Outcomes of 3-D corrective osteotomies for paediatric malunited both-bone forearm fractures

Roth, Kasper C.; Es, Eline M. van; Kraan, Gerald; Verhaar, J.A.; Stockmans, Filip; Colaris, Joost W.

doi:10.1177/17531934211029511

Cited by 9 publications

(11 citation statements)

References 29 publications

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“…Several studies describe 3D-planned corrective limb osteotomies and show their technique to be feasible, leading to good functional outcomes [6][7][8][9][10][11][12][13][14]. Yet, even though the surgery is planned using state-of-the-art 3D software, postoperative evaluation is usually still performed in 2D on plain radiographs since postoperative CTs are not routinely made.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, even though the surgery is planned using state-of-the-art 3D software, postoperative evaluation is usually still performed in 2D on plain radiographs since postoperative CTs are not routinely made. Therefore, the majority of these studies evaluated their achieved accuracy based on postoperative radiographs, thereby only providing the accuracy in two dimensions: the anteroposterior and lateral direction [6][7][8][9]11]. Since the performed correction was planned in three dimensions, it is essential to assess the postoperative result in three dimensions as well to provide the accuracy of the performed correction and to gain insight into the cause of deviation in relation to suboptimal clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, different respective methods and techniques for corrective osteotomies of various mechanisms of deformities (i.e., post-traumatic deformities, growth disturbances, congenital anomalies) have been described. The majority of these methods consist of a surgical guide with a cutting slot for the planned osteotomy plane and drilling holes for preplanned screws [6][7][8][9][10][11][12]. Since the screw holes are predrilled, this technique requires an adequate fit of the preplanned plate in order to achieve the planned correction.…”

Section: Introductionmentioning

confidence: 99%

“…However, due to the deformity of the bone, conventional plates usually do not fit, which potentially compromises accuracy and can lead to impaired functional outcome. For some cases, precontouring the plate provides a solution [11]. However, bending of a plate does not always result in a good fit; therefore, another solution for adequate use of this 3D technology may be provided by using a patient-specific plate [12].…”

Section: Introductionmentioning

confidence: 99%

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A Two-Step Approach for 3D-Guided Patient-Specific Corrective Limb Osteotomies

Assink

Meesters

Duis

et al. 2022

JPM

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Background: Corrective osteotomy surgery for long bone anomalies can be very challenging since deformation of the bone is often present in three dimensions. We developed a two-step approach for 3D-planned corrective osteotomies which consists of a cutting and reposition guide in combination with a conventional osteosynthesis plate. This study aimed to assess accuracy of the achieved corrections using this two-step technique. Methods: All patients (≥12 years) treated for post-traumatic malunion with a two-step 3D-planned corrective osteotomy within our center in 2021 were prospectively included. Three-dimensional virtual models of the planned outcome and the clinically achieved outcome were obtained and aligned. Postoperative evaluation of the accuracy of performed corrections was assessed by measuring the preoperative and postoperative alignment error in terms of angulation, rotation and translation. Results: A total of 10 patients were included. All corrective osteotomies were performed according to the predetermined surgical plan without any complications. The preoperative deformities ranged from 7.1 to 27.5° in terms of angulation and 5.3 to 26.1° in terms of rotation. The achieved alignment deviated on average 2.1 ± 1.0 and 3.4 ± 1.6 degrees from the planning for the angulation and rotation, respectively. Conclusions: A two-step approach for 3D-guided patient-specific corrective limb osteotomies is reliable, feasible and accurate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Two-Step Approach for 3D-Guided Patient-Specific Corrective Limb Osteotomies

Assink

Meesters

Duis

et al. 2022

JPM

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“…Corrective osteotomies are conventionally planned and assessed manually on (biplanar) twodimensional (2D) radiographs 125 . However, recent studies have shown that computer-assisted preoperative planning based on three-dimensional (3D) Computed Tomography (CT) scans significantly improved both functional and radiographic outcome [125][126][127][128] .…”

