Three-Dimensional-Printed Patient-Specific Osteotomy Guides, Repositioning Guides and Titanium Plates for Acute Correction of Antebrachial Limb Deformities in DogsFunding None.
Objective The aim of this study was to describe the use of patient-specific three-dimensional (3D)-printed osteotomy guides, repositioning guides and custom-printed titanium plates for acute correction of antebrachial limb deformities in four dogs.
Methods Retrospective review of antebrachial limb deformities in small breed chondrodystrophic dogs that were surgically corrected using a closing wedge ostectomy of the radius at a predetermined site using patient-specific osteotomy guides. Reduction was achieved without the need for intraoperative measurements using patient-specific 3D-printed repositioning guides secured and manipulated using temporary Kirschner wire fixation. The ostectomy of the radius was stabilized with a patient-specific 3D-printed titanium plate.
Results All limbs were corrected to within 3.5 degrees (standard deviation [SD]: 1 degree) and 7.5 degrees (SD: 3 degrees) of the pre-planned deformity correction in the frontal and sagittal planes, respectively. No complications were encountered. Owners completed a canine orthopaedic index survey at a median postoperative follow-up time of 19 months. Surgery eliminated the main presenting complaint of buckling over of the manus in all cases.
Clinical Significance The 3D-printed osteotomy repositioning guides and titanium plates facilitated accurate acute correction of antebrachial deformities in this case series. The methodology described simplifies intraoperative surgical decision-making on limb position with good clinical outcomes seen in a small number of clinical cases.
Keywordsdeformity correction - custom implant fabrication - corrective osteotomy - 3D printed osteotomy guide - additive manufacturing - dog
D.R.C. partly wrote the manuscript and analysed the data collected. M.J.G. identified suitable cases, partly wrote the manuscript and reviewed the draft manuscript. N.J.B. performed surgery for one of the cases, constructed two of the figures, reviewed the draft manuscript and was one of the authors with the initial thoughts to develop the manuscript. F.L.O. was involved in surgical planning for all cases, implant development, provided 3D reconstruction images for the manuscript and reviewed the manuscript. K.J.P. performed surgery on three of the cases, reviewed the manuscript and was one of the authors with the initial thoughts to develop the manuscript.
Eingereicht: 10. Oktober 2019
Angenommen: 09. März 2020
Artikel online veröffentlicht:
30. April 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
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- 1 Olson NC, Carrig CB, Brinker WO. Asynchronous growth of the canine radius and ulna: effects of retardation of longitudinal growth of the radius. Am J Vet Res 1979; 40 (03) 351-355
- 2 Ramadan RO, Vaughan LC. Premature closure of the distal ulnar growth plate in dogs--a review of 58 cases. J Small Anim Pract 1978; 19 (11) 647-667
- 3 Lau R. Inherited premature closure of distal ulnar physis. J Am Anim Hosp Assoc 1977; 13 (05) 609-612
- 4 Vandewater A, Olmstead ML. Premature closure of the distal radial physis in the dog a review of eleven cases. Vet Surg 1983; 12 (01) 7-12
- 5 Morgan P, Miller C. Osteotomy for correction of premature growth plate closure in 24 dogs. Vet Comp Orthop Traumatol 1994; 7 (03) 129-135
- 6 Marcellin-Little DJ, Ferretti A, Roe SC, DeYoung DJ. Hinged Ilizarov external fixation for correction of antebrachial deformities. Vet Surg 1998; 27 (03) 231-245
- 7 Fox SM, Bray JC, Guerin SR, Burbridge HM. Antebrachial deformities in the dog: treatment with external fixation. J Small Anim Pract 1995; 36 (07) 315-320
- 8 Sereda CW, Lewis DD, Radasch RM, Bruce CW, Kirkby KA. Descriptive report of antebrachial growth deformity correction in 17 dogs from 1999 to 2007, using hybrid linear-circular external fixator constructs. Can Vet J 2009; 50 (07) 723-732
- 9 Deruddere KJ, Snelling SR. A retrospective review of antebrachial angular and rotational limb deformity correction in dogs using intraoperative alignment and type 1b external fixation. N Z Vet J 2014; 62 (05) 290-296
- 10 Franklin SP, Dover RK, Andrade N, Rosselli D. , M Clarke K, Correction of antebrachial angulation-rotation deformities in dogs with oblique plane inclined osteotomies. Vet Surg 2017; 46 (08) 1078-1085
