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Willows leads the way for 3D printing to aid orthopaedic surgery
11 October 2017
The clinical application of 3D printing is a new and exciting area in veterinary orthopaedics. 3D printing was developed in the 1980s as a technique for creation of prototype engineering parts. Since this time there have been enormous technical advances in technology, which have allowed medical applications to be developed.
High quality CT scans are used to create 3D virtual representations of bones which can be directly 3D printed or be used for surgical planning.
For some time Willows has used 3D printing to create accurate models of bones for direct visualisation and surgical planning which have been especially useful in complex fracture cases and limb deformity corrections. Data is collected from high quality CT scans and used to produce a 3D mesh representation of the bone, models up to 45cm can be printed – enough for a life-sized Great Dane femur!
More recently, with further developments of technology and the use of computer aided design (CAD) software, exciting new possibilities have opened up and the specialist orthopaedics team at Willows have used this technology in the management of a number of conditions including; limb deformities, complex fractures, limb sparing surgery for bone cancer and spinal fractures.
Figure 1 – CAD images showing a deformed femur (yellow) next to the normal opposite femur (purple)
Figure 2 – a virtual operation has been performed in the CAD software – the deformed bone has been cut, and the lower section (the bone of the knee joint) has been aligned to match the normal opposite side.
Figure 3 – normal alignment of the deformed bone is achieved.
Figure 4 – a CT scan image of a severely fractured feline humerus (upper bone of the forelimb).
Figure 5a – CAD images showing a 3D virtual representation of the normal opposite humerus (red) which has been mirrored (yellow) to act as a template for realignment of the fractured bone (blue).
Figure 5b & 5c – patient specific drill guides are designed on the CAD and printed.
Figure 6 – the guide system permitted recreation of the planned fracture alignment with only two small surgical approaches at either end of the bone.
Figure 7 – comparison of the mirrored opposite and post – op bones show very good alignment.
Figure 8 – the fracture bone went onto heal without complications and the limb use was normal.
Figure 9 – a 3D printed model of the lower forelimb of a Great Dane with a tumour affecting the lower part of the radius bone. The planned sections of bone to be removed have been marked and the model cut.
Figure 10 – the custom metal plate for this patient.
Figure 11 – the plate has been contoured to fit the model. In theatre this reduces surgical time and significantly assists assessment of limb alignment.
Figure 12 – post-op X-Rays and a video of the dog walking two days after surgery.
Figure 13 – CAD images showing a virtual 3D model of the sixth cervical (neck) vertebra of a dog with wobbler syndrome. The large central hole contains the spinal cord, and the two smaller lower holes each contain a large artery. The cylinders represent the trajectories of screws, which can be adjusted to avoid these virtual structures. In this case four screws will be placed into this vertebra.
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