virtual femoral models. Corrective osteotomies were simulated with VSP. Custom osteotomy guides and reaming guides were designed to facilitate the correction and the placement of an interlocking nail. The preoperative femoral model, virtually aligned femoral model, custom osteotomy guides, and reaming guides were 3D printed, sterilized, and utilized intraoperatively. A CT scan was performed postoperatively to assess femoral length and alignment.ResultsCustom osteotomy and reaming guides were used as intended by the VSP. Postoperative femoral length as well as frontal, sagittal, and axial plane alignment were within 0.7 mm, 2.2°, 0.5°, and 1.6°, respectively, of the virtually planned femoral model. Two months postoperatively, the dog was sound on visual gait examination, and the patella tracked in the trochlear groove throughout stifle range of motion and was unable to be manually luxated. Radiographs obtained 2 months postoperatively revealed static femoral alignment and implants. Both osteotomies were discernable with callus bridging.ConclusionVirtual surgical planning and custom osteotomy and reaming guides facilitated complex femoral corrective osteotomies and interlocking nail placement.

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Efficacy of two reduction methods in conjunction with 3-D–printed patient-specific pin guides for aligning simulated comminuted tibial fractures in cadaveric dogs

Cited by 8 publications

References 39 publications

3D printed fracture reduction guides planned and printed at the point of care show high accuracy – a porcine feasibility study

3D printed fracture reduction guides planned and printed at the point of care show high accuracy – a porcine feasibility study

Minimally invasive plate osteosynthesis of femoral fractures with 3D‐printed bone models and custom surgical guides: A cadaveric study in dogs

Three‐dimensionally printed osteotomy and reaming guides for correction of a multiplanar femoral deformity stabilized with an interlocking nail in a dog

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