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Zindel C, Hodel S, Fürnstahl P, Schweizer A, Fucentese SF, Vlachopoulos L. Dome versus single-cut osteotomies for correction of long bone deformities-technical considerations. Sci Rep 2024; 14:12839. [PMID: 38834604 DOI: 10.1038/s41598-024-62410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
Corrective osteotomy allows to improve joint loading, pain and function. In complex deformities, the biggest challenge is to define the optimal surgical solution, while considering anatomical, technical and biomechanical factors. While the single-cut osteotomy (SCOT) and focal dome osteotomy (FDO) are well-established treatment options, their mathematical relationship remain largely unclear. The aim of the study was (1) to describe the close mathematical relationship between the SCOT and FDO and (2) to analyze and introduce a novel technique-the stepped FDO-as a modification of the classic FDO. The mathematical background and relationship of SCOT and FDO are described for the example of a femoral deformity correction and visualized using a 3D surface model taking into account the benefits for the clinical application. The novel modifications of the stepped FDO are introduced and its technical and clinical feasibility demonstrated. Both, SCOT and FDO, rely on the same deformity axis that defines the rotation axis k for a 3D deformity correction. To achieve the desired correction using a SCOT, the resulting cutting plane is perpendicular to k, while using a FDO will result in a cylindrical cut with a central axis parallel to k. The SCOT and FDO demonstrate a strong mathematical relation, as both methods rely on the same deformity axis, however, resulting in different cutting planes. These characteristics enable a complementary use when defining the optimal type of osteotomy. This understanding enables a more versatile planning approach when considering factors as the surgical approach, biomechanical characteristics of fixation or soft tissue conditions. The newly introduced stepped FDO facilitates an exact reduction of the bone fragments and potentially expands the clinical applicability of the FDO.
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Affiliation(s)
- Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Sandro Hodel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Kabelitz M, Furrer PR, Hodel S, Canonica S, Schweizer A. 3D planning and patient specific instrumentation for intraarticular corrective osteotomy of trapeziometacarpal-, metacarpal and finger joints. BMC Musculoskelet Disord 2022; 23:965. [DOI: 10.1186/s12891-022-05946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intra-articular malunions of the finger can lead to deformity and loss of function and can be treated with intra-articular corrective osteotomies. The aim of this study was to evaluate radiographic joint congruency, feasibility and functional outcome of three-dimensional (3D) printed patient-specific instrumentation (PSI) for corrective osteotomies at the trapeziometacarpal and finger joints.
Methods
Computer-tomography (CT) scans were acquired preoperatively for standard 3D planning, which was followed by calculation of cutting planes and the design of individualized bone surface contact drilling, sawing and reposition guides. Follow-up CT scans and clinical examinations (range of motion, grip strength) were performed. Postoperative complications were documented and patient-reported outcome measurements were assessed (Single Assessment Numeric Evaluation (SANE) score, brief Michigan Hand Questionnaire (MHQ)).
Results
Ten patients (mean age 28.4 ± 12.8,range 13.8–51.3) years) were included with a mean follow-up of 21 ± 18 (3–59) months including seven osteotomies at the trapeziometacarpal or metacarpophalangeal joints and three at the proximal interphalangeal joint (PIP). All radiographic follow-up examinations showed the planned correction with good joint congruency and regular osseous consolidation. At the latest follow-up, the range of motion (ROM) increased and the average grip strength recovered to the level of the contralateral side. No postoperative complication was detected. The mean SANE score improved from 44 ± 23 (0–70) to 82 ± 12 (60–90) after a mean of 72 ± 20 (44–114) months. The mean postoperative brief MHQ was 92 ± 8 (71–98).
Conclusion
The use of 3D PSI in treating intra-articular malunions at the trapeziometacarpal and finger joints restored articular congruency accurately. ROM and grip strength improved postoperatively comparable to the healthy contralateral side and patient-reported outcome measures improved after medium-term follow-up.
