The objective of the study reported here was to assess the utility and reliability of designing, printing, and applying 3-D–printed patient-specific pin guides to facilitate reduction and alignment of tibiae with simulated comminuted, mid diaphyseal fractures. This methodology could be used in clinical cases, because guides could be designed on the basis of a mirror image of the contralateral, intact tibia, requiring only a single CT and surgical procedure. We were specifically interested in assessing the efficacy of 2 methods of articulating the attached pin guides to reduce and align the fractured tibiae and postulated that both methods would yield acceptable fracture alignment. 27įor the present study, we proposed that custom pin guides fabricated with virtual 3-D renderings of CT images of intact tibiae could be applied to accurately reduce a simulated comminuted, mid diaphyseal tibial fracture. The jig was then fabricated and applied during a second surgical procedure to reduce and align the fractured tibia. A reduction jig was developed to articulate the pins securing the proximal and distal fracture segments during a virtual surgical planning session. The fractured limbs, with implanted pins, were then imaged with CT, and the CT volume data were subsequently used to virtually reduce and align the fractured tibia. In that study, Lynch and Davies 27 used a cadaveric tibial fracture model and developed a 2-stage surgical process that included placing pins in the major proximal and distal tibial fracture segments during an initial surgical procedure. 23, 27, 30, 34– 37 A recent cadaveric study 27 evaluated the potential use of virtual surgical planning with application of a printed alignment jig for managing fractures in dogs. Fabricated patient-specific guides have been used as drill, osteotomy, and reduction guides (RGs) to facilitate and maintain alignment for implant placement. 33 Guides are designed to conform to specific topographic features on a bone’s surface, enabling a precise, congruent fit between the guide and bone. ![]() 18– 32 Virtual modeling affords creative preoperative formulation of surgical procedures and allows for the fabrication of bone models and patient-specific guides that can be used prior to or during surgery. Virtual surgical planning based on CT imaging and 3-D printing are being used with increasing frequency in both human and small animal orthopedic surgery. 1, 2, 6– 14 Gaining proficiency in MIPO can be technically challenging, and the availability of intraoperative fluoroscopy greatly facilitates the process. Manual traction, intramedullary pins, external fixators (EFs), and appropriate plate contouring have been used to facilitate indirect closed reduction of appendicular long bone fractures during MIPO in dogs. 1– 5 MIPO uses indirect reduction techniques to align the major fracture segments prior to implant application. Minimally invasive plate osteosynthesis (MIPO) is an emerging treatment modality in small animal orthopedics.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |