Implementation of a semiautomatic method to design patient-specific instruments for corrective osteotomy of the radius

Abstract

Purpose 3D-printed patient-specific instruments (PSIs), such as surgical guides and implants, show great promise for accurate navigation in surgical correction of post-traumatic deformities of the distal radius. However, existing costs of computer-aided design and manufacturing process prevent everyday surgical use. In this paper, we propose an innovative semiautomatic methodology to streamline the PSIs design. Methods The new method was implemented as an extension of our existing 3D planning software. It facilitates the design of a regular and smooth implant and a companion guide starting from a user-selected surface on the affected bone. We evaluated the software by designing PSIs starting from preoperative virtual 3D plans of five patients previously treated at our institute for corrective osteotomy. We repeated the design for the same cases also with commercially available software, with and without dedicated customization. We measured design time and tracked user activity during the design process of implants, guides and subsequent modifications. Results All the designed shapes were considered valid. Median design times (t) were reduced for implants ((t I ) 2.2 min) and guides ((t G ) 1.0 min) compared to the standard ((t I ) 13 min and (t G ) 8 min) and the partially customized ((t I ) 6.5 min and (t G ) 6.0 min) commercially available alternatives. Mouse and keyboard activities were reduced (median count of strokes and clicks during implant design ((s I ) 53, and guide design ((s G ) 27) compared to using standard software ((s I ) 559 and (s G ) 380) and customized commercial software ((s I ) 217 and (s G ) 180). Conclusion Our software solution efficiently streamlines the design of PSIs for distal radius malunion. It represents a first step in making 3D-printed PSIs technology more accessible.

An automatic genetic algorithm framework for the optimization of three-dimensional surgical plans of forearm corrective osteotomies

“…An example of the generated PSI for intraoperative navigation of a distal radius osteotomy is shown in Figure 15. The accuracy of PSI navigation for corrective osteotomies has been previously evaluated, showing an improve in the postoperative outcome (Asada et al, 2014;Bauer et al, 2017a;Byrne et al, 2017;Caiti et al, 2018;Farshad et al, 2017;Gouin et al, 2014;Kunz et al, 2013;Michielsen et al, 2018;Omori et al, 2014;Roner et al, 2018;Rosseels et al, 2018;Schweizer et al, 2016;Vlachopoulos et al, 2015) The presented framework has some technical and clinical limitations. In the first place, the number of cases included in this study was not enough to provide statistical relevance to the quantitative and qualitative analysis performed.…”

“…Example of that can be seen for cases 7, 17, and 20, where the GS solution was preferred by 83% of the readers. In the future, patient-specific osteosynthesis and osteotomy implants such as the one described by Caiti et al (2018) and Omori et al (2014) could be integrated into the optimization framework.…”

Patient-specific plate for navigation and fixation of the distal radius: a case series

“…A patient-specific polyamide drilling/cutting guide and a plate were subsequently designed (Fig. 2 ) [ 10 ], and the digital files were sent to Xilloc Medical for further processing and 3D titanium printing (Xilloc Medical, Sittard-Geleen, The Netherlands). All patient-specific instruments were sterilized at our institute.…”

“…Over the last few decades, a number of techniques have emerged to plan the repositioning of bone segments preoperatively in 3D [9][10][11][12][13][14][15][16][17][18][19][20][21]. The availability of physically printed or virtually displayed bone models allows for a better appreciation of the deformity and helps planning alignment in the coronal, sagittal, and transverse planes.…”

A 3D printed cast for minimally invasive transfer of distal radius osteotomy: a cadaver study

“…1): After positioning the arm in a reproducible position (detailed in section 2a), a preoperative bilateral CT scan is acquired. Then, the 3D pre-operative planning is performed as described in [18][19][20][21][22], where the osteotomy plane and bone repositioning are defined. Next, the cast and the external cutting guide are designed, via Computer Aided Design Fig.…”