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Mathematically Directed Single-Cut Osteotomy. Medicina (B Aires) 2022; 58:medicina58070971. [PMID: 35888691 PMCID: PMC9323407 DOI: 10.3390/medicina58070971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
A mathematically directed osteotomy (MDO) is a surgical planning technique for correcting long bone deformities. Using a mathematically derived osteotomy plane, the single-cut correction simultaneously addresses angular deformity, axial malrotation, and minor shortening. This review describes an MDO’s indications for use, defines its input and output variables, includes the required graphs for osteotomy planning, and provides intraoperative tips and tricks for successful execution. Finally, the authors present a digital MDO calculator to simplify the complex computations and allow for more precise planning.
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Lee HR, Adam GO, Kim SJ. Application of Patient-Specific Instrumentation in a Dog Model with Antebrachial Growth Deformity Using a 3-D Phantom Bone Model. Vet Sci 2022; 9:vetsci9040157. [PMID: 35448655 PMCID: PMC9024640 DOI: 10.3390/vetsci9040157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/18/2022] [Indexed: 12/10/2022] Open
Abstract
One of the most frequent bone deformities in dogs is antebrachial growth deformity (AGD), which results from malunion of the distal growth plates. The objective of the present study was to re-align the limbs, which can correct the length mismatch and reset the coherence of the joint with the aid of a 3-D phantom model for surgical preplanning. A 14-month-old, intact female Golden Retriever with an angular deformity of the left radius and ulna was selected for the study. The diagnosis was confirmed by orthogonal radiographs. Moreover, computed tomography (CT) scans revealed a multiplane deformity with valgus, procurator, and external rotation of the left radius. The pre-surgical planning started with the quantification of the angular deformity, followed by a simulated virtual osteotomy, and concluded with an in vitro rehearsal surgery on 3-D printed phantom bone models. In the operating room, prefabricated patient-specific instrumentation (PSI) was attached at the planned site of the radial bone surface for a precise closing wedge osteotomy. Then two locking plates were fixed routinely. Post-operative radiographs showed accurate correction of the deformity as we had planned. At 12 weeks post-operatively, the follow-up surveys revealed improved gait, weight-bearing, and progression of bone healing. Our PSI design, based on novel surgical planning, was steady yet straightforward during the osteotomy. The osteotomy was performed without difficulty since the PSI that pre-determined the sites and angles let the surgeon perform the antebrachial malformation surgery. This method of operation reduces stress on the operator and helps to improve accuracy, repeatability, and surgery time.
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Affiliation(s)
| | - Gareeballah Osman Adam
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, Sudan University of Science and Technology, Khartoum P.O. Box 204, Sudan;
- R&D Division, HUVET Co., Ltd., Iksan 54531, Korea
| | - Shang-Jin Kim
- College of Veterinary Medicine, Jeonbuk National University, Specialized Campus, Iksan 54596, Korea
- Correspondence: ; Tel.: +82-63-850-0963
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An Easy and Economical Way to Produce a Three-Dimensional Bone Phantom in a Dog with Antebrachial Deformities. Animals (Basel) 2020; 10:ani10091445. [PMID: 32824895 PMCID: PMC7552735 DOI: 10.3390/ani10091445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Accurate planning, for corrective surgeries in case of bone cutting, is necessary to obtain a precise coordination of the skeleton and to achieve the owner’s satisfaction. The present experiment displays a simple and cost-effective technique for surgical planning, utilizing a 3-D bone phantom model in a dog with foreleg deformity. Abstract 3-D surgical planning for restorative osteotomy is costly and time-consuming because surgeons need to be helped from commercial companies to get 3-D printed bones. However, practitioners can save time and keep the cost to a minimum by utilizing free software and establishing their 3-D printers locally. Surgical planning for the corrective osteotomy of antebrachial growth deformities (AGD) is challenging for several reasons (the nature of the biapical or multiapical conformational abnormalities and lack of a reference value for the specific breed). Pre-operative planning challenges include: a definite description of the position of the center of rotation of angulation (CORA) and proper positioning of the osteotomies applicable to the CORA. In the present study, we demonstrated an accurate and reproducible bone-cutting technique using patient-specific instrumentations (PSI) 3-D technology. The results of the location precision showed that, by using PSIs, the surgeons were able to accurately replicate preoperative resection planning. PSI results also indicate that PSI technology provides a smaller standard deviation than the freehand method. PSI technology performed in the distal radial angular deformity may provide good cutting accuracy. In conclusion, the PSI technology may improve bone-cutting accuracy during corrective osteotomy by providing clinically acceptable margins.
