Inkjet & Digital Printing

Reducing the Guess Work with Patient-Specific Guides

Wednesday 29. July 2015 - A 51-year old male patient of Dr. Evans, orthopaedic surgeon and Director of the Hand and Upper Extremity department at the Cleveland Clinic, presented with a distal radius malunion, exhibiting a notably excessive volar tilt.

Case presented by P. Evans, MD, Cleveland Clinic, Ohio
Surgical Planning with a Personal Touch
A 51-year old male patient of Dr. Evans, orthopaedic surgeon and Director of the Hand and Upper Extremity department at the Cleveland Clinic, presented with a distal radius malunion, exhibiting a notably excessive volar tilt. Normally a severe deformity such as this poses a challenge to surgeons. Fortunately, Dr. Evans and his personal engineer at Materialise were able to work out the correct positions of the osteotomy and distal fragment. They did so by mirroring the healthy contralateral arm (shown in blue), thereby determining the patient’s pre-injury radial length, volar tilt, and radial inclination. With this information, it was possible to establish the original bone position and create a 3D virtual plan for restoring it. In order to transfer this plan efficiently and successfully into the OR, three patient-specific SurgiCase Guides were designed for the osteotomy and volar plate fixation.
The Right Tools for the Job
The first two guides were used to drill holes for screws in their pre-determined positions and the final guide allowed the planned osteotomy position to be accurately translated into the OR. In order to test the guides, an anatomical model of the deformed bone was created at Materialise, using 3D printing technology, and sent to Dr. Evans. This ensured that later in the OR, when fitting the first guide onto the patient, the guide fit well and Dr. Evans was able to pin it to the bone with k-wires.
It is important to note that each guide is customized to fit perfectly with the instrumentation chosen by the surgeon. In this case, TriMed instruments were inserted into each hole of the guide for drilling.
After the holes were drilled using the first two guides, the third guide was put in place to complete the planned osteotomy. Then, with the drilling and osteotomy complete, a plate was used as a reduction template and affixed to the bone using the pre-drilled holes.
Not only did the surgery go smoothly, but the planned bone positions were verified as a match to the surgical outcome, meaning that the procedure was a great success. Dr. Evans was pleased with the positive outcome and the ease with which it was achieved thanks to Materialise’s surgical planning services and SurgiCase Guides: “The custom cut guide takes the guess work out and gives anatomic restoration of alignment, length and rotation. Very precise.”
Peter Evans, MD, PhD, came to Cleveland Clinic in 2001 from Johns Hopkins Bayview Medical Center, where he was Chief of the Division of Hand and Upper Extremity, the Division of Sports Medicine, and the Director of Orthopaedic Research.
After receiving his medical degree from University of Calgary in Calgary, Alberta, Canada, Dr. Evans completed a comprehensive surgical internship at the University of Toronto in Toronto, Canada.
His orthopaedic surgery residency and shoulder and sports medicine fellowship were both completed at the University of Toronto. In addition, Dr. Evans has a PhD from the University of Toronto, The Institute of Medical Sciences, School of Graduate Studies. Then, Dr. Evans completed a hand microsurgery and arthroscopy fellowship from Wake Forest University School of Medicine in Winston-Salem, N.C.
Dr. Evans has authored numerous publications and book chapters and has made many presentations at national and international conferences. He is very active in research, including peripheral nerve regeneration and transplantation and clinical outcomes. Dr. Evans’ specialty interests include shoulder, elbow, and hand surgery including arthroplasty; sports medicine and arthroscopic shoulder, elbow, and wrist surgery; peripheral nerve regeneration; and transplantation.