The treating doctors at Salzburg University Hospital decided to recreate the missing piece of bone using a 3D printer. This has been possible in the hospital on your own since last year and has now been done for the first time with a child. Five weeks after the accident, the boy is being released today.
On December 28th, ten-year-old Felix and his younger brother Simon are helping their father and grandfather with woodwork on Ulrichshögl in Ainring, Bavaria, when a steel cable breaks. A rope clamp comes loose and is thrown against the boy’s head. The metal part penetrates the top of the skull and gets stuck. The father tries to stop the bleeding and makes an emergency call. He then takes the boy with a quad bike with a trailer out of the forest to a meadow, where they wait for the rescue workers. Felix – still conscious – receives anesthesia from the emergency doctor and is flown by helicopter to the Salzburg University Hospital.
The boy comes into the shock room, a CT scan shows that there is a foreign body stuck in his head: a rope clamp about four to five centimeters in size. The calotte – the bony roof of the skull – is partially shattered. In an initial four-hour operation, two pediatric surgeons and a neurosurgeon remove the metal part and many bone fragments from Felix’s brain, insert an intracranial pressure probe and temporarily close the skull. Then the child goes to the intensive care unit.
“The first few times are particularly tricky”
“The first time is particularly tricky. The brain swells, something could become inflamed, bleeding and disorders occur,” says Roman Metzger, head of the Salzburg University Hospital for Pediatrics and Adolescent Medicine. At the beginning, the parents are not even allowed to stroke their son because any impulse to the brain should be avoided. They fear for a long time – forecasts are initially not possible. “We actually expect a number of delicate phases after the operation. There is also a risk of neurological consequences,” explains Metzger. But after a few days Felix feels better. “Nothing happened as expected, it was a stroke of luck.”
But it is clear that a large part of the skull roof is missing – and since September 2023, the university hospital has had the opportunity to produce a replacement using an in-house 3D printer. That’s Werner Wurm’s job. “So far, this has been done by external companies, which took an average of three to four weeks,” says the head of the clinic’s 3D laboratory. “For Felix, we worked with the surgeons to design and print an implant tailored to his needs within five days.” The material used is “PEEK”, an extremely robust medical plastic that is not rejected by the body.
Hurdles before the procedure
However, there were hurdles: For planned interventions, a CT scan is carried out beforehand in order to accurately model the implant on the intact skull. Felix was brought in with cracked bones and the template was missing. “We therefore virtually mirrored the existing skull shape based on the 3D data set from the CT images and first made a model of the opposite side,” reports neurosurgeon Johannes Pöppe. The missing part was then constructed based on the model and installed on January 17th. Felix is operated on again for almost three hours, the implant fits to within half a millimeter.
The Salzburg University Hospital is one of the first hospitals with its own 3D laboratory. Since last September, 24 implants have been printed – so far only for adults. “As far as we know, this is the first time that a child has had a 3D-printed sculpture made in-house,” says neurosurgeon Pöppe. Postscript: possibly worldwide.
Technology may also be the future
Technology may also be the future. “The goal is precision medicine,” says department head Metzger. “Where implants don’t come off the shelf and you have to access fixed sizes, but where they are designed for the individual.” Felix’s skullcap plastic is intended to remain in the boy’s head for decades. “I can’t say yet whether his growth will result in a bone gap that would have to be covered again. That can be the case, but it doesn’t have to be.”
What is certain is that the ten-year-old will be released from the hospital today, just five weeks after his accident. “In the beginning there was talk of months,” says his mother. He says his biggest wish now is to celebrate New Year’s Eve with his best friends. After the semester break, he wants to start school again “part-time”, i.e. gradually. However, his hobbies – mountain biking and skiing – have to be put on hold. And the music club where Felix plays the tenor horn will also have to do without him for a long time.
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