Bilateral pelvic osteotomy for malunion of a vertical shear fracture with 3D-printed patient-specific cutting guides: a case report.

Abstract

Pelvic osteotomies present a surgical option to restore pelvic alignment, improve function and pain in sequelae of pelvic ring fractures. Understanding the three-dimensional deformity is a crucial step within preoperative planning; furthermore, accurate intraoperative execution of the planning can be challenging. In recent years, patient-specific guides and 3D modeling have emerged as promising technologies in orthopedic and trauma surgery to enhance surgical precision and facilitate intraoperative decision-making. We present the case of a 41-year-old male patient with a pelvic malunion, resulting from a vertical shear fracture occurring 8 years prior. The patient presented with a 4-cm cranial displacement of the right hemipelvis, accompanied by pubic symphysis disruption and fusion of S1 to L5 vertebra. Severely altered posture in the coronal and sagittal plane was associated with sitting imbalance, impaired gait, and chronic pain. We analyzed the deformity and planned the surgical correction on a 3D interactive virtual model. Moreover, we developed 2 patient-specific cutting guides and one patient-specific reduction guide, allowing accurate bilateral pelvic osteotomies, subsequent realignment, and restoration of the pelvic anatomy. For the first time, 3D modeling and 3D-printed patient-specific guides were effectively employed in pelvic malunion surgery, enhancing the precision of preoperative planning, and providing valuable assistance during intraoperative procedures.