Computer-Aided Surgical Simulation for Correcting Complex Limb Deformities in Children

Leonardo Frizziero,Stefano Stallone,Giovanni Trisolino,Alfredo Liverani,Gian Maria Santi,Francesca Napolitano,Elena Maredi,Paola Papaleo,Stefano Stilli,Giovanni Luigi Di Gennaro,Paola Zarantonello

doi:10.3390/app10155181

Leonardo Frizziero, Stefano Stallone + Show 9 more

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https://doi.org/10.3390/app10155181

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Abstract

This work aims to present an in-house low-cost computer-aided simulation (CASS) process that was recently implemented in the preoperative planning of complex osteotomies for limb deformities in children. Five patients admitted to the Unit of Paediatric Orthopaedics and Traumatology from April 2018 to December 2019, for correcting congenital or post-traumatic limb deformities were included in the study. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software, and the surgery was planned and simulated starting from the 3D digital model. 3D printed sterilizable models were fabricated using a low-cost 3D printer, and animations of the operation were generated with the aim to accurately explain the operation to parents. All procedures were successfully planned using our CASS method and the 3D printed models were used during the operation, improving the understanding of the severely abnormal bony anatomy. The surgery was precisely reproduced according to CASS and the deformities were successfully corrected in four cases, while in one case, the intraoperative intentional undersizing of the bone osteotomy produced an incomplete correction of a congenital forearm deformity. Our study describes the application of a safe, effective, user-friendly, and low-cost CASS process in paediatric orthopaedics (PO) surgery. We are convinced that our study will stimulate the widespread adoption of this technological innovation in routine clinical practice for the treatment of rare congenital and post-traumatic limb deformities during childhood.

Highlights

Computer-aided surgical simulation (CASS) is becoming an increasingly important means of improving skills acquisition, optimizing clinical outcomes, and promoting patient safety in orthopaedics and traumatology [1]
The present study is a pilot of an ongoing prospective research aimed at developing, refining, and implementing in clinical practice specific CASS tools and processes, in the field of paediatric orthopaedics (PO) surgery
Children presenting with congenital or post-traumatic deformities of the limbs requiring corrective osteotomies who were admitted at the Unit of Paediatric Orthopaedics and Traumatology from April 2018 to December 2019 were included in the study

Summary

Introduction

Computer-aided surgical simulation (CASS) is becoming an increasingly important means of improving skills acquisition, optimizing clinical outcomes, and promoting patient safety in orthopaedics and traumatology [1]. The combination of computer-aided design (CAD), three-dimensional (3D). Printing technology, and mixed (virtual/augmented) reality is emerging as the cutting edge, opening new horizons in surgery. While there have been great strides in other fields of surgery [2], CASS is in its relative infancy within paediatric orthopaedics (PO). PO often deals with the surgical treatment of congenital or acquired limbs and spine deformities during infancy.

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