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Singh S, Andronic O, Kaiser P, Jud L, Nagy L, Schweizer A. Recent advances in the surgical treatment of malunions in hand and forearm using three-dimensional planning and patient-specific instruments. HAND SURGERY & REHABILITATION 2020; 39:352-362. [PMID: 32544631 DOI: 10.1016/j.hansur.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 01/10/2023]
Abstract
Malunions of the forearm and hand cause significant disability. Moreover, intraarticular deformities may contribute to early onset osteoarthritis. Such conditions require precise surgical correction in order to improve functional outcomes and prevent early or late complications. The purpose of this study was to describe the technical advantages of accurate anatomical reconstruction using 3D guided osteotomies and patient specific instruments (PSI) in multiple joints of the hand and forearm. Acquisition of three-dimensional (3D) datasets and surgical implementation of PSI was performed in a series of patients between December 2014 and July 2017. Patients had intra- or extra-articular malunions of the forearm, radiocarpal joint, trapeziometacarpal joint, or proximal interphalangeal joint. A previously described 3D surface model that incorporates CT data was used for segmentation (Mimics®, Materialise™, Belgium). For all the cases, CT scans of both forearms were acquired to use the contralateral uninjured side as the anatomic reconstruction template. Computer-assisted assessment of the deformity, the preoperative plan, and the design of PSI are described. Outcomes were determined by evaluating step-off correction, fusion, changes in range of motion (ROM) and grip strength. Six patients were included in the study; all achieved fusion. Improved clinical outcomes including pain reduction, better ROM and grip strength were obtained. Complete correction of intraarticular step-off was achieved in all cases with intraarticular malunions. 3D guided osteotomies are an established surgical treatment option for malunions of the hand and forearm. 3D analysis is a helpful diagnostic tool that provides detailed information about the underlying deformity. PSI can be developed and used for surgical correction with maximal accuracy for both intraarticular step-off and angular deformity.
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Affiliation(s)
- S Singh
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - O Andronic
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - P Kaiser
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - L Jud
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - L Nagy
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - A Schweizer
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
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Wirth SH, Espinosa N. The Use of Virtual Planning and Patient-specific Guides to Correct Complex Deformities of the Foot and Ankle. Foot Ankle Clin 2020; 25:257-268. [PMID: 32381313 DOI: 10.1016/j.fcl.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article provides an overview regarding the virtual planning and precise execution of corrective osteotomies around the foot and ankle. Based on 3-dimensional data obtained from CT scans, surgeons are able to create a virtual plan of how to correct a complex deformity. This plan is transferred into the production of true patient-specific guides, designed to perform a specific surgical intervention. The authors have extensive experience with this technique and were involved in the development of the method. The current article provides an overview regarding the virtual planning and precise execution of corrective osteotomies around the foot and ankle.
