Three‐dimensional corrective osteotomies of mal‐united clavicles—is the contralateral anatomy a reliable template for reconstruction?

Hingsammer, Andreas; Vlachopoulos, Lazaros; Dominik, Meyer C.; Fürnstahl, Philipp

doi:10.1002/ca.22572

Cited by 15 publications

(15 citation statements)

References 43 publications

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“…The healthy contralateral clavicle was mirrored and served as reconstruction template [17]. By iterative closest point (ICP) algorithm, the mirrored bone model was superimposed on the medial fragment of the pathological clavicle as previously described [16].…”

Section: Methodsmentioning

confidence: 99%

3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments

et al. 2019

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Background Preoperative three-dimensional planning and intraoperative navigation by patient-specific instruments is a promising method for the exact correction of bone deformities. Nevertheless, disadvantages of current concepts are the missing options of adapting the surgical plan intraoperatively. By providing the surgeons with a controlled length adjustment through the patient-specific instruments, the application area can usefully be expanded in the treatment of clavicle osteosyntheses. Methods In three cases, preoperative three-dimensional surgical planning with the intraoperative use of patient-specific instruments was applied. The computer-assisted assessments of clavicle deformities, the preoperative plan, and the design of patient-specific instruments were created on the basis of computed tomography data. Reduction guides for restoring length and rotation according to the mirrored healthy contralateral side were enhanced with adaptable length adjustment functions. The screw thread of the reduction guides enabled temporary distraction of the clavicle fracture fragments and a controlled compression of the optionally used interposed bone block between clavicle fragments. Results Navigated clavicle osteosyntheses by enhanced patient-specific instruments was executed uneventful in all three cases. The surgeon was able to adapt clavicle length in a planned axis intraoperatively as clinically desired. Conclusion Computer-assisted planning of clavicle osteosynthesis and surgical navigation with additional adaptable patient-specific instruments can usefully expand the previous application areas. By using guided length adjustments, the fragments and optionally the graft can be compressed along a planned axis as desired to ensure optimal bone healing. Level of evidence Basic science study, Surgical technique Electronic supplementary material The online version of this article (10.1186/s13018-019-1151-8) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments

et al. 2019

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“…The leave‐one‐out tests were performed for each of the six configurations

R_{e}

R_{d}

R_{p}

U_{e}

U_{d}

, and

U_{p}

and for all of the 59 forearm bones, resulting in a total of 354 tests. For the quantification of the accuracy of the prediction, that is, the deviation between predicted and original shape, we used two different measurement techniques that have been used previously in studies investigating contralateral differences of bone anatomy based on 3D models . In the first technique, the model surfaces where discretized as dense point sets (sampled in 1 mm resolution), permitting to determine the distance for a given point on one model surface to the closest point on the other surface.…”

Section: Methodsmentioning

confidence: 99%

“…In the second measurement method the difference between ground‐truth and the predicted part was measured with a surface‐registration method, permitting to quantify the differences between two 3D surfaces in all six degrees of freedom (three translations and three rotations) according to an anatomical coordinate system. As illustrated in Figure for configuration

U_{e}

and

R_{p}

, the fitted SSM are separated by a simulated osteotomy plan (Fig.…”

Section: Methodsmentioning

confidence: 99%

Prediction of normal bone anatomy for the planning of corrective osteotomies of malunited forearm bones using a three‐dimensional statistical shape model

