Three-Dimensional Computer-Assisted Surgical Planning and Use of Three-Dimensional Printing in the Repair of a Complex Articular Femoral Fracture in a Dog

Abstract

Objective The main purpose of this study was to describe the use and benefits of 3-dimensional (3D) computer-assisted surgical planning (CASP) and printing in a complex articular fracture repair in a dog.

Study Design Case report.

Animals Client-owned dog.

Results One dog with a closed, severely comminuted, distal femoral supracondylar and bicondylar fracture underwent a preoperative computed tomography scan. Three-dimensional CASP was performed using computer-aided design software. Three-dimensional CASP allowed for visualization of the fracture fragments and virtual surgery, including reduction of the fragments and implant placement. A 3D model of the affected femur was printed and a bone plate was pre-contoured to the model. Intraoperative fracture reduction and stabilization were performed without complications. Postoperative radiographs revealed successful execution of the planned procedure. Subsequent radiographs and clinical examination indicated that bone healing was achieved with return to normal function of the limb. Three-dimensional CASP and the printed 3D model allowed for improved understanding of the anatomical relationship between fracture fragments, preoperative implant selection and contouring, and the ability to practice fracture reduction and implant placement preoperatively. The model was also used for client education, and to teach students and residents.

Conclusion Three-dimensional CASP and printed models are valuable tools in the preoperative planning of complex fracture repairs, educating clients and teaching students and residents.

Keywords

dog - articular fracture - 3D printing - 3D computer-assisted surgical planning - virtual surgery

Author Contribution

Both authors contributed to conception of study, study design and acquisition of data and data analysis and interpretation. Both authors also drafted, revised and approved the submitted manuscript.

• References

• 1 DeCamp CE, Johnston SA, Dejardin LM. Fractures of the femur and patella. In: DeCamp CE, Johnston SA, Dejardin LM, Schaefer SL, eds. Brinker, Piermattei, and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. 5th ed. St. Louis: Elsevier; 2016: 518-596
• 2 Unger M, Montavon PM, Heim UFA. Classification of fractures of long bones in the dog and cat: introduction and clinical application. Vet Comp Orthop Traumatol 1990; 3: 41-50
• 3 Braden TD, Eicker SW, Abdinoor D. , et al. Characteristics of 1000 femur fractures in the dog and cat. Vet Comp Orthop Traumatol 1995; 8: 38-44
• 4 McLaughlin Jr R. Intra-articular stifle fractures and arthrodesis. Vet Clin North Am Small Anim Pract 1993; 23 (04) 877-895
• 5 Frydman GH, Cuddy LC, Kim SE, Pozzi A. Treatment of bicondylar femoral fractures complicated by concurrent ligament or tendon injuries in four dogs. Vet Comp Orthop Traumatol 2014; 27 (04) 324-332
• 6 Houlton JEF, Dunning D. Perioperative patient management. In: Johnson AL, Houlton JEF, Vannini R. , eds. AO Principles of Fracture Management in the Dog and Cat. Davos, Switzerland: AO Publishing; 2005: 1-25
• 7 Rengier F, Mehndiratta A, von Tengg-Kobligk H. , et al. 3D printing based on imaging data: review of medical applications. Int J CARS 2010; 5 (04) 335-341
• 8 Gross BC, Erkal JL, Lockwood SY, Chen C, Spence DM. Evaluation of 3D printing and its potential impact on biotechnology and the chemical sciences. Anal Chem 2014; 86 (07) 3240-3253
• 9 Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging applications of bedside 3D printing in plastic surgery. Front Surg 2015; 2 (25) 25
• 10 Harrysson O, Cormier DR, Marcellin-Little DJ. , et al. Rapid prototyping for treatment of canine limb deformities. Rapid Prototyping J 2003; 9 (01) 37-42
• 11 Dismukes DI, Fox DB, Tomlinson JL, Essman SC. Use of radiographic measures and three-dimensional computed tomographic imaging in surgical correction of an antebrachial deformity in a dog. J Am Vet Med Assoc 2008; 232 (01) 68-73
• 12 DeTora MD, Boudrieau RJ. Complex angular and torsional deformities (distal femoral malunions). Preoperative planning using stereolithography and surgical correction with locking plate fixation in four dogs. Vet Comp Orthop Traumatol 2016; 29 (05) 416-425
• 13 Crosse KR, Worth AJ. Computer-assisted surgical correction of an antebrachial deformity in a dog. Vet Comp Orthop Traumatol 2010; 23 (05) 354-361
• 14 Winer JN, Verstraete FJM, Cissell DD, Lucero S, Athanasiou KA, Arzi B. The application of 3-dimensional printing for preoperative planning in oral and maxillofacial surgery in dogs and cats. Vet Surg 2017; 46 (07) 942-951
• 15 Liska WD, Marcellin-Little DJ, Eskelinen EV, Sidebotham CG, Harrysson OL, Hielm-Björkman AK. Custom total knee replacement in a dog with femoral condylar bone loss. Vet Surg 2007; 36 (04) 293-301
• 16 Oxley B, Behr S. Stabilisation of a cranial cervical vertebral fracture using a 3D-printed patient-specific drill guide. J Small Anim Pract 2016; 57 (05) 277
• 17 Oxley B. Bilateral shoulder arthrodesis in a Pekinese using three-dimensional printed patient-specific osteotomy and reduction guides. Vet Comp Orthop Traumatol 2017; 30 (03) 230-236
• 18 Cohen A, Laviv A, Berman P, Nashef R, Abu-Tair J. Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108 (05) 661-666
• 19 Johnson KA. Piermattei's Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. 5th ed. St. Louis: >Elsevier; 2016: 388-391
• 20 Jaegger G, Marcellin-Little DJ, Levine D. Reliability of goniometry in Labrador Retrievers. Am J Vet Res 2002; 63 (07) 979-986
• 21 Waran V, Narayanan V, Karuppiah R, Owen SL, Aziz T. Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons. J Neurosurg 2014; 120 (02) 489-492
• 22 Bruyère F, Leroux C, Brunereau L, Lermusiaux P. Rapid prototyping model for percutaneous nephrolithotomy training. J Endourol 2008; 22 (01) 91-96
• 23 Watson RA. A low-cost surgical application of additive fabrication. J Surg Educ 2014; 71 (01) 14-17
• 24 Costello JP, Olivieri LJ, Su L. , et al. Incorporating three-dimensional printing into a simulation-based congenital heart disease and critical care training curriculum for resident physicians. Congenit Heart Dis 2015; 10 (02) 185-190
• 25 Cone JA, Martin TM, Marcellin-Little DJ, Harrysson OLA, Griffith EH. Accuracy and repeatability of long-bone replicas of small animals fabricated by use of low-end and high-end commercial three-dimensional printers. Am J Vet Res 2017; 78 (08) 900-905