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Affiliation(s)
- Stephan H Wirth
- Department of Orthopaedics, University of Zurich, The Balgrist, Forchstrasse 340, Zurich 8008, Switzerland
| | - Norman Espinosa
- Institute for Foot and Ankle Reconstruction, Fussinstitut Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
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Hirsiger S, Schweizer A, Miyake J, Nagy L, Fürnstahl P. Corrective Osteotomies of Phalangeal and Metacarpal Malunions Using Patient-Specific Guides: CT-Based Evaluation of the Reduction Accuracy. Hand (N Y) 2018; 13:627-636. [PMID: 28895433 PMCID: PMC6300182 DOI: 10.1177/1558944717726135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical planning of corrective osteotomies is traditionally based on conventional radiographs and clinical findings. In the past 10 years, 3-dimensional (3D) preoperative planning approaches with patient-specific guides have been developed. However, the application of this technology to posttraumatic deformities of the metacarpals and phalangeal bones has not yet been investigated. Our goal was to evaluate the feasibility of the surgical application to the latter and to evaluate the extent and precision of correction. METHODS We present results of 6 patients (8 osteotomies) treated with phalangeal or metacarpal corrective osteotomy. Deformities were located in the third ray in 1, fourth ray in 3, and fifth ray in 4 cases. Six malunited metacarpal bones (1 intra-articular) and 2 deformed proximal phalanges were treated. Computer-based 3D preoperative planning using the contralateral hand as a template allowed the production of 3D-printed patient-specific guides that were used intraoperatively for navigation. The precision of the reduction was assessed using pre- and postoperative computed tomography by comparing the postoperative bone model with the preoperatively simulated osteotomy. Range of motion and grip strength were documented pre- and postoperatively. RESULTS The mean follow-up time was 6 months (range: 5-11 months). Rotational deformity was reduced from a mean of 10.0° (range: 7.2°-19.3°) preoperatively to 2.3° (range: 0.7°-3.7°) postoperatively, and translational incongruency decreased from a mean of 1.4 mm (range: 0.7-2.8 mm) to 0.4 mm (range: 0.1-0.9 mm). CONCLUSION Preliminary results indicate that a precise reduction for corrective osteotomies of metacarpal and phalangeal bones can be achieved by using 3D planning and patient-specific guides.
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Affiliation(s)
| | | | | | | | - Philipp Fürnstahl
- University of Zurich, Switzerland,Philipp Fürnstahl, Department of
Orthopedics, University Hospital Balgrist, University of Zurich, Forchstrasse
340, Zürich 8008, Switzerland.
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9
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Vlachopoulos L, Schweizer A, Meyer DC, Gerber C, Fürnstahl P. Computer-assisted planning and patient-specific guides for the treatment of midshaft clavicle malunions. J Shoulder Elbow Surg 2017; 26:1367-1373. [PMID: 28395943 DOI: 10.1016/j.jse.2017.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The surgical treatment of malunions after midshaft clavicle fractures is associated with a number of potential complications and the surgical procedure is challenging. However, with appropriate and meticulous preoperative surgical planning, the surgical correction yields satisfactory results. The purpose of this study was to provide a guideline and detailed overview for the computer-assisted planning and 3-dimensional (3D) correction of malunions of the clavicle. METHODS The 3D bone surface models of the pathologic and contralateral sides were created on the basis of computed tomography data. The computer-assisted assessment of the deformity, the preoperative plan, and the design of patient-specific guides enabling compression plating are described. RESULTS We demonstrate the benefit and versatility of computer-assisted planning for corrective osteotomies of malunions of the midshaft clavicle. In combination with patient-specific guides and compression plating technique, the correction can be performed in a more standardized fashion. We describe the determination of the contact-optimized osteotomy plane. An osteotomy along this plane facilitates the correction and enlarges the contact between the fragments at once. We further developed a technique of a stepped osteotomy that is based on the calculation of the contact-optimized osteotomy plane. The stepped osteotomy enables the length to be restored without the need of structural bone graft. The application of the stepped osteotomy is presented for malunions of the clavicle with shortening and excessive callus formation. CONCLUSIONS The 3D preoperative planning and patient-specific guides for corrective osteotomies of the clavicle may help reduce the number of potential complications and yield results that are more predictable.
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Affiliation(s)
- Lazaros Vlachopoulos
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Computer Vision Laboratory, ETH Zürich, Zürich, Switzerland.
