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Optimizing Reduction Guide Stability in Osteotomy Using Patient-Specific Instrumentation: A Basic Guideline. | LitMetric

AI Article Synopsis

  • The study explores the effectiveness of patient-specific instruments (PSIs) in osteotomy surgeries, focusing on their potential for deformation during procedures, which can impact accuracy.
  • Finite element analysis (FEA) was used to test various design adjustments of a reduction guide, including dimensions and K-wire configurations, to improve stability.
  • Key findings indicate that increasing the guide's height significantly reduces deformation under bending and torsion, while altering K-wire slot orientation also plays a crucial role in maintaining guide stability during different types of osteotomies.

Article Abstract

Background: The use of patient-specific instruments (PSIs) for osteotomies is becoming more popular in orthopaedic surgery for correcting mechanical axis and posttraumatic deformities. However, the PSI reduction guides have great potential for intraoperative deformation, which adversely affects the accuracy of the procedure.

Purpose: To conduct a finite element analysis (FEA) to analyze different design parameters to improve the intraoperative stability of the reduction guides.

Study Design: Descriptive laboratory study.

Methods: A reduction guide with a rectangular cross section and four 4-mm K-wire slots was simplified, and the following parameters were modified: width, height, profile design, K-wire thickness, and positions. Bending and torsional moments were applied to the guide construct and guide deformation and equivalent stress were determined using FEA.

Results: Increasing the profile height by 25% resulted in a 44% reduction in guide deformation for bending (37% for torsion). A 25% increase in profile width led to an 18% deformation reduction for bending (22% for torsion). Transverse K-wire slots resulted in 51% less deformation in torsion compared with longitudinally oriented slots. Placing the central K-wire slots 25% closer to the osteotomy reduced guide deformation by 20% for bending and 11% for torsion.

Conclusion: The most effective methods to increase reduction guide stability are to increase the guide height and reduce the central K-wire distance to the osteotomy.

Clinical Relevance: When performing opening or closing wedge osteotomies, which mainly involve bending of the guide, a high-profile guide and longitudinally oriented K-wire slots should be used. When torque is expected as in rotational osteotomies, the K-wire holes in guides should be oriented transversely to reduce intraoperative deformation.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632856PMC
http://dx.doi.org/10.1177/23259671241275124DOI Listing

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