Mauler

Langguth

Schweizer

et al. 2017

Journal Orthopaedic Research

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Corrective osteotomies of the forearm based on 3D computer simulation using contralateral anatomy as a reconstruction template is an approved method. Limitations are existing considerable differences between left and right forearms, and that a healthy contralateral anatomy is required. We evaluated if a computer model, not relying on the contralateral anatomy, may replace the current method by predicting the pre-traumatic healthy shape. A statistical shape model (SSM) was generated from a set of 59 CT scans of healthy forearms, encoding the normal anatomical variations. Three different configurations were simulated to predict the pre-traumatic shape with the SSM (cross-validation). In the first two, only the distal or proximal 50% of the radius were considered as pathological. In a third configuration, the entire radius was assumed to be pathological, only the ulna being intact. Corresponding experiments were performed with the ulna. Accuracy of the prediction was assessed by comparing the predicted bone with the healthy model. For the radius, mean rotation accuracy of the prediction between 2.9 ± 2.2° and 4.0 ± 3.1° in pronation/supination, 0.4 ± 0.3° and 0.6 ± 0.5° in flexion/extension, between 0.5 ± 0.3° and 0.5 ± 0.4° in radial-/ulnarduction. Mean translation accuracy along the same axes between 0.8 ± 0.7 and 1.0 ± 0.8 mm, 0.5 ± 0.4 and 0.6 ± 0.4 mm, 0.6 ± 0.4 and 0.6 ± 0.5 mm, respectively. For the ulna, mean rotation accuracy between 2.4 ± 1.9° and 4.7 ± 3.8° in pronation/supination, 0.3 ± 0.3° and 0.8 ± 0.6° in flexion/extension, 0.3 ± 0.2° and 0.7 ± 0.6° in radial-/ulnarduction. Mean translation accuracy between 0.6 ± 0.4 mm and 1.3 ± 0.9 mm, 0.4 ± 0.4 mm and 0.7 ± 0.5 mm, 0.5 ± 0.4 mm and 0.8 ± 0.6 mm, respectively. This technique provided high accuracy, and may replace the current method, if validated in clinical studies. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2630-2636, 2017.

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“…Through further processing in Mesh-Lab (Visual Computing Lab, Pisa, Italy), the fractured elements were separated. Furthermore, the healthy contralateral clavicle was mirrored, using the symmetrical features of the body to create a healthy reconstruction of the fractured clavicle [21][22][23]. These models were 3D-printed with polylactic acid (PLA) plastic ( Fig.…”

Section: D-printing Patient-specific Plastic Replicasmentioning

confidence: 99%

Can 3D-printing avoid discomfort-related implant removal in midshaft clavicle fractures? A four-year follow-up

Doremalen

Linde

Kootstra

et al. 2020

Arch Orthop Trauma Surg

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Introduction Due to the variation in shape and curvature of the clavicle, plates often have to be adjusted during surgery to acquire a good fit. Poorly fitted plates can cause discomfort, eventually requiring implant removal. 3D-printed replicas of the fractured clavicle can assist in planning of the surgical approach, plate selection and, if necessary, adjustment of the plate prior to surgery. We hypothesized this method of preoperative preparation would reduce implant-related discomfort resulting in a reduced reoperation rate Materials and methods In a prospective cohort study, perioperative plate handling and clavicle fixation were timed and follow-up data were collected from participants undergoing operative treatment for a midshaft clavicle fracture. The control group (n = 7) received conventional surgery with standard precontoured plates. For the intervention group (n = 7), 3D-printed replicas of the fractured clavicle and a mirrored version of the healthy contralateral clavicle were available prior to surgery for planning of the surgical approach, and for plate selection and contouring. Primary outcome was reoperation rate due to implant-related discomfort. Secondary outcomes were complications and time differences in the different surgical phases (reduction, fixation and overall operation time) Results More participants in the control group had the plate removed due to discomfort compared to the intervention group (5/7 vs. 0/6; P = 0.012). One participant was excluded from the intervention group due to a postoperative complication; an infection occurred at the implant site. No relevant time difference in surgical plate handling was found between both groups. Conclusions Preoperative preparation using 3D-printed replicas of the clavicle fracture may reduce implant removal caused by plated-related discomfort. No relevant effect on surgery time was found. Trial registration Registered with ‘toetsingonline.nl’, trial number NL51269.075/14, 17-02-2015

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Three‐dimensional corrective osteotomies of mal‐united clavicles—is the contralateral anatomy a reliable template for reconstruction?

Cited by 15 publications

References 43 publications

3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments

3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments

Prediction of normal bone anatomy for the planning of corrective osteotomies of malunited forearm bones using a three‐dimensional statistical shape model

Can 3D-printing avoid discomfort-related implant removal in midshaft clavicle fractures? A four-year follow-up

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