- 11 Kim SY, Snowdon KA, DeCamp CE. Single oblique osteotomy for correction of antebrachial angular and torsional deformities in a dog. J Am Vet Med Assoc 2017; 251 (03) 333-339
- 12 Balfour RJ, Boudrieau RJ, Gores BR. T-plate fixation of distal radial closing wedge osteotomies for treatment of angular limb deformities in 18 dogs. Vet Surg 2000; 29 (03) 207-217
- 13 Rovesti GL, Schwarz G, Bogoni P. Treatment of 30 angular limb deformities of the antebrachium and the crus in the dog using circular external fixators. The Open Veterinary Science J 2009; 3 (01) 41-54
- 14 Kwan TW, Marcellin-Little DJ, Harrysson OLA. Correction of biapical radial deformities by use of bi-level hinged circular external fixation and distraction osteogenesis in 13 dogs. Vet Surg 2014; 43 (03) 316-329
- 15 Theyse LF, Voorhout G, Hazewinkel HAW. Prognostic factors in treating antebrachial growth deformities with a lengthening procedure using a circular external skeletal fixation system in dogs. Vet Surg 2005; 34 (05) 424-435
- 16 Piras L, Peirone B, Fox D. Effects of antebrachial torsion on the measurement of angulation in the frontal plane: a cadaveric radiographic analysis. Vet Comp Orthop Traumatol 2012; 25 (02) 89-94
- 17 Meola SD, Wheeler JL, Rist CL. Validation of a technique to assess radial torsion in the presence of procurvatum and valgus deformity using computed tomography: a cadaveric study. Vet Surg 2008; 37 (06) 525-529
- 18 Kroner K, Cooley K, Hoey S, Hetzel SJ, Bleedorn JA. Assessment of radial torsion using computed tomography in dogs with and without antebrachial limb deformity. Vet Surg 2017; 46 (01) 24-31
- 19 Crosse KR, Worth AJ. Computer-assisted surgical correction of an antebrachial deformity in a dog. Vet Comp Orthop Traumatol 2010; 23 (05) 354-361
- 20 Hamilton-Bennett SE, Oxley B, Behr S. Accuracy of a patient-specific 3D printed drill guide for placement of cervical transpedicular screws. Vet Surg 2018; 47 (02) 236-242
- 21 Oxley B. A 3-dimensional-printed patient-specific guide system for minimally invasive plate osteosynthesis of a comminuted mid-diaphyseal humeral fracture in a cat. Vet Surg 2018; 47 (03) 445-453
- 22 Worth AJ, Crosse KR, Kersley A. Computer-assisted surgery using 3D printed saw guides for acute correction of antebrachial angular limb deformities in dogs. Vet Comp Orthop Traumatol 2019; 32 (03) 241-249
- 23 Brown DC. The Canine Orthopedic Index. Step 3: Responsiveness testing. Vet Surg 2014; 43 (03) 247-254
- 24 Johnson KA. The forelimb. In: Piermattei's atlas of surgical approaches to the bones and joints of the dog and cat. Amsterdam, Netherlands: Elsevier; 2013: 160-308
- 25 Pratesi A, Moores AP, Downes C, Grierson J, Maddox TW. Efficacy of postoperative antimicrobial use for clean orthopedic implant surgery in dogs: A prospective randomized study in 100 consecutive cases. Vet Surg 2015; 44 (05) 653-660
- 26 Cook JL, Evans R, Conzemius MG. et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39 (08) 905-908
- 27 Fox DB, Tomlinson JL, Cook JL, Breshears LM. Principles of uniapical and biapical radial deformity correction using dome osteotomies and the center of rotation of angulation methodology in dogs. Vet Surg 2006; 35 (01) 67-77
- 28 Knapp JL, Tomlinson JL, Fox DB. Classification of angular limb deformities affecting the canine radius and ulna using the center of rotation of angulation method. Vet Surg 2016; 45 (03) 295-302
- 29 Fitzpatrick N, Nikolaou C, Farrell M. et al. The double-arch modified type-1b external skeletal fixator. Technique description and functional outcome for surgical management of canine antebrachial limb deformities. Vet Comp Orthop Traumatol 2011; 24 (05) 374-382
- 30 Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 2016; 15 (01) 115
- 31 Yap FW, Calvo I, Smith KD, Parkin T. Perioperative risk factors for surgical site infection in tibial tuberosity advancement: 224 stifles. Vet Comp Orthop Traumatol 2015; 28 (03) 199-206
- 32 Disegi J. Wrought 18% Chromium-14% Nickel-2.5% Molybdenum Stainless Steel Implant Material. Paoli, PA: AO ASIF Materials Technical Commission; 1998
- 33 Serhan H, Slivka M, Albert T, Kwak SD. Is galvanic corrosion between titanium alloy and stainless steel spinal implants a clinical concern?. Spine J 2004; 4 (04) 379-387
- 34 Høl PJ, Mølster A, Gjerdet NR. Should the galvanic combination of titanium and stainless steel surgical implants be avoided?. Injury 2008; 39 (02) 161-169