Abstract
BackgroundPreoperative 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.MethodsIn 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.ResultsNavigated 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.ConclusionComputer-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 evidenceBasic science study, Surgical technique
Highlights
Clavicle fractures are common, predominantly treated non-surgical and affected patients demonstrate pleasing outcomes [1]
Data processing Bilateral computer tomography (CT) images of the clavicle including the proximal part of the humerus and the entire scapula were acquired
The navigated clavicle osteosynthesis was executed uneventful in all three cases
Summary
Predominantly treated non-surgical and affected patients demonstrate pleasing outcomes [1]. Non- and malunions are rare but may result in reduced shoulder function and/or persisted pain [2, 3]. Surgical management is considered to improve shoulder function and reduce pain [4, 5]. The aim is, according to the “Arbeitsgemeinschaft fuer Osteosynthesefragen” (AO) principles, to obtain fragment compression allowing optimal bone healing [4]. Preoperative three-dimensional planning and intraoperative navigation by patient-specific instruments is a promising method for the exact correction of bone deformities. 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
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