Primary reconstruction of orbital fractures using patient-specific titanium milled implants: the Helsinki protocol

Abstract

Preoperative virtual planning and the use of patient-specific implants enable exact reconstruction of orbital fractures. We present our results and experience of reconstruction of isolated orbital fractures with patient-specific implants, according to the Helsinki protocol, in 15 patients who were followed up for at least three months postoperatively. The mean (range) difference between the positions of virtually planned, and postoperative, implants was 1.9 (0.5-5.6) mm. The postoperative volume of the fractured orbit was 1.34ml less than that of the non-fractured side, but this was not clinically relevant. None of the patients required reoperation and none had any implant-related complications during follow up. We conclude that patient-specific implants are an adaptable and reliable treatment for primary orbital trauma, and that the Helsinki protocol may have wider applications in the treatment of facial fractures.

Surgical Management of Panfacial Fractures

“…33 Kärkkäinen et al also reported 15 patients who underwent repair of primary orbital fractures with patient-specific implants without any revisions or complications. 34 Their study demonstrates the accuracy and reliability of custom-fabricated implants. Cost analysis is needed for routine use, but custom implants may play a useful role in obtaining optimal results in complex facial trauma cases.…”

Advanced Diagnostics and Three-dimensional Virtual Surgical Planning in Orbital Reconstruction

“…20). 5 An STL of the PSI, or a preliminary design, can be imported in the software to check that it meets all parameters on implant shape and positioning, and to see whether the design will provide a unique fit to the designated position (see Fig. 21).…”

What are the limitations of the non-patient-specific implant in titanium reconstruction of the orbit?

“…Category Description 1 Isolated defect of the orbital floor or the medial wall, 1-2 cm 2 , within the anterior two-thirds 2 Defect of the orbital floor and/or of the medial wall, >2 cm 2 , within the anterior two-thirds…”

“…Bony ledge preserved at the medial margin of the infraorbital fissure 3 Defect of the orbital floor and/or of the medial wall, >2 cm 2 , within the anterior two-thirds Missing bony ledge medial to the infraorbital fissure 4…”