Correction of complex three-dimensional deformities at the proximal femur using indirect reduction with angle blade plate and patient-specific instruments: a technical note

Combined Correction of Coronal and Rotational Deformities of the Femur With Distal Femoral Osteotomy Using Patient-Specific Instrumentation

BACKGROUND

Distal femoral osteotomy (DFO) can be used to simultaneously correct coronal and rotational deformities. Patient-specific instruments (PSIs) are known to be helpful in such complex osteotomies, but data on surgical accuracy for the combined correction of coronal and rotational deformities of the femur are missing.

PURPOSE

To investigate the radiological results of DFO for simultaneous correction of coronal and rotational deformities using PSIs.

STUDY DESIGN

Case series; Level of evidence, 3.

METHODS

All included patients underwent DFO (34 patients, 36 knees) using PSIs for combined correction of coronal and rotational deformities. The hip-knee-ankle angle (HKA) was measured in weightbearing long-leg radiographs, and the femoral torsion was assessed using computed tomography scans, both pre- and postoperatively. The achieved corrections of HKA and femoral torsion were determined for each knee, and surgical accuracy was calculated.

RESULTS

HKA and femoral torsion changed significantly from preoperatively to postoperatively (from 2.4° ± 3.6° vs 0.1° ± 1.8° [P < .001] and 31.2° ± 17.2° vs 18.7° ± 7.4° [P < .001]). The difference from planned to achieved correction was statistically greater for HKA (-2.9° ± 3.8° vs -2.3° ± 3.5°; P = .018) than for femoral torsion (-12.4° ± 11.8° vs -12.3° ± 12.2°; P = .771), which did not reach significance. The accuracies of HKA and femoral torsion correction were 1.1° ± 1° and 2.4° ± 1.9°, respectively.

CONCLUSION

Coronal and rotational deformities of the femur can accurately be corrected simultaneously by a DFO, utilizing PSIs. High accuracy was achieved for the correction of both coronal and rotational deformities, with absolute mean differences from planned to achieved correction of 1.1° and 2.4°, respectively.

Small changes of femoral torsion in varus or valgus distal femoral osteotomy using patient-specific instruments

PURPOSE

Hinge fractures show a relatively high incidence in varus and valgus distal femoral osteotomy (DFO) and can lead to delayed- or non-union. Another observed complication of a hinge fracture is an unintentional change of the postoperative femoral torsion of up to + 9.5° in conventionally performed DFO. We hypothesize that the change of femoral torsion in case of a hinge fracture is less pronounced when DFO is performed using patient-specific instruments (PSI) compared to the literature of conventionally performed DFO.

METHODS

All patients who underwent varus or valgus DFO using PSI from January 2014 to September 2023 were included. Radiographs and computed tomography (CT) scans were used to screen for hinge fractures. Pre- and postoperative femoral torsion was measured in CT.

RESULTS

Thirty-five medial closing-wedge DFO (MCW-DFO), 27 lateral closing-wedge DFO (LCW-DFO), and 27 lateral opening-wedge DFO (LOW-DFO) were included, resulting in a total of 89 included osteotomies. A total of 55 hinge fractures (61.8%) were observed. The femoral torsion changed significantly from 20.5° ± 7.7° to 15.5° ± 8.1° (p < 0.001) in LOW-DFO with a hinge fracture, whereas the other two techniques showed no significant change of femoral torsion.

CONCLUSION

The use of PSI in varus and valgus DFO showed only small changes of the postoperative femoral torsion, even in case of a hinge fracture. The change of femoral torsion was depending on the type of DFO and was only significant in LOW-DFO, however, not exceeding a mean change of 5°.

Clinical Applications of "In-Hospital" 3D Printing in Hip Surgery: A Systematic Narrative Review

Introduction: Interest in 3D printing for orthopedic surgery has been increasing since its progressive adoption in most of the hospitals around the world. The aim of the study is to describe all the current applications of 3D printing in patients undergoing hip surgery of any type at the present time. Materials and Methods: We conducted a systematic narrative review of publications indexed in MedLine through the search engine PubMed, with the following parameters: 3D printing AND (orthopedics OR traumatology) NOT tissue engineering NOT scaffold NOT in vitro and deadline 31 July 2023. After reading the abstracts of the articles, papers were selected according to the following criteria: full text in English or Spanish and content related to hip surgery. Those publications involving experimental studies (in vitro or with anatomical specimens) or 3D printing outside of hospital facilities as well as 3D-printed commercial implants were excluded. Results are presented as a reference guide classified by disease, including the used software and the steps required for the development of the idea. Results: We found a total of 27 indications for in-house 3D printing for hip surgery, which are described in the article. Conclusions: There are many surgical applications of 3D printing in hip surgery, most of them based on CT images. Most of the publications lack evidence, and further randomized studies should be encouraged to assess the advantages of these indications.

A case report demonstrating the utilization of computer-aided design technology and intramedullary nails for the management of femoral deformity and fracture

BACKGROUND

To effectively address severe deformities at the fracture site in patients, meticulous preoperative preparation is essential. This involves ensuring the restoration of the normal structural force line of the affected area and prevention of any residual deformities. By utilizing E3D technology prior to surgery, creating models based on individual patient image data and performing osteotomy, the required surgical parameters can be measured, thereby reducing surgical risks and enhancing precision.

CASE PRESENTATION

This article documents a case involving a fractured femoral shaft resulting in femoral deformation. In this case, computer-aided design technology was employed for preoperative planning and data measurement to guide the corrective osteotomy and fracture fixation procedures.

CONCLUSION

The E3D software utilizes advanced techniques such as customized osteotomy, virtual reduction and internal fixation insertion technology. This enables the software to accurately pre-select the correction of femoral deformities and determine the appropriate specifications and types of internal implants. As a result, the software can create precise, rational, and personalized repair plans tailored to each patient's needs.