Rapid Prototyping and 3D Modeling of Osteotomy Jigs and Drill Guides in Hand and Wrist Surgery

Abstract

Computer-generated 3D modeling, prototyping, and custom jig fabrication have gained popularity in a short space of time in hand and wrist surgery. Currently used applications include custom jig fabrication for the correction of malunion and other deformities, computerized motion analysis of carpal and forearm kinematics, and 3D prints and renders for visual planning and analysis in skeletal pathology and trauma. Authors are reporting improvements for a variety of reasons, including identifying new carpal and forearm kinematic patterns and pathology, decreased planning and fluoroscopy times, more efficient surgery, and greater accuracy. Commercially available services offering this technology are becoming popular. Some centers are performing these services in-house, which has become easier with the availability of free software and relatively inexpensive 3D printers. The infancy of these techniques in hand and wrist surgery preclude the presence of long-term clinical studies, cost-benefit analysis, and randomized controlled trials, which will undoubtedly come with time. 3D preoperative planning and custom jig fabrication is a compelling addition to the hand and wrist surgeons’ practice, and has been well received in the literature. Improved access to desktop planning and 3D models will see the use of this technology expand. Future developments may include 3D-printed patient-specific prostheses and bone scaffolds.

<p>Present and future for technologies to develop patient-specific medical devices: a systematic review approach</p>

“…From the RE + CAD + CAE + RP technologies, other types of personalized products have been generated, such as pre-operative devices adjusted to bone geometry 34,36,37,40–42,45,50,59,61,66,67,94–96. These researchers used common practices for product development such as bone reconstruction software and performing alignment and healthy bone symmetry operations on the affected area.…”

“…Patient-specific technologies (PSTs) facilitate the interpretation of CT images and reduce uncertainty in diagnosis and treatment 99. PSTs also improve fracture characterization and inform the surgical approach, from defining a preoperative plan to producing a final PSD 21,35,37,40,41,43,45,46,48,56,57,65,66,70,95,99…”

“…PSDs are useful in complex and difficult cases,36 or in cases with a high risk of complications and unfavorable sequelae for the patient 38,44,45,64. Digital and physical resources can improve data visualization during surgery,58 and surgical pre-planning expands the utility of intraoperative navigation devices 37,48…”

“…Various authors stated that certainty in the surgical procedure would reduce the cost and time of treatment, decreasing the risks of infections or adverse outcomes 2,34,45. Decreased surgery time would improve the quality of the intervention and make the procedure more profitable 37,39,41,48…”

“…The need for specialized software and hardware to support PSD development requires additional personnel with technical skills in design and product development 37. Because these tools require high financial investment for a health care institution, their availability in hospital units is limited and they are more commonly found in laboratories and universities 39…”