Patient-tailored plate for bone fixation and accurate 3D positioning in corrective osteotomy

  • J. G. G. Dobbe
  • J. C. Vroemen
  • S. D. Strackee
  • G. J. Streekstra
Original Article

Abstract

A bone fracture may lead to malunion of bone segments, which gives discomfort to the patient and may lead to chronic pain, reduced function and finally to early osteoarthritis. Corrective osteotomy is a treatment option to realign the bone segments. In this procedure, the surgeon tries to improve alignment by cutting the bone at, or near, the fracture location and fixates the bone segments in an improved position, using a plate and screws. Three-dimensional positioning is very complex and difficult to plan, perform and evaluate using standard 2D fluoroscopy imaging. This study introduces a new technique that uses preoperative 3D imaging to plan positioning and design a patient-tailored fixation plate that only fits in one way and realigns the bone segments as planned. The method is evaluated using artificial bones and renders realignment highly accurate and very reproducible (d err < 1.2 ± 0.8 mm and φ err < 1.8° ± 2.1°). Application of a patient-tailored plate is expected to be of great value for future corrective osteotomy surgeries.

Keywords

Additive manufacturing Computer-assisted planning Custom implant Cutting guide Patient-specific treatment 

References

  1. 1.
    Athwal GS, Ellis RE, Small CF, Pichora DR (2003) Computer-assisted distal radius osteotomy. J Hand Surg 28A(6):951–958Google Scholar
  2. 2.
    Bilić R, Kovjanić J, Kolundžić R (2005) Quantification of changes in graft dimension after corrective osteotomy of the distal end of the radius. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechosl 72:375–380Google Scholar
  3. 3.
    Carelsen B, Jonges R, Strackee SD, Maas M, Van Kemenade P, Grimbergen CA, Her M, Streekstra GJ (2009) Detection of in vivo dynamic 3-D motion patterns in the wrist joint. IEEE Trans Biomed Eng 56(4):1236–1244PubMedCrossRefGoogle Scholar
  4. 4.
    Cartiaux O, Paul L, Docquier PL, Francq BG, Raucent B, Dombre E, Banse X (2009) Accuracy in planar cutting of bones: an ISO-based evaluation. Int J Med Robotics Comput Assist Surg 5:77–84CrossRefGoogle Scholar
  5. 5.
    Ciocca L, De Crescenzio F, Fantini M, Scotti R (2009) CAD/CAM and rapid prototyped scaffold construction for bone regenerative medicine and surgical transfer of virtual planning: a pilot study. Comp Med Imag Graph 33:58–62CrossRefGoogle Scholar
  6. 6.
    Croitoru H, Ellis RE, Prihar R, Small CF, Pichora DR (2001) Fixation-based surgery: a new technique for distal radius osteotomy. Comp Aid Surg 6:160–169CrossRefGoogle Scholar
  7. 7.
    Cronier F, Pietu G, Dujardin C, Bigorre N, Ducellier F, Gerard R (2010) The concept of locking plates. Orthop Traumatol Surg Res 956:S17–S36CrossRefGoogle Scholar
  8. 8.
    Cooney WP, Cobyns H, Linscheid RL (1980) Complications of Colles’ fractures. J Bone Joint Surg 62:613–619PubMedGoogle Scholar
  9. 9.
    Dobbe JGG, Strackee SD, Schreurs AW, Jonges R, Carelsen B, Vroemen JC, Grimbergen CA, Streekstra GJ (2011) Computer-assisted planning and navigation for corrective distal radius osteotomy, based on pre- and intraoperative imaging. IEEE Trans Biomed Eng 58(1):182–190PubMedCrossRefGoogle Scholar
  10. 10.
    Dobbe JGG, Du Pré KJ, Kloen P, Blankevoort L, Streekstra GJ (2011) Computer-assisted and patient-specific 3-D planning and evaluation of a single-cut rotational osteotomy for complex long-bone deformities. Med Biol Eng Comput 49:1363–1370PubMedCrossRefGoogle Scholar
  11. 11.
    Hafez MA, Chelule KL, Seedhom BB, Sherman KP (2006) Computer-assisted total knee arthrosplasty using patient-specific templating. Clin Orth Rel Res 444:184–192CrossRefGoogle Scholar
  12. 12.
    Hankemeier S, Mommsen P, Krettek C, Jagodzinski M, Brand J, Meyer C, Meller R (2010) Accuracy of high tibial osteotomy: comparison between open- and closed-wedge technique. Knee Surg Sports Traumatol Arthrosc 18:1328–1333PubMedCrossRefGoogle Scholar
  13. 13.
    Hollevoet N, Van MG, Van SP, Verdonk R (2000) Comparison of palmar tilt, radial inclination and ulnar variance in left and right wrists. J Hand Surg 25:431–433Google Scholar
  14. 14.
    Ibánes L, Schroeder W (2003) The insight segmentation and registration toolkit. Software guide. Kitware Inc., Clifton Park. ISBN 1-930934-15-7Google Scholar
  15. 15.
    Van de Kraats EB, Penney Tomaževič D, Van Walsum T, Niessen WJ (2005) Standardized evaluation methodology for 2D–3D registration. IEEE Trans Med Imag 24(9):1177–1189CrossRefGoogle Scholar
  16. 16.
