Angular Limb Deformities with Med Dimensions 3D Printed Surgical Guides

From Dr. Andrew Jackson

Honey is a 1 year old female spayed Beagle mixed breed dog presented with a right forelimb angular limb deformity. Her deformity was quite pronounced compared to the left forelimb, which had mild typical valgus deformity. Radiographs revealed a biapical deformity of the right forelimb.

I contacted Med Dimensions and presented this case and inquired about what type of support that they could provide. Although I have performed numerous angular limb corrections, the world of 3D printing and guides is new. We discussed the plan of printing both models, osteotomy guides and reduction guides based on CT. Everyone was very helpful in explaining the process and we had no problems getting the imaging to the team. We had a preplanning meeting with 3D rendering of the proposed correction. It was very reassuring to know that everyone was on the same page as far as general osteotomies and angles of osteotomies. Further 3D rending of the osteotomy guides and reduction guides helped to further visualize the surgery and the use of the printed guides.

Prior to surgery I received the guides and models in a very manageable time frame. Med Dimensions has a very quick turn-around from image capture to actual guides and models. We completed a mock surgery with mock guides. This allowed plate contouring prior to the actual surgery. The ultimate benefit to using the guides is reduction in the time operating and the decrease in stress. The guide, once in place, provided a nice template for an accurate cut. There tended to be a bit less consternation than there usually is when performing osteotomies.

Once the osteotomies were completed the reduction guide, which is my favorite guide, helps with reduction, obviously, but enables fine-tuning of the plate placement and osteotomy reduction. This is a real time saver and stress reducer!

Lastly, working with the Med Dimensions team was wonderful. Correspondence was quick, easy and punctual. The models were of excellent quality and the guides were also of excellent quality. I will definitely be working with the team again and would definitely recommend this team to any other surgeon. I think that angular limb deformity surgery and planning are things that require a lot of experience and that is important, but this process could help to lower the learning curve and definitely the time in surgery.

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The OR Times

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Week of 12/15/2019

Welcome to the OR Times! This forum will discuss several hot topics in surgery, and how we may be able to assist with all kinds of growing problems. I’m a professional technical consultant for a plethora of medical devices, and can provide real OR insight as to how pre-op products can totally change the trajectory of success of surgery. I will be writing a post weekly, however there may be an occasional relevant article or story provided by a different author.

For my first article I want to address incomplete fractures and osteochondral deformities of weight bearing bones/joints on canine patients. One of the many complications that can arise during these surgeries is blood loss- specifically in trauma cases; the more time during surgery, the more chances there are for blood loss and likelihood of a blood transfusion. These issues only put more stress on the surgeons, increased OR time, higher infection rate, and increased cost for the owners of the animals.

What can be done to prevent this is either:

  1. new and expensive instrumentation/video
  2. detail oriented pre-op models

There is obviously plenty of evidence of the benefit of new instrumentation and technology, but it can be very expensive. Where pre-op models can prove their worth is in their cost-effective nature and practicality. For example, a specific canine case in 2017.

Pictured above is a distal femur osteochondral defect on a canine patient. In the surgeons hand is the model used for reference.

The above model was used for making practice cuts pre-surgery, and later used as a visual aid during the difficult surgery. The young dog had a distal femoral deformation which lead to patellar subluxation. The surgeon provided CT scans of the dog, Med Dimensions isolated and converted the femur into a 3D printable STL file. Once the femur model was printed, it was provided to the surgeon, who used the model in pre-op strategy and as a reference point during the surgery. The use of this model lead to a solution for all of the problems I mentioned in the second paragraph for this specific case.

This is just one example of how I’ve seen these models be beneficial before, during, and after surgery. I’m looking forward to sharing more of these seemingly endless success stories with you! Please leave a comment if you have any questions, and reach out to me at fred@m3dimensions.com if there is anything you’d like me to cover!

-Fred

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