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Dominik C Meyer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Dobbe JGG, Strackee SD, Streekstra GJ. Minimizing the Translation Error in the Application of an Oblique Single-Cut Rotation Osteotomy: Where to Cut? IEEE Trans Biomed Eng 2017; 65:821-827. [PMID: 28682244 DOI: 10.1109/tbme.2017.2721498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE An oblique single cut rotation osteotomy enables correcting angular bone alignment in the coronal, sagittal, and transverse planes, with just a single oblique osteotomy, and by rotating one bone segment in the osteotomy plane. However, translational malalignment is likely to exist if the bone is curved or deformed and the location of the oblique osteotomy is not obvious. METHODS In this paper, we investigate how translational malalignment depends on the osteotomy location. We further propose and evaluate by simulation in 3-D, a method that minimizes translational malalignment by varying the osteotomy location and by sliding the distal bone segment with respect to the proximal bone segment within the oblique osteotomy plane. The method is finally compared to what three surgeons achieve by manually selecting the osteotomy location in 3-D virtual space without planning in-plane translations. RESULTS The minimization method optimized for length better than the surgeons did, by 3.2 mm on average, range (0.1, 9.4) mm, in 82% of the cases. A better translation in the axial plane was achieved by 4.1 mm on average, range (0.3, 14.4) mm, in 77% of the cases. CONCLUSION The proposed method generally performs better than subjectively choosing an osteotomy position along the bone axis. SIGNIFICANCE The proposed method is considered a valuable tool for future alignment planning of an oblique single-cut rotation osteotomy since it helps minimizing translational malalignment.
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Bauer DE, Zimmermann S, Aichmair A, Hingsammer A, Schweizer A, Nagy L, Fürnstahl P. Conventional Versus Computer-Assisted Corrective Osteotomy of the Forearm: a Retrospective Analysis of 56 Consecutive Cases. J Hand Surg Am 2017; 42:447-455. [PMID: 28434832 DOI: 10.1016/j.jhsa.2017.03.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Accuracy and feasibility of corrective osteotomies using 3-dimensional planning tools and patient-specific instrumentation has been reported by multiple authors with promising results. However, studies describing clinical outcomes following these procedures are rare. Therefore, the purpose of this study was to compare the results of computer-assisted corrective osteotomies of the diaphyseal and distal radius with a conventional non-computer-assisted technique regarding duration of surgery, consolidation of the osteotomy, and complications. Also, subjective and objective clinical outcome parameters were assessed. METHODS We retrospectively compared the results of 31 patients who underwent a corrective osteotomy performed conventionally with 25 patients treated with a computer-assisted method (CA) using patient-specific instrumentation. Baseline data were similar among both groups. The duration of surgery, bony consolidation, complications, gain in range of motion, and subjective outcome were recorded. RESULTS The mean operating time was significantly shorter in the CA group compared with the conventional group. After 12 weeks, significantly more osteotomies were considered healed in the CA group compared with the conventional group. Two patients in the CA group required revision surgery to treat nonunion of the osteotomy. Otherwise clinical results were similar among both groups. CONCLUSIONS The results demonstrate that the computer-assisted method facilitates shorter operation times while providing similar clinical results. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- David Ephraim Bauer
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Stefan Zimmermann
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Alexander Aichmair
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas Hingsammer
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ladislav Nagy
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Team, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Wojciechowski W, Molka A, Tabor Z. Automated measurement of parameters related to the deformities of lower limbs based on x-rays images. Comput Biol Med 2016; 70:1-11. [PMID: 26773234 DOI: 10.1016/j.compbiomed.2015.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/01/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
Abstract
Measurement of the deformation of the lower limbs in the current standard full-limb X-rays images presents significant challenges to radiologists and orthopedists. The precision of these measurements is deteriorated because of inexact positioning of the leg during image acquisition, problems with selecting reliable anatomical landmarks in projective X-ray images, and inevitable errors of manual measurements. The influence of the random errors resulting from the last two factors on the precision of the measurement can be reduced if an automated measurement method is used instead of a manual one. In the paper a framework for an automated measurement of various metric and angular quantities used in the description of the lower extremity deformation in full-limb frontal X-ray images is described. The results of automated measurements are compared with manual measurements. These results demonstrate that an automated method can be a valuable alternative to the manual measurements.
