Treatment of complex tibia deformation with Surgical Model

Treatment of complex tibia deformation due to an old diaphysis fracture healed incorrectly (malunion)


Dr. Vladislav Zlatinov
Central Vet Clinic
Sofia, Bulgaria

History


Bianca a 10 months old female mixed dog,  weight 23kg. Found on the street with a visibly deformed posterior

Radiology study showing the presence of complex tibia deformation due to an old diaphysis fracture healed incorrectly (malunion).



The classification and evaluation of the deformation are difficult due to the geometric complexity- distortion in at least two planes of the limb- frontal and axial.

Orthogonal x-rays of the bone allow only two-dimensional (in two planes) to evaluate the images.

Study with computed tomography and subsequent 3D reconstruction help to classify deflationand quantitative measurements of deviations from normal reference values.
Available :
Internal tibial twisting (torsio) – 78 degrees;  
Tibial valgus –  30 degrees.
The combination causes complex high-stage angular deviation.

Correction plan


Surgical treatment- corrective osteotomy including: -acute correction with closing wedge osteotomy with the pre-calculated value and position of wedge incision also the excessive tibial valgus must be adjusted.

The next part of the correction is the derotation of the twisted tibia in the axial axis. There is plan  to fixated osteotomy with plate.

Technical Challenges


The unusual form of deformation, diaffy, in at least two planes, increases the risk of suboptimal evaluation before and during surgery. Most vulnerable to error is the position of the wedge osteotomy.

The absence of specific reference anatomical markers in the diaphysis of the tibia puts at risk its correct positioning.

The closest starting points, above and below, are in a “confusing” deflated position relative to each other. Incorrect positioning of osteotomy could cause secondary platation deflation

Clinical condition


Intricate high-level agulate deviation
The closest reference points above and below-lying joint (their planes of movements) are in a confusingly deformed position relative to each other.


Simulation of Operation on OS IMPLANTS SURGICAL MODEL


We developed personalized 3D printed surgical model.

Simulation of the planned operation on a 3D printed model, demonstrates the final result in advance and confirms the accuracy of the preoperative calculations and planning.

In the video, the placed needles are paralysed in the direction of movements of the knee and spots joints;
play a role as reference planes which the end of the intervention must be reusable to each other.

Surgical correction repeats the simulation of 3D pattern correctionWedge-shaped, closing osteotomy .


Postoperative result assessment:
– Excellent recovery of tibia shape (alignment)
– Good bone aposition (osteotomy contact)
– Stable fixation with plaque
– Without secondary deformation

Short term follow up


Three months after surgery we observe full clinical recovery.



End result – Bianca, one year after the op-ed


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