Corrective osteotomies using patient-specific 3D-printed guides: a critical appraisal

  • Wouter Rosseels
  • Michiel Herteleer
  • An Sermon
  • Stefaan Nijs
  • Harm HoekstraEmail author
Original Article



Over the last decade, the technique of 3D planning has found its way into trauma surgery. The use of this technique in corrective osteotomies for treatment of malunions provides the trauma surgeon with a powerful tool. However, this technique is not entirely straightforward. We aimed to define potential pitfalls of this technique and possible solutions to overcome these shortcomings.

Materials and methods

Ten patients with either a uni-, bi- or triplanar malunion of the long bones were included in this study. These patients were divided into three groups: a weight-bearing group and a non-weight-bearing group, the latter was divided into the humerus group and the forearm group, subsequently. 2D correction parameters were defined and compared within every group, as well as the interpretations of 3D visualization.


The weight-bearing group revealed an undercorrection for almost all clinical measurements of the femur and tibia, while there was adequate matching of the osteotomies and of screw entry points in all cases. In the humerus group, coronal correction angles were nearly perfect in all cases, while axial and sagittal correction rates, however, differed substantially. Screw entry points and osteotomies were all at the level as planned. The forearm group showed undercorrection in multiple planes while there were good matching entry points for the screw trajectories.


Four major pitfalls were encountered using the 3D printing technique: (1) careful examination of the planned guide positioning is mandatory, since suboptimal intra-operative guide positioning is most likely the main cause of the incomplete correction; (2) the use of pre-drilled screw holes do not guarantee adequate screw positioning; (3) translation of bone fragments over the osteotomy planes in case of an oblique osteotomy is a potential hazard; (4) the depth of the osteotomy is hard to estimate, potentially leading to extensive cartilage damage.


Malunion 3D-guided osteotomy Osteosynthesis 



Els Bruynooghe; Marterialise, Leuven, Belgium.

Compliance with ethical standards

Conflict of interest

Wouter Rosseels, Michiel Herteleer, An Sermon, Stefaan Nijs and Harm Hoekstra have no conflicts of interest.

Ethical approval

The study protocol was approved by the Ethics Committee of the University Hospitals Leuven. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed consent

A written informed consent was obtained from all patients or legal guardians.


  1. 1.
    Victor J, Premanathan A. Virtual 3D planning and patient specific surgical guides for osteotomies around the knee: a feasibility and proof-of-concept study. Bone Jt J. 2013;95:153–8.CrossRefGoogle Scholar
  2. 2.
    Rengier F, Mehndiratte A, von Tengg-Kobligk H, Zechmann CM, Unterhinninghofen R, Kauczor HU, Giesel FL. 3D printing based on imaging data: review of medical applications. Int J CARS. 2010;5:335–41.CrossRefGoogle Scholar
  3. 3.
    Kunz M, Ma B, Rudan JF, Ellis RE, Pichora DR. Image-guided distal radius osteotomy using patient-specific instrument guides. J Hand Surg Am. 2013;38:1618–24.CrossRefGoogle Scholar
  4. 4.
    Schweizer A, Fürnstahl P, Nagy L. Three-dimensional correction of distal radius intra-articular malunions using patient-specific drill guides. J Hand Surg Am. 2013;38:2339–47.CrossRefGoogle Scholar
  5. 5.
    Takeyasu Y, Oka K, Miyake J, Kataoka T, Moritomo H, Murase T. Preoperative computer simulation-based three-dimensional corrective osteotomy for cubitus varus deformity with use of a custom-designed surgical device. J Bone Jt Surg Am. 2013;95:1731–9.CrossRefGoogle Scholar
  6. 6.
    Hoekstra H, Rosseels W, Sermon A, Nijs S. Corrective limb osteotomy using patient specific 3D-printed guides: A technical note. Injury. 2016;47(10):2375–80.CrossRefGoogle Scholar
  7. 7.
    Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. 1983;105(2):136–44.CrossRefGoogle Scholar
  8. 8.
    Kataoka T, Oka K, Miyake J, Omori S, Tanaka H, Murase T. 3-Dimensional prebent plate fixation in corrective osteotomy of malunited upper extremity fractures using a real-sized plastic bone model prepared by preoperative computer simulation. J Hand Surg. 2013;38A:909–19.CrossRefGoogle Scholar
  9. 9.
    Honingmann P, Thieringer F, Steiger R, Haefeli M, Schumacher R, Henning J. A simple 3-dimensional printed aid for a corrective palmar opening wedge os teotomy of the distal radius. J Hand Surg Am. 2016;41:464–9.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Wouter Rosseels
    • 1
  • Michiel Herteleer
    • 2
    • 3
  • An Sermon
    • 2
    • 4
  • Stefaan Nijs
    • 2
    • 4
  • Harm Hoekstra
    • 2
    • 4
    Email author
  1. 1.Faculty of MedicineKU Leuven-University of LeuvenLeuvenBelgium
  2. 2.Department of Trauma SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  3. 3.Department of Organ SystemsKU Leuven-University of LeuvenLeuvenBelgium
  4. 4.Department of Development and RegenerationKU Leuven-University of LeuvenLeuvenBelgium

Personalised recommendations