gms | German Medical Science

Objectives: Congenital and post-traumatic abnormalities in paediatric populations often present difficult management dilemmas, with the primary deformity complicated by temporal changes in growth and remodelling of bones and joints. Residual deformities may be multi-planar, necessitating correction of not only angular but also rotational deformities, which may occur at multiple levels. Careful pre- and peri-operative planning is required to ensure optimum correction.

Minimising operative time is favourable under general anaesthesia but also to reduce post-operative pain and swelling in children that may undergo relatively large corrections in a single procedure. Locally available 'off-the-shelf' hardware may not be suitable for use, particularly when complex correction is required such as in Madelung deformity.

We suggest that the use of digital pre-operative planning, with the option for custom 3D-printed templates that can be used intra-operatively, will greatly facilitate the management of upper limb paediatric deformities.

Method: Paediatric patients with complex limb abnormalities, including radial growth arrest after fracture and Madelung deformity were selected for this preliminary study (n=4). Pre-operative 3D-simulations of deformities were generated (Materialise, Leuven) based on patient CT imaging, guiding decision-making on metalwork selection, osteotomy sites and production of custom-made template guides (separate for drilling and cutting) which were printed, sterilised and used intra-operatively.

Results: All patients in our series underwent successful correction of their deformity with reduced operative times. Initial clinical and radiological follow-up did not identify any early complications but a longer follow-up period may be needed.

Conclusion: A case-series based algorithm for the use of 3D computer imaging in this group of patients is presented, highlighting its role in planning, hardware selection, operative options and custom template printing. Management of complex upper limb deformities can be difficult, even for the experienced paediatric orthopaedic or plastic surgeon. Steps to simplify this process will facilitate adequate correction and reduce theatre times. Additional expense associated with this process will likely diminish with increasing use and availability.