Objective: To determine the influence of a custom 3D-printed guide for placement of cortical bone screws in the equine navicular bone.Study design: Ex vivo study. Sample population: Eight pairs of normal adult equine forelimbs.Methods: A 3.5 × 55 mm cortical screw was placed in the longitudinal axis of each intact navicular bone. Screws were placed with a 3D-printed guide (3D) in one bone and with a traditional aiming device (AD) in the contralateral bone within each pair. Duration of surgery and the number of fluoroscopy images were compared between techniques. Screw placement was subjectively evaluated by gross examination and scored by three boarded veterinary surgeons.Results: The use of a 3D-printed guide reduced the duration of surgery by 6.6 min (±1.5 min) compared to traditional screw placement (20.7 min ± 4.8 min, p < .01). Fewer peri-operative fluoroscopic images were obtained when the 3D guide was used (18 images ± 2.6 images vs. 40 images ± 5.1, p < .01). No difference was detected in navicular screw placement. Conclusion:The use of a 3D guide decreased the time required to place screws and the number of intraoperative images taken without affecting screw placement in intact navicular bones.Clinical relevance: 3D-printed guides can aid in the study, practice, and execution of surgical procedures reducing surgical time and radiation exposure throughout the operative period achieving similar results to those obtained with a conventional approach.
Objective The aim of this study was to evaluate the surgical execution of a virtual surgical plan (VSP) with three-dimensional (3D) guides against a freehand approach in the equine navicular bone using an automated in silico computer analysis technique. Study Design Eight pairs of cadaveric forelimb specimens of adult horses were used in an ex vivo experimental study design with in silico modelling. Limbs received either a 3.5 mm cortical screw according to a VSP or using an aiming device. Using computed tomography and computer segmentation, a comparison was made between the executed screw and the planned screw using the Hausdorff distance (HD). Results Navicular bone mean HD registration error was –0.06 ± 0.29 mm. The VSP with 3D printing demonstrated significantly superior accuracy with a mean deviation of 1.19 ± 0.42 mm compared with aiming device group (3.53 ± 1.24 mm, p = 0.0018). The VSP group was 5.0 times more likely to result in a mean aberration of less than 1.0 mm (95% confidence interval, 0.62–33.4). A 3.5 mm screw with an optimal entry point can have a maximum deviation angle of 3.23 ± 0.07, 2.70 ± 0.06 and 2.37 ± 0.10 degrees in a proximal, dorsal and palmar direction respectively, prior to violating one of the cortical surfaces. Conclusion Procedures performed using the 3D guides have a high degree of accuracy, with minimal mean deviations (<1 mm and <1 degree) of a VSP compared with those using the conventional aiming device. The use of VSP and the HD for evaluation of orthopaedic surgeries and outcome measures shows promise for simplifying and improving surgical accuracy.
ObjectiveTo report the technique, surgical approach, and postoperative features in horses treated via a 3‐dimensional (3D) printed guide‐assisted keratoma resection created using computed tomography (CT) or magnetic resonance imaging (MRI)‐based segmentation.AnimalsFive client‐owned horses.Study designShort case series.MethodsHorses were placed under general anesthesia for imaging (CT and MRI) and underwent a second anesthesia for surgery. Two horses had guides created from CT‐based imaging, 3 horses had guides created from MRI. Various sized nonarbored hole saws were used to create accurate and precise portals for keratoma removal. Surgical sites were managed until keratinized granulation tissue had formed and the defect was sealed with an artificial hoof wall patch.ResultsAll keratomas were successfully removed as a single piece either intact with the hoof wall or easily extracted after the hoof wall portal was created in a surgical time between 20 and 90 min. All CT created guides fitted without issue; MRI‐created guides required minor adjustments with a rotary device for proper fit. All cases had minor debridement adjacent to P3 and circumferential lamellar tissue. All horses returned to previous level of performance 2 to 4 months postoperatively.ConclusionUse of 3D printed guides led to accurate targeting of keratomas with small surgical portals and short surgical times. Due to challenges with MRI‐based segmentation, CT is preferred.
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