Anatomical models perfectly identical to reality that ‘enter’ the operating room providing fundamental support to the orthopedic surgeon. These are some of the application possibilities of 3D printing technology in pediatric orthopedics that will be among the central themes of the next Congress of the Italian Society of Traumatology and Pediatric Orthopedics (Sitop) scheduled from 30 September to 1 October in Naples and simultaneously in streaming.
From ‘photography’ to 3D viewing
Thanks to the CT scan with three-dimensional acquisitions and through the bioengineering collaboration of the three-dimensional printer, the surgeon arrives at the operating table with a corrective operating program already outlined in the smallest details. “In the recent past – he explains Pasquale Guida, director of the Orthopedics department of the Santobono hospital in Naples, Campania hub of pediatric traumatology and president of the next Sitop Congress – the preoperative reconnaissance was entrusted solely to the radiographs, which in essence are like photographs and, therefore, represent the bone in only two of the dimensions of space “. Therefore, depth of field is lacking, because what is actually a solid is represented on a plane.
The risk of false positives and negatives
Not only. The vision of the pathology with the x-rays alone provides a morphological representation that is not always precise. In fact, it is not always possible to obtain a perfect front and side view and false positives and false negatives are possible. “It may happen that with the radiographs alone the surgeon then finds in the field a situation different from the one planned with dilation of the surgical times and therefore with the need to reach the final goal with operational paths different from those foreseen”, continues the expert. The use of three-dimensional technology now allows a reconstruction of the real appearance of the bone in height, width and depth. “The surgeon – specific Guide – will be able to plan both the surgical cuts and the synthesis instruments that he will use on the little patient, choosing, thanks to the model, the most appropriate ones and effectively corresponding to the child’s measurements in the three planes of the space. It will be a faster and above all more precise surgery ”.
The 3D brace for radius fractures
The Santobono pediatric hospital in Naples was the first Center to publish a scientific work in the Journal Pediatric Orthopedic on the use of this technology in children. “After obtaining the authorization from the Ethics Committee, thanks to the collaboration with the Cnr – says Guida – we started with the setting up inside our hospital of a laboratory with three-dimensional printers, scanners and with an active collaboration with biomedical engineers . The first experience involved the creation of a brace in bivalve plastic material as an alternative to the plaster cast device for fractures of the radius on a population of about 40 children “. The results were encouraging: “The use of the 3D printer to create orthoses and models of the bones to be treated is useful in a wide range of congenital and acquired pathologies as well as in cancerous ones,” explains Guida.
The use of the 3D printer for osteosarcomas
According to data from the Italian Cancer Registries Association (AIRTUM), osteosarcomas represent 2% of all cancers observed between 0 and 19 years. In pediatric age (0-14 years) the disease has a similar incidence between males and females, while in adolescence, i.e. between 15 and 19 years, it is more frequent in males (10.4 cases per million every year) than in females (1.7 cases per million every year). Until recently, the sacrifice of the limb (with amputation or disarticulation) was envisaged for bone tumor pathologies, while today there is a tendency to save it while remaining extensive the resection of the malignant tumor mass. “These models – explains the orthopedist – make it possible to establish the cut of the prostheses, used above all in the case of osteosarcoma, which is the most common malignant bone tumor and which requires chemotherapy in the pre-operative phase. Also for this specific pathology – he is keen to remember the next president of Sitop – the Santobono, in collaboration with the professor Flavio Fazioli of the Irccs Oncological Institute of Pascale and with the oncohematological center of Pausilipon, has managed to create a center in which osteosarcomas and Ewing’s sarcomas are treated with the limb salvage technique. Thanks to 3D printing, we can accurately establish the amount of bone to be resected and the type of cuts, and then implant the bone coming from the bank with a biological transplant or, after having dealt with the biomechanics laboratory, a totally artificial prosthesis which, in addition to everything else, it has a huge economic benefit “.
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