Fixing a fractured arthrodesed hip with rapid prototype templating and minimal invasive plate osteosynthesis

Christian Fang, Benjamin Fang, Tak-Man Wong, Tak-Wing Lau, Terence Pun, Frankie Leung, Christian Fang, Benjamin Fang, Tak-Man Wong, Tak-Wing Lau, Terence Pun, Frankie Leung

Abstract

Case: We present an elderly lady with an intertrochanteric fracture of a previously fused hip. A 3D printed model of her pelvis and femur was used for implant templating before surgery. Minimal invasive fixation was performed with a spanning reversed distal femur locking plate without the need for removal of the previous implant. Multiple long locking screws were placed in the supra-acetabular region. The patient had union in 4 months, return to function and no complication.

Conclusion: The technique allowed us to optimize implant selection and insert screws safely at difficult trajectories using minimal invasive surgery.

Keywords: 3D printing; Fracture; Hip fusion; Minimal invasive; Plating.

Figures

Fig. 1
Fig. 1
a) Pre-injury radiograph of an 88-year-old lady showing solid arthrodesis of the left hip with a DHS. b) X-ray showing an intertrochanteric fracture after injury. c) Reformatted coronal CT scan revealing the fracture in the trochanteric region with suspected loosening of the DHS lag screw.
Fig. 2
Fig. 2
a) The 3D printed model was templated against a 4.5/5.0 mm curved broad LCP and a contralateral distal femur LCP. b) Artefacts from CT scan on the model were removed with a Rongeur to allow better contouring. c) Simulated preliminary fixation using Kirschner wires in the iliac oblique and d) obturator oblique views.
Fig. 3
Fig. 3
a) Intraoperative photograph showing sub-muscular placement of the plate via a Smith-Peterson approach. b) Distal locking screws were placed though mini-incisions through the anterior quadriceps.
Fig. 4
Fig. 4
a) Postoperative obturator oblique view showing multiple long locking screws directed towards the supraacetabular ilium. b) Iliac oblique view showing screws superior to the sciatic foramen. c) Post-operative AP view after fixation with presence of a fracture gap. d) Complete union by callus formation at just over 4 months.

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