It all started when a 58-year-old woman fell, sustaining an intra-articular radius fracture. Her initial treatment consisted of closed reduction and percutanious k-wire fixation. Shortly after the k-wires were removed, the patient began to experience problems moving her wrist and severe pain. By the time she reported this to a doctor, she was already suffering from a complex intra-articular malunion, a condition that is difficult to treat with traditional techniques. Fortunately, the patient then consulted Dr. Stockmans who in turn, collaborated with Materialise to find a solution to her painful situation.

3D visualization of the separate bone fragments before the surgery – step-off in joint clearly visible 3D visualization of the separate bone fragments before the surgery – step-off in joint clearly visible Virtual planning of the correct post-operative position of the bone fragments. Virtual planning of the correct post-operative position of the bone fragments.

Investigating the Problem from Every Possible Angle

Since traditional X-ray images often don’t provide enough information for diagnosis and treatment, a CT scan was taken to better understand the complexity of this patient’s malunion. In order to get the full picture of the patient’s pathology including the otherwise impossible to see space between the joints, Dr. Stockmans uploaded the scanner images to SurgiCase Connect, an application that helped him better communicate with his personal engineer at Materialise. Using the scanner images, his engineer made a detailed 3D reconstruction of the individual bone fragments and Dr. Stockmans was able to look at the injury from every possible angle.

Trying Multiple Approaches using 3D Virtual Surgical Planning

Dr. Stockmans and his personal engineer at Materialise started the surgical planning process by creating three planes through the original fracture lines. However, when they performed the virtual surgery in SurgiCase Connect, it was obvious that this approach would not work. They then tried perforating the bone by drilling a series of holes in close proximity on the original fracture lines. This would weaken the bone in a controlled manner and allow the surgeon to break the bone again following the original fracture line, thus not damaging the bone anymore than it already was. This approach proved successful when performed virtually. Using SurgiCase Connect, Dr. Stockmans was then able to show the surgical plan to his patient and give her confidence that a successful outcome would be achieved.

 

One of the patient-specific drill guides made by Materialise based on the surgeon's virtual surgical plan.

Fig. 4: One of the patient-specific drill guides made by Materialise based on the surgeon's virtual surgical plan.

Achieving the Desired Outcome with Patient-Specific Surgical Guides

Materialise engineers designed patient-specific surgical guides for Dr. Stockmans, based on his virtual surgical plan. The surgeon used these guides to transfer his planning into the operating room, which helped him limit the risk for error during surgery.

 

X-ray 4 weeks after surgery

Fig. 5: X-ray 4 weeks after surgery

Four weeks after the surgery a visible improvement in the patient’s condition was noticed. Prior to entering the operating room, she had severe pain and only 20% mobility in her wrist. The surgery, performed with the use of Materialise’s patient-specific surgical guides, alleviated the pain and restored her wrist to full functionality.

 

Filip Stockmans, MD, is a professor at the Katholieke Universiteit Leuven, Campus Kortrijk Belgium. Trained in Hand & Microsurgery at the Kleinert Institute in Louisville, Kentucky and University of Umea in Sweden, Dr. Stockmans has been in private practice for over 20 years.

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