Using a weight bearing CT (WBCT)-first approach for diagnosing syndesmotic instability is the most cost-effective…
Custom surgical guides help improve placement and surgical success. Dr. Kristian Buedts, MD, a foot and ankle surgeon at ZNA Middleheim in Antwerp, Belgium recently shared how he uses weight bearing CT scans to create his own surgical guides, and then how he 3D prints those guides at his hospital.
Dr. Buedts highlighted the challenges associated with arthrosis in younger patients, noting that osteo-arthritis typically develops in younger patients as a post-traumatic symptom. More than half the time, the condition presents as asymmetrical wear of the tibio-talar joint (Witteveen 2013), and realignment surgery is often considered to avoid the implications of ankle replacement and joint fusion in younger patients (Krahenbuhl 2017).
These surgeries have been made easier by the accurate 3D representations made possible with weight bearing CT scans, providing professionals like Dr. Buedts with a more consistent pre-operative planning process that included the following steps:
- Computer simulation software aids in generation of 3D models
- Displacement is calculated by comparing the affected bone to the normal side through superimposition
- Virtual osteotomies are conducted
- Commercial software helps translate these simulations into custom-made guides
- These guides are 3D printed to assist with the actual surgery
In one case, a patient with ankle instability in the ankle joint as a result of ligamentous laxity and a complex cavo-varus deformity with congruent varus deformity in the ankle joint, among other problems, underwent a corrective dome osteotomy.
While cases such as the patient’s are often hard to reproduce and are difficult to operate on, Dr. Buedts and his team utilized weight bearing CT imaging and the 3D printing of pre-operative guides that were used during the procedure to achieve an extremely positive outcome.
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