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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


Schweizer, Andreas; Mauler, Flavien; Vlachopoulos, Lazaros; Nagy, Ladislav; Fürnstahl, Philipp (2016). 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. Journal of Hand Surgery, 41(1):59-69.

Abstract

PURPOSE: To present results regarding the accuracy of the reduction of surgically reconstructed scaphoid nonunions or fractures using 3-dimensional computer-based planning with and without patient-specific guides.
METHODS: Computer-based surgical planning was performed with computed tomography (CT) data on 22 patients comparing models of the pathological and the opposite uninjured scaphoid in 3 dimensions. For group 1 (9 patients), patient-specific guides were designed and manufactured using additive manufacturing technology. During surgery, the guides were used to define the orientation of the reduced fragments. The scaphoids in group 2 (13 patients) were reduced with the conventional freehand technique. All scaphoids in both groups were fixed with a headless compression screw or K-wires, and all bone defects (except one) were filled with autologous bone grafts or vascularized grafts. Postoperative CT scans were acquired 2 or more months after the operations to monitor consolidation and compare the final result with the preoperative plan. The clinical results and accuracy of the reconstructions were compared.
RESULTS: In group 1, 8 of 9 scaphoids healed after 2 to 6 months, and partial nonunion after 9 months was observed in one patient. In group 2, 11 of 13 scaphoids healed between 2 and 34 months whereas 2 scaphoids did not consolidate. Comparison of the preoperative and postoperative 3-dimensional data revealed an average residual displacement of 7° (4° in flexion-extension, 4° in ulnar-radial deviation, and 3° in pronation-supination) in group 1. In group 2, residual displacement after surgery was 26° (22° in flexion-extension, 12° in ulnar-radial deviation, and 7° in pronation-supination). The difference in the accuracy of reconstruction was significant.
CONCLUSIONS: Although the scaphoid is small, patient-specific guides can be used to perform scaphoid reconstructions. When the guides were used, the reconstructions were significantly more anatomic compared with those resulting from the freehand technique.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Abstract

PURPOSE: To present results regarding the accuracy of the reduction of surgically reconstructed scaphoid nonunions or fractures using 3-dimensional computer-based planning with and without patient-specific guides.
METHODS: Computer-based surgical planning was performed with computed tomography (CT) data on 22 patients comparing models of the pathological and the opposite uninjured scaphoid in 3 dimensions. For group 1 (9 patients), patient-specific guides were designed and manufactured using additive manufacturing technology. During surgery, the guides were used to define the orientation of the reduced fragments. The scaphoids in group 2 (13 patients) were reduced with the conventional freehand technique. All scaphoids in both groups were fixed with a headless compression screw or K-wires, and all bone defects (except one) were filled with autologous bone grafts or vascularized grafts. Postoperative CT scans were acquired 2 or more months after the operations to monitor consolidation and compare the final result with the preoperative plan. The clinical results and accuracy of the reconstructions were compared.
RESULTS: In group 1, 8 of 9 scaphoids healed after 2 to 6 months, and partial nonunion after 9 months was observed in one patient. In group 2, 11 of 13 scaphoids healed between 2 and 34 months whereas 2 scaphoids did not consolidate. Comparison of the preoperative and postoperative 3-dimensional data revealed an average residual displacement of 7° (4° in flexion-extension, 4° in ulnar-radial deviation, and 3° in pronation-supination) in group 1. In group 2, residual displacement after surgery was 26° (22° in flexion-extension, 12° in ulnar-radial deviation, and 7° in pronation-supination). The difference in the accuracy of reconstruction was significant.
CONCLUSIONS: Although the scaphoid is small, patient-specific guides can be used to perform scaphoid reconstructions. When the guides were used, the reconstructions were significantly more anatomic compared with those resulting from the freehand technique.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:January 2016
Deposited On:01 Feb 2016 15:29
Last Modified:03 Feb 2017 04:10
Publisher:Elsevier
ISSN:0363-5023
Publisher DOI:https://doi.org/10.1016/j.jhsa.2015.10.009
PubMed ID:26710736

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