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Affiliation(s)
- Wadim Wojciechowski
- Medical Center iMed24, ul. Życzkowskiego 29, 31-864 Krakow, Poland; Jagiellonian University Medical College, Kopernika 19, 31-501 Krakow, Poland
| | - Adrian Molka
- Cracow University of Technology, ul. Warszawska 24, 31-155 Krakow, Poland
| | - Zbisław Tabor
- Cracow University of Technology, ul. Warszawska 24, 31-155 Krakow, Poland.
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13
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Fürnstahl P, Schweizer A, Graf M, Vlachopoulos L, Fucentese S, Wirth S, Nagy L, Szekely G, Goksel O. Surgical Treatment of Long-Bone Deformities: 3D Preoperative Planning and Patient-Specific Instrumentation. COMPUTATIONAL RADIOLOGY FOR ORTHOPAEDIC INTERVENTIONS 2016. [DOI: 10.1007/978-3-319-23482-3_7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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14
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Vlachopoulos L, Schweizer A, Graf M, Nagy L, Fürnstahl P. Three-dimensional postoperative accuracy of extra-articular forearm osteotomies using CT-scan based patient-specific surgical guides. BMC Musculoskelet Disord 2015; 16:336. [PMID: 26537949 PMCID: PMC4634814 DOI: 10.1186/s12891-015-0793-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/28/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Computer assisted corrective osteotomy of the diaphyseal forearm and the distal radius based on computer simulation and patient-specific guides has been described as a promising technique for accurate reconstruction of forearm deformities. Thereby, the intraoperative use of patient-specific drill and cutting guides facilitate the transfer of the preoperative plan to the surgery. However, the difference between planned and performed reduction is difficult to assess with conventional radiographs. The aim of this study was to evaluate the accuracy of this surgical technique based on postoperative three-dimensional (3D) computed tomography (CT) data. METHODS Fourteen patients (mean age 23.2 (range, 12-58) years) with an extra-articular deformity of the forearm had undergone computer assisted corrective osteotomy with the healthy anatomy of the contralateral uninjured side as a reconstruction template. 3D bone surface models of the pathological and contralateral side were created from CT data for the computer simulation. Patient-specific drill and cutting guides including the preoperative planned screw direction of the angular-stable locking plates and the osteotomy planes were used for the intraoperative realization of the preoperative plan. There were seven opening wedge osteotomies and nine closing wedge (or single-cut) osteotomies performed. Eight-ten weeks postoperatively CT scans were obtained to assess bony consolidation and additionally used to generate a 3D model of the forearm. The simulated osteotomies- preoperative bone models with simulated correction - and the performed osteotomies - postoperative bone models - were analyzed for residual differences in 3D alignment. RESULTS On average, a significant higher residual rotational deformity was observed in opening wedge osteotomies (8.30° ± 5.35°) compared to closing wedge osteotomies (3.47° ± 1.09°). The average residual translation was comparable small in both groups, i.e., below 1.5 mm and 1.1 mm for opening and closing wedge osteotomies, respectively. CONCLUSIONS The technique demonstrated high accuracy in performing closing wedge (or single-cut) osteotomies. However, for opening wedge osteotomies with extensive lengthening, probably due to the fact that precise reduction was difficult to achieve or maintain, the final corrections were less accurate.
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Affiliation(s)
- Lazaros Vlachopoulos
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Matthias Graf
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Ladislav Nagy
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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15
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Abstract
The forearm is a complex anatomical and functional unit with unique osseous, soft tissue and articular relationships. Disruption of these important relations can have a significant impact, leading to pain, instability of the radio-ulnar articulation and reduced range of motion. The gold standard for treating forearm fractures in adults remains anatomic reduction, stable plate fixation and preservation of the surrounding blood supply. Failure to achieve these goals may lead to malunion, requiring reconstructive surgery, which can be technically challenging. In this review, we discuss the essential aspects of anatomy and pathomechanics, clinical and radiological assessment and the state of the art in pre-operative planning and deformity correction surgery.
