Abstract
Gradual distraction with an external fixator is a widely used treatment for severe postburn ankle contracture (SPAC). However, application of external fixators is complex, and conventional two-dimensional (2D) imaging-based surgical planning is not particularly helpful due to a lack of spatial geometry. The purpose of this study was to evaluate the surgical planning process for this procedure with patient-specific three-dimension-printed models (3DPMs). In this study, patients coming from two centers were divided into two cohorts (3DPM group vs. control group) depending on whether a 3DPM was used for preoperative surgical planning. Operation duration, improvement in metatarsal-tibial angle (MTA), range of motion (ROM), the American Orthopedic Foot and Ankle Society (AOFAS) scores, complications, and patient-reported satisfaction were compared between two groups. The 3DPM group had significantly shorter operation duration than the control group ((2.0±0.3) h vs. (3.2±0.3) h, P<0.01). MTA, ROM, and AOFAS scores between the two groups showed no significant differences pre-operation, after the removal of the external fixator, or at follow-up. Plantigrade feet were achieved and gait was substantially improved in all patients at the final follow-up. Pin-tract infections occurred in two patients (one in each group) during distraction and were treated with wound care and oral antibiotics. Patients in the 3DPM group reported higher satisfaction than those in the control group, owing to better patient-surgeon communication. Surgical planning using patient-specific 3DPMs significantly reduced operation duration and increased patient satisfaction, while providing similar improvements in ankle movement and function compared to traditional surgical planning for the correction of SPAC with external fixators.
Highlights
Severe postburn ankle contracture (SPAC) is a disabling deformity characterized by excessive hyper‐ trophic scarring and limited range of motion (ROM); it significantly impairs the patient’s daily activity and quality of life (Pehde et al, 2020)
Ilizarov frames were used in six patients and combined-type external fixators in four patients. 3D-printed models (3DPMs) were used for surgical planning in five patients
The results of this study showed that preoperative surgical planning using patient-specific 3DPMs significantly reduced the operation duration for correction of severe postburn ankle contracture (SPAC) with external fixators, it improved patient satisfaction while providing similar improvements in ROM and AOFAS scores compared to traditional surgical planning
Summary
Severe postburn ankle contracture (SPAC) is a disabling deformity characterized by excessive hyper‐ trophic scarring and limited range of motion (ROM); it significantly impairs the patient’s daily activity and quality of life (Pehde et al, 2020). SPAC is often associated with substantial shortening of tendons, liga‐ ments, and neurovascular bundles (Carmichael et al., 2005). Complete correction of SPAC is unfeasible because it may overstretch these contracted tissues or increase the risk of neurovascular injury, ischemia, and even amputation (Tan et al, 2019). Gradual dis‐ traction with an external fixator is required to lengthen the contracted tissues and achieve plantigrade, painless, and stable foot and ankle (van Roermund et al, 1998). Since Ilizarov (1988) first introduced the Ilizarov frame, external fixators (e.g., hexapod frames and unilateral, bilateral, and combined-type external fixators) have been widely used in the treatment of ankle deformities caused by trauma, burn injury, infection, congenital malformation, and neuromuscular pathology (Paley et al, 2006).
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