In-House, Fast FDM Prototyping of a Custom Cutting Guide for a Lower-Risk Pediatric Femoral Osteotomy

Abstract

Three-dimensional printed custom cutting guides (CCGs) are becoming more and more investigated in medical literature, as a patient-specific approach is often desired and very much needed in today’s surgical practice. Three-dimensional printing applications and computer-aided surgical simulations (CASS) allow for meticulous preoperatory planning and substantial reductions of operating time and risk of human error. However, several limitations seem to slow the large-scale adoption of 3D printed CCGs. CAD designing and 3D printing skills are inevitably needed to develop workflow and address the study; therefore, hospitals are pushed to include third-party collaboration, from highly specialized medical centers to industrial engineering companies, thus increasing the time and cost of labor. The aim of this study was to move towards the feasibility of an in-house, low-cost CCG 3D printing methodology for pediatric orthopedic (PO) surgery. The prototype of a femoral cutting guide was developed for its application at the IOR—Rizzoli Orthopedic Institute of Bologna. The element was printed with an entry-level 3D printer with a high-temperature PLA fiber, whose thermomechanical properties can withstand common steam heat sterilization without bending or losing the original geometry. This methodology allowed for extensive preoperatory planning that would likewise reduce the overall surgery time, whilst reducing the risks related to the intervention.

How to Sterilize Polylactic Acid Based Medical Devices?

“…Frizziero and co-workers were able to produce and sterilize by autoclaving 3D-printed custom cutting guides (CCGs) for paediatric orthopaedic surgery maintaining their mechanical properties and the design geometry of the original design. Although they do not specify the tests performed in their study, the fact that the autoclaving process did not affect the guide was because they used a high-temperature PLA fibre (HTPLA) with thermomechanical properties that can withstand common steam sterilization without bending or losing the original geometry [ 32 ].…”

Current Concepts in the Resection of Bone Tumors Using a Patient-Specific Three-Dimensional Printed Cutting Guide

“…After confirming the geometric measurements of the targeted bone, the internal surface of the PSG is designed to perfectly fit the cortical bone of the patient. Surgeons and engineers can determine the cutting position via discussions and then define several slits and holes for sawblade insertion and fixation pins while cutting [ 14 , 15 ]. In addition, a contact-surface widening technique or deformable clip can be used [ 13 ].…”

The Flipping-Wedge Osteotomy: How 3D Virtual Surgical Planning (VSP) Suggested a Simple and Promising Type of Osteotomy in Pediatric Post-Traumatic Forearm Deformity

“…In recent years, we have treated several congenital and post-traumatic deformities using VSP and 3D-printed PSIs [ 10 , 11 , 12 , 13 ]. In particular, we reported a case of forearm malunion in a 15-year-old boy treated by repositioning a local bone wedge [ 11 ].…”