Case-based technical remarks on patient-specific instrumentation for corrective osteotomies in hand surgery

Abstract

The paper aims to comment on interdisciplinary cooperation in preoperative planning, the technical details of materials and technologies used in the production process, and the differences between them from the engineers’ and surgeons’ points of view. Also, intraoperative difficulties, technical issues, and intraoperative tips are described in detail.Four patients with forearm fracture malunions were enrolled in a retrospective study. The study group consisted of two boys with improperly healed both-bone forearm fractures (radius and ulna), a girl with a radius shaft fracture malunion, and an adult patient with a distal radius fracture malunion.All patients underwent corrective osteotomy of the forearm bones using patient-specific instrumentation made with three-dimensional printing technology to improve the function of the upper limb. The production process and technical preparation of gauges and implants were presented in detail.The paper presents in detail the intraoperative difficulties resulting from planning and creating patient-specific instrumentation. Moreover, some intraoperative difficulties, technical issues and intraoperative tips are described depending on the indications and the type of surgery. A total estimate of preoperative time needed for surgical planning, including the time needed to produce individual implants, is approximately four weeks. The estimated surgical time saved is approximately 30 minutes, but a more important aspect is the ability to achieve greater precision in osteotomy and deformation correction.The limitations of the work are the small number of patients assessed and the different profiles of the patients presented.Most published papers focus on the indications for and advantages of these procedures and the clinical results of these procedures. It is typical for developing technologies to highlight the positive aspects of the technique. We present possible drawbacks and technical issues regarding preoperative planning and intraoperative tips and difficulties, which are rarely seen in the literature.