3D printing surgical guide for nonunion: Technique tip Articles uri icon

authors

  • CUERVAS MONS, MANUEL
  • ESPINOSA, JOSE M.
  • PÉREZ MAÑANES, RUBÉN
  • CALVO, JOSE
  • TRAPERO MORENO, DIEGO
  • PARRA, GUILLERMO

publication date

  • June 2022

start page

  • 128

end page

  • 130

issue

  • 2

volume

  • 32

International Standard Serial Number (ISSN)

  • 0885-9698

Electronic International Standard Serial Number (EISSN)

  • 2333-0600

abstract

  • Arthrodesis in the foot and ankle is sometimes an ideal solution for our patients; unfortunately, this procedure does not come without several potential complications that can prove to be challenging.1 Even when fusion is successful, poor alignment can cause stability issues, poor gait mechanics, difficulty with shoe fit, and decreased function.2

    Special attention is paid to the subject of nonunion, as it is one of the most common and challenging adverse outcomes following arthrodesis procedures.1 Diagnosis of symptomatic nonunion is an important step in order to establish an optimum treatment plan. There are many imaging techniques [plain radiography, bone scan, computed tomography (CT), and magnetic resonance imaging] but none of these are as important as the physician's clinical evaluation. A high index of suspicion and appropriate treatment are paramount for successful outcomes.3 Early and aggressive treatment of any arthrodesis complication is essential for good clinical outcomes.1 If anatomic reduction and arthrodesis position are stable and the patient shows evidence of good bone-healing potential, then nonoperative methods are appropriate,1 but the presence of a fibrous or cartilaginous pseudoarthrosis in a symptomatic patient is an operative indication,2 and resection of the nonviable pseudoarthrosis tissue is critical to allow boney ingrowth.1

    However, finding the accurate nonunion plane intraoperatively could be challenging. Through a traditional open approach, in the beginning, nothing but a bone wall is visible, and landmarks are scarce to decide an appropriate cutting plane. Therefore, the only way to begin the resection is by slowly progressing, by "blind" bone excision with osteotomes and rongeurs.4 Different operative tips have been suggested to identify and mark the nonunion plane, such as using intraoperative fluoroscopy, bony landmarks and/or needles. Notwithstanding these tips could help us to find part of the nonunion plane, it is a 3-dimensional (3D) deformity and could be difficult to identify it completely. This is crucial as the complete resection of the nonviable pseudoarthrosis is critical to allow bony ingrowth.1

    The advancements in 3D printing technology have allowed for the use of custom-designed implants for difficult-to-treat pathologies.5 Previous surgeries present a unique challenge to arthrodesis, nevertheless, in symptomatic patients revision surgery is needed if the position of the fusion is not mechanically sound, or if fixation has failed.1

    We present a technical tip to identify the nonunion plane, by using a customized 3D printed surgical guide for resection and hindfoot rearthrodesis.

subjects

  • Aeronautics
  • Electronics
  • Medicine
  • Naval Engineering

keywords

  • nonunion; pseudoarthrosis; 3d printing