Section: Introductionmentioning

confidence: 99%

Computer-Assisted Osteotomy Planning

Kuiper¹

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In this thesis, the ultimate goal has been to strive towards (automatic) computer assisted planning of reconstructive osteotomies. However, the quality of the output of such a workflow depends on the quality of all the intermediary steps, between the acquisition of a medical image, to the virtual reconstruction of the bone. In each chapter of this thesis, we have tried to overcome some of the challenges posed by these steps, and to evaluate the intermediate results. First, a method to improve the registration of CT to MRI scans for knee joint images was developed. Large deformations can arise due to differences in patient positioning between scanners, making registration complex. The study showed that non-rigid registration using deformable B-Splines could be improved by initializing the registration with a rigid registration of bones and estimating soft tissue deformation using a dual quaternion-based interpolation step. Second, an automatic and efficient deep learning-based method for semantic segmentation of six separate bones from lower extremity CT scans was proposed and validated. Existing deep learning segmentation algorithms were found to be slow and memory-intensive for this application. The optimized architecture of a cascaded U-net approach outperformed the state-of-the-art nn-Unet in memory efficiency, speed, and accuracy. Automated morphometric measurements on the hip joint were clinically validated, showing good to excellent correlation with measurements derived from manual segmentations. Third, the impact of using CT and MRI to segment bone and/or cartilage on pre-operative osteotomy planning of the forearm in adolescent patients was evaluated. An automated, deterministic planning method was developed to directly compare planning outcomes and avoid inter- or intraoperator variation. Segmentations of bone from both CT and MRI were used to assess the impact of different modalities on planning. Additionally, segmentations of bone and bone combined with cartilage from MR images were analyzed to study the influence of cartilage on planning outcomes. Results showed excellent correlation between realignment parameters across different segmentations, with small significant differences in the translational part of realignment. A positive correlation was found between cartilage amount and differences in planning on bone and bone with cartilage, suggesting the importance of considering cartilage impact on joint shape in young patients. However, further research is needed to explore MRI as a potential replacement for CT in osteotomy planning due to the small sample size and time-consuming manual segmentation. Lastly, a method to automatically quantify alignment parameters describing lower extremity morphology from 3D bone models was evaluated. A completely automatic pipeline was developed to extract these parameters using a CT scan as input. The alignment parameters were calculated using landmarks from previous studies and expanded upon to quantify all parameters needed for lower extremity realignment planning. This automatic method eliminated the need for manual operation and produced results that closely corresponded to intrarater variability. This advancement could pave the way for automatic realignment planning of lower extremities, addressing cases where a healthy contralateral example is unavailable for unilateral bone realignment planning.

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Impact of bone and cartilage segmentation from CT and MRI on both bone forearm osteotomy planning

et al. 2023

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Introduction The use of MRI scans for pre-operative surgical planning of forearm osteotomies provides additional information of joint cartilage and soft tissue structures and reduces radiation exposure in comparison with the use of CT scans. In this study, we investigated whether using 3D information obtained from MRI with and without cartilage information leads to a different outcome of pre-operative planning. Methods Bilateral CT and MRI scans of the forearms of 10 adolescent and young adult patients with a unilateral bone deformation were acquired in a prospective study. The bones were segmented from CT and MRI, and cartilage only from MRI. The deformed bones were virtually reconstructed, by registering the joint ends to the healthy contralateral side. An optimal osteotomy plane was determined that minimized the distance between the resulting fragments. This process was performed in threefold: using the CT and MRI bone segmentations, and the MRI cartilage segmentations. Results Comparison of bone segmentation from MRI and CT scan resulted in a 0.95 ± 0.02 Dice Similarity Coefficient and 0.42 ± 0.07 mm Mean Absolute Surface Distance. All realignment parameters showed excellent reliability across the different segmentations. However, the mean differences in translational realignment between CT and MRI bone segmentations (4.5 ± 2.1 mm) and between MRI bone and MRI bone and cartilage segmentations (2.8 ± 2.1 mm) were shown to be clinically and statistically significant. A significant positive correlation was found between the translational realignment and the relative amount of cartilage. Conclusion This study indicates that although bone realignment remained largely similar when using MRI with and without cartilage information compared to using CT, the small differences in segmentation could induce statistically and clinically significant differences in the osteotomy planning. We also showed that endochondral cartilage might be a non-negligible factor when planning osteotomies for young patients.

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Outcomes of 3-D corrective osteotomies for paediatric malunited both-bone forearm fractures

Cited by 9 publications

References 29 publications

A Two-Step Approach for 3D-Guided Patient-Specific Corrective Limb Osteotomies

A Two-Step Approach for 3D-Guided Patient-Specific Corrective Limb Osteotomies

Computer-Assisted Osteotomy Planning

Impact of bone and cartilage segmentation from CT and MRI on both bone forearm osteotomy planning

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