Corrective Osteotomies of Phalangeal and Metacarpal Malunions Using Patient-Specific Guides: CT-Based Evaluation of the Reduction Accuracy

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.

Intra-Articular Proximal Phalanx Osteotomy Using a Three-Dimensional Printed Template: A Case Report

“…Hirsiger et al [8] reported satisfactory outcomes, correcting phalangeal and metacarpal malunions using 3D patient-specific templating, a similar technique to our case. However, their series only included one intra-articular malunion, which consisted of an metacarpal base intra-articular malunion [8].…”

<p>The Accuracy of Three-Dimensional Planned Bone Tumor Resection Using Patient-Specific Instrument</p>

“…The here presented type of measurements have been used to verify the accuracy of bone malunion correction in orthopaedic surgery. 18 , 19 …”

“…The here presented type of measurements have been used to verify the accuracy of bone malunion correction in orthopaedic surgery. 18,19 So far, there is only one experimental study directly comparing the accuracy between PSI and optical navigation with respect to bone tumor surgery: While both achieved acceptable accuracy, surgeons described intra-operative use of PSI as simpler. Moreover, the average time required for resection was significantly lower in the PSI group.…”

3D accuracy and clinical outcomes of corrective osteotomies with patient-specific instruments in complex upper extremity deformities: an approach for investigation and correlation

“…Computer-aided 3D surgery planning with the implementation of 3D printed patient-specific templates, including the information for drill, cutting, and re-positioning in the different bony parts (the so-called patient-specific instruments = PSIs), seems to be a promising tool to optimize the intervention results in these cases. So far, a limited number of studies, case series, and case reports considering upper extremity deformities have investigated the relevance of this technique and found promising results [ 1 – 4 , 6 – 13 ]. However, the comparability of these studies is limited due to the various methods, software, and hardware tools used for 3D planning and printing.…”