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      Putting 3D modelling and 3D printing into practice: virtual surgery and preoperative planning to reconstruct complex post-traumatic skeletal deformities and defects

      review-article
      1 , 2 , 3 , 2 , 4 , 5 , *
      SICOT-J
      EDP Sciences
      3D printing and modelling, Orthopaedics, Virtual surgery planning, Limb salvage, Printing, three-dimensional

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          Abstract

          3D printing technology has revolutionized and gradually transformed manufacturing across a broad spectrum of industries, including healthcare. Nowhere is this more apparent than in orthopaedics with many surgeons already incorporating aspects of 3D modelling and virtual procedures into their routine clinical practice. As a more extreme application, patient-specific 3D printed titanium truss cages represent a novel approach for managing the challenge of segmental bone defects. This review illustrates the potential indications of this innovative technique using 3D printed titanium truss cages in conjunction with the Masquelet technique. These implants are custom designed during a virtual surgical planning session with the combined input of an orthopaedic surgeon, an orthopaedic engineering professional and a biomedical design engineer. The ability to 3D model an identical replica of the original intact bone in a virtual procedure is of vital importance when attempting to precisely reconstruct normal anatomy during the actual procedure. Additionally, other important factors must be considered during the planning procedure, such as the three-dimensional configuration of the implant. Meticulous design is necessary to allow for successful implantation through the planned surgical exposure, while being aware of the constraints imposed by local anatomy and prior implants. This review will attempt to synthesize the current state of the art as well as discuss our personal experience using this promising technique. It will address implant design considerations including the mechanical, anatomical and functional aspects unique to each case.

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          Most cited references59

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          Problems, Obstacles, and Complications of Limb Lengthening by the Ilizarov Technique

          Dror Paley (1990)
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            Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration.

            Based on a new concept, a procedure combining induced membranes and cancellous autografts allows the reconstruction of wide diaphyseal defects. In the first stage of this procedure, a cement spacer is inserted into the defect; the spacer is responsible for the formation of a pseudo-synovial membrane. In the second stage, the defect is reconstructed two months later by an autologous cancellous bone graft. The aim of this study was to evaluate the histological and biochemical characteristics of these membranes induced in rabbits. Histological studies carried out two, four, six, and eight weeks following implantation revealed a rich vascularization. Qualitative and quantitative immunochemistry showed production of growth factors (VEGF, TGFbeta1) and osteoinductive factors (BMP-2). Maximum BMP-2 production was obtained four weeks after the implantation, and, at this time, induced membranes favored human bone marrow stromal cell differentiation to the osteoblastic lineage. Should these results be confirmed in humans, bone reconstruction could be carried out earlier than previously thought and in better conditions than expected, the membrane playing the role of an in situ delivery system for growth and osteoinductive factors.
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              Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system.

              Three-dimensional anatomical correction is desirable for the treatment of a long-bone deformity of the upper extremity. We developed an original system, including a three-dimensional computer simulation program and a custom-made surgical device designed on the basis of simulation, to achieve accurate results. In this study, we investigated the clinical application of this system using a corrective osteotomy of malunited fractures of the upper extremity. Twenty-two patients with a long-bone deformity of the upper extremity (four with a cubitus varus deformity, ten with a malunited forearm fracture, and eight with a malunited distal radial fracture) participated in this study. Three-dimensional computer models of the affected and contralateral, normal bones were constructed with use of data from computed tomography, and a deformity correction was simulated. A custom-made osteotomy template was designed and manufactured to reproduce the preoperative simulation during the actual surgery. When we performed the surgery, we placed the template on the bone surface, cut the bone through a slit on the template, and corrected the deformity as preoperatively simulated; this was followed by internal fixation. All patients underwent radiographic and clinical evaluations before surgery and at the time of the most recent follow-up. A corrective osteotomy was achieved as simulated in all patients. Osseous union occurred in all patients within six months. Regarding cubitus varus deformity, the humerus-elbow-wrist angle and the anterior tilt of the distal part of the humerus were an average of 2 degrees and 28 degrees, respectively, after surgery. Radiographically, the preoperative angular deformities were nearly nonexistent after surgery. All radiographic parameters for malunited distal radial fractures were normalized. The range of forearm rotation in patients with forearm malunion and the range of wrist flexion-extension in patients with a malunited distal radial fracture improved after surgery. Corrective osteotomy for a malunited fracture of the upper extremity with use of computer simulation and a custom-designed osteotomy template can accurately correct the deformity and improve the clinical outcome.
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                Author and article information

                Journal
                SICOT J
                SICOT J
                sicotj
                SICOT-J
                EDP Sciences
                2426-8887
                2017
                21 February 2017
                : 3
                : ( publisher-idID: sicotj/2017/01 )
                : 16
                Affiliations
                [1 ] Department of Orthopaedic Surgery, Royal Brisbane Hospital Herston Queensland 4029 Australia
                [2 ] Orthopaedic Research Centre of Australia Herston Queensland 4029 Australia
                [3 ] 4WEB Medical Frisco TX 75033 USA
                [4 ] Department of Orthopaedic Surgery, University of Texas Health Science Center San Antonio TX 78229 USA
                [5 ] Institute of Health and Biomedical Innovation, Queensland University of Technology Brisbane Queensland 4059 Australia
                Author notes
                [* ]Corresponding author: glatt@ 123456uthscsa.edu
                Article
                sicotj160112 10.1051/sicotj/2016043
                10.1051/sicotj/2016043
                5319375
                28220752
                610f0b98-4fb6-4414-823a-e95d6afd0d4e
                © The Authors, published by EDP Sciences, 2017

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 September 2016
                : 26 November 2016
                Page count
                Figures: 2, Tables: 0, Equations: 0, References: 69, Pages: 10
                Categories
                Lower Limb
                Special Issue: "Deformity correction, limb lengthening and reconstruction" Guest Editor: Y. ElBatrawy
                Review Article

                3d printing and modelling,orthopaedics,virtual surgery planning,limb salvage,printing,three-dimensional

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