    Lozano-Calderon SA, Brouwer KM, Doornberg JN, Goslings JC, Kloen P, Jupiter JB (2010) Long-term outcomes of corrective osteotomy for the treatment of distal radius malunion. J Hand Surg 35B:370–380Google Scholar
  17. 17.
    Menon MRG, Walker JL, Court-Brown CM (2008) The epidemiology of fractures in adolescents with reference to social deprivation. J Bone Joint Surg (Br) 90-B:1482–1486Google Scholar
  18. 18.
    Milner SA, Davis TRC, Muir KR, Greenwood DC, Doherty M (2002) Long-term outcome after tibial shaft fracture: Is malunion important? J Bone Joint Surg (Am) 84-A:971–980Google Scholar
  19. 19.
    Murase T, Kunihiro O, Moritomo H, Goto A, Yoshikawa H, Sugamoto K (2008) Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg Am 90(11):2375–2389PubMedCrossRefGoogle Scholar
  20. 20.
    Miyake J, Murase T, Moritomo H, Sugamoto K, Yoshikawa H (2011) Distal radius osteotomy with volar locking plates based on computer simulation. Clin Orthop Relat Res 469:1766–1773PubMedCrossRefGoogle Scholar
  21. 21.
    Oka K, Murase T, Moritomo H, Goto A, Sugamoto K, Yoshikawa H (2010) Corrective osteotomy using customized hydroxyapatite implants prepared by preoperative computer simulation. Int J Med Robotics Comput Assist Surg 6:186–193Google Scholar
  22. 22.
    Oka K, Murase T, Moritomo H, Goto A, Nakao R, Sugamoto K, Yoshikawa H (2011) Accuracy of corrective osteotomy using a custom-designed devise based on a novel computer simulation system. J Orthop Sci 16:85–92PubMedCrossRefGoogle Scholar
  23. 23.
    Paley D (2005) Principles of deformity correction, 1st edn. Springer, Berlin. ISBN 3-540-41665-XGoogle Scholar
  24. 24.
    Patton MW (2004) Distal radius malunion. J Am Soc Surg Hand 4(4):266–274CrossRefGoogle Scholar
  25. 25.
    Paul L, Cartiaux O, Docquier PL, Banse X (2009) Ergonomic evaluation of 3D plane positioning using a mouse and a haptic device. Int J Med Robot Comp Ass Surg 5:435–443CrossRefGoogle Scholar
  26. 26.
    Pearle AD, Kendoff D, Musahl V (2009) Perspectives on computer-assisted orthopaedic surgery: movement toward quantitative orthopaedic surgery. J Bone Joint Surg 92(Suppl 1):7–12CrossRefGoogle Scholar
  27. 27.
    Pichler W, Clement H, Hausleitner L, Tanzer K, Tesch NP, Grechenig W (2008) Various circular arc radii of the distal volar radius and the implications on volar plate osteosynthesis. Orthopedics 30(12):1192Google Scholar
  28. 28.
    Prommersberger KJ, Froehner SC, Schmitt RR, Lanz UB (2004) Rotational deformity in malunited fractures of the distal radius. J Hand Surg 29A:110–115Google Scholar
  29. 29.
    Rieger M, Gabl M, Gruber H, Jaschke WR, Mallouhi A (2005) CT virtual reality in the preoperative workup of malunited distal radius fractures: preliminary results. Eur Radiol 15:792–797PubMedCrossRefGoogle Scholar
  30. 30.
    Roser SM, Ramachandra S, Blair H, Grist W, Carlson GW, Christensen AM, Weimer KA, Steed MB (2010) The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results. J Oral Maxillofac Surg 68:2824–2832PubMedCrossRefGoogle Scholar
  31. 31.
    Simpson AL, Ma B, Slagel B, Borschneck DP, Ellis RE (2008) Computer-assisted distraction osteogenesis by Ilizarov’s method. Int J Med Robotics Comput Assist Surg 4:310–320CrossRefGoogle Scholar
  32. 32.
    States RA, Pappas E (2006) Precision and repeatability of the Optotrak 3020 motion measurement system. J Med Eng Tech 30(1):11–16CrossRefGoogle Scholar
  33. 33.
    Vroemen JC, Dobbe JGG, Jonges R, Strackee SD, Streekstra GJ (2012) Three-dimensional assessment of bilateral symmetry of the radius and ulna for planning corrective surgeries. J Hand Surg (Am) 37A:982–988CrossRefGoogle Scholar
  34. 34.
    Westphal R, Winkelbach S, Wahl F, Gösling T, Oszwald M, Hüfner T, Krettek C (2009) Robot-assisted long bone fracture reduction. Int J Robot Res 28(10):1259–1278CrossRefGoogle Scholar
  35. 35.
    Wieland AWJ, Dekkers GHG, Brink PRG (2005) Open wedge osteotomy for malunited extraarticular distal radius fractures with plate osteosynthesis without bone grafting. Eur J Trauma 31:148–153CrossRefGoogle Scholar
  36. 36.
    Zheng G, Su Y, Liao G, Jiao P, Liang L, Zhang S, Liu H (2012) Mandible reconstruction assisted by preoperative simulation and transferring templates: cadaveric study of accuracy. J Oral Maxillofac Surg 70:1480–1485PubMedCrossRefGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2012

Authors and Affiliations

  • J. G. G. Dobbe
    • 1
  • J. C. Vroemen
    • 2
  • S. D. Strackee
    • 2
  • G. J. Streekstra
    • 1
  1. 1.Department of Biomedical Engineering and Physics, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Plastic, Reconstructive and Hand Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

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