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Use of Hausdorff Distance and Computer Modelling to Evaluate Virtual Surgical Plans with Three-Dimensional Printed Guides against Freehand Techniques for Navicular Bone Repair in Equine OrthopaedicsFunding This work was completed with support from the Florida Veterinary Scholars Program, the University of Florida College of Veterinary Medicine, the 2019 ACVS Surgeon in Training Grant, discretionary funds from the Surgical Translation and 3D Printing Research Laboratory at the University of Florida and DePuy Synthes.
Objective The aim of this study was to evaluate the surgical execution of a virtual surgical plan (VSP) with three-dimensional (3D) guides against a freehand approach in the equine navicular bone using an automated in silico computer analysis technique.
Study Design Eight pairs of cadaveric forelimb specimens of adult horses were used in an ex vivo experimental study design with in silico modelling. Limbs received either a 3.5 mm cortical screw according to a VSP or using an aiming device. Using computed tomography and computer segmentation, a comparison was made between the executed screw and the planned screw using the Hausdorff distance (HD).
Results Navicular bone mean HD registration error was –0.06 ± 0.29 mm. The VSP with 3D printing demonstrated significantly superior accuracy with a mean deviation of 1.19 ± 0.42 mm compared with aiming device group (3.53 ± 1.24 mm, p = 0.0018). The VSP group was 5.0 times more likely to result in a mean aberration of less than 1.0 mm (95% confidence interval, 0.62–33.4). A 3.5 mm screw with an optimal entry point can have a maximum deviation angle of 3.23 ± 0.07, 2.70 ± 0.06 and 2.37 ± 0.10 degrees in a proximal, dorsal and palmar direction respectively, prior to violating one of the cortical surfaces.
Conclusion Procedures performed using the 3D guides have a high degree of accuracy, with minimal mean deviations (<1 mm and <1 degree) of a VSP compared with those using the conventional aiming device. The use of VSP and the HD for evaluation of orthopaedic surgeries and outcome measures shows promise for simplifying and improving surgical accuracy.
Keywordsthree-dimensional - virtual surgical plan - computer modelling - orthopaedic surgery - equine
A.H.B. performed the final computer analysis and finalized the manuscript and figures. He contributed to conception of study, study design, acquisition of data, data analysis and interpretation, and drafting/revising and approving the submitted manuscript and is publically accountable for relevant content. H.C.K. performed the segmentation and initial computer matching of the navicular bones and the initial manuscript draft. She acquired the data, performed data analysis and interpretation, and drafted/revised and approved the submitted manuscript. E.E.P. performed the surgeries and the original study. He acquired the data and approved the submitted manuscript. A.J.M. was one of the authors with the initial thoughts to develop the manuscript and reviewed the final version. She contributed to conception of study, data analysis and interpretation, drafting /revising and approving the submitted manuscript.
Received: 10 August 2020
Accepted: 01 December 2020
Article published online:
13 January 2021
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