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Computer-assisted and patient-specific 3-D planning and evaluation of a single-cut rotational osteotomy for complex long-bone deformities. Med Biol Eng Comput 2011; 49:1363-70. [PMID: 21947766 PMCID: PMC3223570 DOI: 10.1007/s11517-011-0830-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 09/08/2011] [Indexed: 11/27/2022]
Abstract
Malunion after long bone fracture results in an incorrect position of the distal bone segment. This misalignment may lead to reduced function of the limb, early osteoarthritis and chronic pain. An established treatment option is a corrective osteotomy. For complex malunions, a single-cut rotational osteotomy is sometimes preferred in cases of angular deformity in three dimensions. However, planning and performing this type of osteotomy is relatively complex. This report describes a computer-assisted method for 3-D planning and realizing a single-cut rotational osteotomy with a patient-specific cutting guide for orienting the osteotomy and an angled jig for adjusting the rotation angle. The accuracy and reproducibility of the method is evaluated experimentally using plastic bones. In addition, complex rotational deformities are simulated by a computer to investigate the relation between deformity and correction parameters. The computed relation between deformity and correction parameters enables the surgeon to judge the feasibility of a single-cut rotational osteotomy. This appears possible for deformities combining axial misalignment with sufficient axial rotation. The proposed 3-D method of preoperative planning and transfer with a patient-specific cutting guide and angled jig renders the osteotomy procedure easily applicable, accurate, reproducible, and is a good alternative for complex and expensive navigation systems.
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17
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Paccola CAJ. A SIMPLIFIED WAY OF DETERMINING THE DIRECTION OF A SINGLE-CUT OSTEOTOMY TO CORRECT COMBINED ROTATIONAL AND ANGULAR DEFORMITIES OF LONG BONES. Rev Bras Ortop 2011; 46:329-34. [PMID: 27047829 PMCID: PMC4799231 DOI: 10.1016/s2255-4971(15)30206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 03/03/2010] [Indexed: 06/05/2023] Open
Abstract
The direction of the obliquity of the cut for performing single-cut osteotomy to correct combined angular and rotational deformities is difficult to determine. The appropriate obliquity, i.e. whether clockwise or anticlockwise in relation to the perpendicular to the bone axis, is usually determined through trials using plastic bone models to imitate the deformity, or on bananas, on which different simulations can be made. This is very confusing and difficult. In this study, we propose a table, with entries for angular and rotational deformities and the affected side. The correct obliquity of the cut in relation to the perpendicular to the diaphyseal axis is directly indicated in the table. A step-by-step review of the preoperative planning of the single-cut osteotomy is also presented, with emphasis on the proposed contribution.
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18
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Schweizer A, Fürnstahl P, Harders M, Székely G, Nagy L. Complex radius shaft malunion: osteotomy with computer-assisted planning. Hand (N Y) 2010; 5:171-8. [PMID: 19826878 PMCID: PMC2880679 DOI: 10.1007/s11552-009-9233-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 09/25/2009] [Indexed: 11/27/2022]
Abstract
We report about two cases with a combined axial and angular malunion of the radius shaft with functional loss of pro-supination. For the preoperative planning, a computer simulation was developed that allows the quantification of the malunion by comparing the 3-d surface model of the impaired bone with the contralateral anatomy. The proximal parts of the left and right radii are superimposed, while the different positions of the distal parts are used to quantify the malunion. This task is performed fully automatically which reduces the overall planning time. The osteotomies were performed according to the results of the computer-aided planning. The first case showed 1 year postoperatively an increase of pronation from 40° to 70° at expense of supination from 95° to 90°. The patient was practically pain-free and reported functional improvement. The second case showed 6 months postoperatively an improvement of supination from 15° to 40° and of pronation from 50° to 60°. The computer-assisted operation planning facilitated the quantification of combined axial and angular malunions which were difficult to detect on plain radiographs.
