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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2019 | Research article

3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments

Authors: S. Roner, P. Bersier, P. Fürnstahl, L. Vlachopoulos, A. Schweizer, K. Wieser

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2019

Abstract

Background

Preoperative three-dimensional planning and intraoperative navigation by patient-specific instruments is a promising method for the exact correction of bone deformities. Nevertheless, disadvantages of current concepts are the missing options of adapting the surgical plan intraoperatively. By providing the surgeons with a controlled length adjustment through the patient-specific instruments, the application area can usefully be expanded in the treatment of clavicle osteosyntheses.

Methods

In three cases, preoperative three-dimensional surgical planning with the intraoperative use of patient-specific instruments was applied. The computer-assisted assessments of clavicle deformities, the preoperative plan, and the design of patient-specific instruments were created on the basis of computed tomography data. Reduction guides for restoring length and rotation according to the mirrored healthy contralateral side were enhanced with adaptable length adjustment functions. The screw thread of the reduction guides enabled temporary distraction of the clavicle fracture fragments and a controlled compression of the optionally used interposed bone block between clavicle fragments.

Results

Navigated clavicle osteosyntheses by enhanced patient-specific instruments was executed uneventful in all three cases. The surgeon was able to adapt clavicle length in a planned axis intraoperatively as clinically desired.

Conclusion

Computer-assisted planning of clavicle osteosynthesis and surgical navigation with additional adaptable patient-specific instruments can usefully expand the previous application areas. By using guided length adjustments, the fragments and optionally the graft can be compressed along a planned axis as desired to ensure optimal bone healing.

Level of evidence

Basic science study, Surgical technique

Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476–84. https://www.ncbi.nlm.nih.gov/pubmed/9619941.CrossRef

Jupiter JB, Leffert RD. Non-union of the clavicle. Associated complications and surgical management. J Bone Joint Surg Am [Internet]. 1987;69:753–60 Available from: https://www.ncbi.nlm.nih.gov/pubmed/3597476.CrossRef

McKee MD, Wild LM, Schemitsch EH. Midshaft malunions of the clavicle. J. Bone Jt. Surg. - Ser. A. 2003;85:790–7.CrossRef

Laursen MB, Døssing KV. Clavicular nonunions treated with compression plate fixation and cancellous bone grafting: The functional outcome. J Shoulder Elb Surg. 1999;8:410–3.CrossRef

Martetschläger F, Gaskill TR, Millett PJ. Management of clavicle nonunion and malunion. J Shoulder Elb Surg. 2013;22:862–8.CrossRef

Rosenberg N, Neumann L, Wallace AW. Functional outcome of surgical treatment of symptomatic nonunion and malunion of midshaft clavicle fractures. J Shoulder Elb Surg. 2007;16:510–3.CrossRef

Olsen BS, Vsel MT, Søjbjerg JO. Treatment of midshaft clavicular nonunion with plate fixation and autologous bone grafting. J Shoulder Elb Surg. 1995.

Der Tavitian J, Davison JNS, Dias JJ. Clavicular fracture non-union surgical outcome and complications. Injury. 2002.

Perren SM. Evolution of the internal fixation of long bone fractures: The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Jt Surg [Internet]. 2002;84:1093–110. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12463652.CrossRef

10.

Murase T, Oka K, Moritomo H, Goto A, Yoshikawa H, Sugamoto K. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J. Bone Joint Surg. Am. [Internet]. The American Orthopedic Association; 2008 [cited 2015 Dec 21];90:2375–2389. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18978406

11.

Schweizer A, Fürnstahl P, Harders M, Székely G, Nagy L. Complex radius shaft malunion: Osteotomy with computer-assisted planning. Hand. 2010;5:171–8.CrossRef

12.

Miyake J, Murase T, Oka K, Moritomo H, Sugamoto K, Yoshikawa H. Computer-assisted corrective osteotomy for malunited diaphyseal forearm fractures. J Bone Jt. Surg Am. 2012.

13.

Roner S, Vlachopoulos L, Nagy L, Schweizer A, Fürnstahl P. Accuracy and early clinical outcome of 3-dimensional planned and guided single-cut osteotomies of malunited forearm bones. J. Hand Surg. Am. 2017;42:1031.e1–8.CrossRef

14.

Schweizer A, Fürnstahl P, Nagy L. Three-dimensional computed tomographic analysis of 11 scaphoid waist nonunions. J. Hand Surg. Am. 2012.

15.

Vlachopoulos L, Schweizer A, Meyer DC, Gerber C, Fürnstahl P. Three-dimensional corrective osteotomies of complex malunited humeral fractures using patient-specific guides. J. Shoulder Elb. Surg. [Internet]. Elsevier Inc. 2016;25:2040–7 Available from: https://doi.org/10.1016/j.jse.2016.04.038.CrossRef

16.

Vlachopoulos L, Schweizer A, Meyer DC, Gerber C, Fürnstahl P. Computer-assisted planning and patient-specific guides for the treatment of midshaft clavicle malunions. J. Shoulder Elb. Surg. [Internet]. Elsevier Inc. 2017;26:1367–73 Available from: https://doi.org/10.1016/j.jse.2017.02.011.CrossRef

17.

Hingsammer AM, Lazaros V, Dominik MC, Fürnstahl P. Three-dimensional corrective osteotomies of mal-united clavicles - Is the contralateral anatomy a reliable template for reconstruction? Clin. Anat. 2015;28:865–71.CrossRef

18.

Schweizer A, Mauler F, Vlachopoulos L, Nagy L, Fürnstahl P. Computer-assisted 3-dimensional reconstructions of scaphoid fractures and nonunions with and without the use of patient-specific guides: early clinical outcomes and postoperative assessments of reconstruction accuracy. J. Hand Surg. Am. [Internet]. Elsevier Inc. 2016;41:59–69 Available from: https://www.ncbi.nlm.nih.gov/pubmed/26710736.CrossRef

19.

Bel JC. Pitfalls and limits of locking plates. Orthop. Traumatol. Surg. Res. [Internet]. Elsevier Masson SAS. 2018; Available from: https://doi.org/10.1016/j.otsr.2018.04.031.

20.

Grewal S, Dobbe JGG, Kloen P. Corrective osteotomy in symptomatic clavicular malunion using computer-assisted 3-D planning and patient-specific surgical guides. J. Orthop. [Internet]. Elsevier. 2018;15:438–41 Available from: https://www.ncbi.nlm.nih.gov/pubmed/29881172.CrossRef

21.

Essig H, Rana M, Kokemueller H, Von See C, Ruecker M, Tavassol F, et al. Pre-operative planning for mandibular reconstruction—a full digital planning workflow resulting in a patient specific reconstruction. Head Neck Oncol. 2011;3:1–7.CrossRef

22.

Zeng C, Xing W, Wu Z, Huang H, Huang W. A combination of three-dimensional printing and computer-assisted virtual surgical procedure for preoperative planning of acetabular fracture reduction. Injury [Internet]. Elsevier Ltd. 2016;47:2223–7 Available from: https://doi.org/10.1016/j.injury.2016.03.015.

Title: 3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments
Authors: S. Roner
P. Bersier
P. Fürnstahl
L. Vlachopoulos
A. Schweizer
K. Wieser
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2019
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-019-1151-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments

Abstract

Background

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Level of evidence

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