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Affiliation(s)
- Andreas Schweizer
- Department of Orthopaedic Surgery, University of Zurich, Uniklinik Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Philipp Fürnstahl
- ETH Zurich, Computer Vision Laboratory, Sternwartstrasse 7, 8092 Zurich, Switzerland
| | - Matthias Harders
- ETH Zurich, Computer Vision Laboratory, Sternwartstrasse 7, 8092 Zurich, Switzerland
| | - Gábor Székely
- ETH Zurich, Computer Vision Laboratory, Sternwartstrasse 7, 8092 Zurich, Switzerland
| | - Ladislav Nagy
- Department of Orthopaedic Surgery, University of Zurich, Uniklinik Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland
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19
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Subburaj K, Ravi B, Agarwal M. Computer-aided methods for assessing lower limb deformities in orthopaedic surgery planning. Comput Med Imaging Graph 2009; 34:277-88. [PMID: 19963346 DOI: 10.1016/j.compmedimag.2009.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 06/13/2009] [Accepted: 11/04/2009] [Indexed: 01/17/2023]
Abstract
Accurate, simple, and quick measurement of anatomical deformities at preoperative stage is clinically important for decision making in surgery planning. The deformities include excessive torsional, angular, and curvature deformation. This paper presents computer-aided methods for automatically measuring anatomical deformities of long bones of the lower limb. A three-dimensional bone model reconstructed from CT scan data of the patient is used as input. Anatomical landmarks on femur and tibia bone models are automatically identified using geometric algorithms. Medial axes of femur and tibia bones, and anatomical landmarks are used to generate functional and reference axes. These methods have been implemented in a software program and tested on a set of CT scan data. Overall, the performance of the computerized methodology was better or similar to the manual method and its results were reproducible.
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Affiliation(s)
- K Subburaj
- OrthoCAD Network Research Centre, Department of Mechanical Engineering, Indian Institute of Technology Bombay, Powai, Mumbai 400076, India
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20
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Correction of forearm malunion guided by the preoperative complaint. Clin Orthop Relat Res 2008; 466:1419-28. [PMID: 18404294 PMCID: PMC2384037 DOI: 10.1007/s11999-008-0234-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 03/10/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Diaphyseal malunion of the forearm may cause loss of pronation and supination, a painful distal radioulnar joint, and aesthetic problems. Seventeen patients (10 males, seven females; mean age, 20.6 +/- 9.3 years) were operated on because of symptomatic malunion after a pediatric forearm fracture. Six patients had predominant loss of pronation (Group 1), four had predominant loss of supination (Group 2), and seven had a painful distal radioulnar joint (Group 3). An osteotomy of the radius was performed in seven patients and of both forearm bones in 10. All patients were available for clinical and radiologic assessments at a minimum followup of 6 months (mean +/- standard deviation, 3.7 +/- 2.3 years; range, 0.5-9.9 years). Release of the contracted interosseous membrane frequently was necessary for patients in Groups 1 and 2 to allow for correction and did not result in weakness, instability of the distal radioulnar joint, or synostosis. The overall improvement in range of motion after osteotomies for patients with a supination deficit was much better than in those with a pronation deficit. All patients in Group 3 gained a pain-free and stable distal radioulnar joint and their range of motion was unchanged. Therefore, ability to improve overall range of motion through forearm osteotomies is dependent on the patients' preoperative complaint. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Smith EJ, Bryant JT, Ellis RE. Kinematic geometry of osteotomies. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2005; 8:902-9. [PMID: 16685932 DOI: 10.1007/11566465_111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This paper presents a novel method for defining an osteotomy that can be used to represent all types of osteotomy procedures. In essence, we model an osteotomy as a lower-pair mechanical joint to derive the kinematic geometry of the osteotomy. This method was implemented using a commercially available animation software suite in order to simulate a variety of osteotomy procedures. Two osteotomy procedures are presented for a femoral malunion in order to demonstrate the advantages of our kinematic model in developing optimal osteotomy plans. The benefits of this kinematic model include the ability to evaluate the effects of various kinds of osteotomy and the elimination of potentially error-prone radiographic assessment of deformities.
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Affiliation(s)
- Erin J Smith
- Mechanical Engineering, Queen's University at Kingston, Canada
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