Xavier Simcock, MD, hand, and upper extremity surgeon at Midwest Orthopedics at Rush, talks about the benefits of utilizing 3D printing and modeling before surgery.
So, talk to me about this 3D technology that you used for Bridget’s surgery.
Dr. Simcock: So, we’re really lucky these days that technology has come a long way. Before, we could only really interpret what was going on in a complex area by making X-rays, which is, you know, taking a 3D object and making it 2D, right? These days we can do CT scans and even computer imaging to really recreate the model exactly as it is. We’ve taken it one step further now where we can print out that model and actually recreate what her bone looks like. So, this allows us, in this specific situation, to do the surgery prior to actually doing it in vivo, or on her in-person. So, I can make sure that the bone is perfect prior to actually doing the operation.
And so, compared to how it was done previously, how much more effective does this make the surgery?
Dr. Simcock: So, we’re actively studying that now to see the accuracy in which we can do this. But before there was kind of like a guessing element in terms of making the bone perfect and we’d have to, you know, be a little bit more creative during the time of surgery and that would take longer. These days, what we’ve found with other surgeries is that, you know, we’re much faster because we know exactly where we’re going to put the bone, we’ve done all the hard work beforehand, making sure that it’s perfect, you know, in a model. And then, during the time of surgery, we’re more accurate and more, you know, efficient so that we can do it safely for them.
And how often have you used this before surgery?
Dr. Simcock: So, 3D modelling hasn’t really been available and widespread until the last couple of years. So, in the last couple of years we’ve been able to do it, you know, for these very unique malunions, meaning that the bone hasn’t healed well. And we’ve been doing it routinely for malunions in the last couple of years and usually we see one or two a month.
You said it makes the surgery quicker. How much quicker does it make the surgery compared to before?
Dr. Simcock: Every case is different, right? But if you take a complex elbow surgery that could take four to six hours, right? And then if you’ve done it previously on a model, we can shorten it down to an hour and a half or two hours. So, it can be dramatic, the difference in the time.
And what are the benefits that this provides to the patient?
Dr. Simcock: Well, it makes it more accurate, right? So, before there was an element where we were playing God in the sense that we were hoping to make it better, but we weren’t sure. Now if we can actually cut the bone, recreate exactly what the axis should be and rotation and then put it back together, there’s no guesswork, we know exactly what the final result should look like, then we just have to mirror that during the time of the operation.
And talk to me about Bridget’s surgery, why did she come to you?
Dr. Simcock: So, Bridget was a very sweet girl and she had an unfortunate accident where she broke her arm. X-rays looked OK and she was treated by an outside provider and healed, but unfortunately it healed in a crooked position, right? Slowly, over time, she started to notice the difference where, unfortunately, she went from a hand that should be able to turn flat, and in today’s world, it’s incredibly important to be able to type and what we call pronate the hand, but unfortunately she could no longer do that. So, it was out straight in front of her all the time and she could open it up like this. When I saw her, I realized that there was a deformity on her X-ray that – because it had healed in an incorrect position, which we call a malunion. And so I offered her to get a CT scan and create a 3D model so that I could plan the surgery for her to hopefully improve her motion. And luckily she went from not being able to turn her hand down at all to being able to completely turn her hand, and so we’ve gained almost 90 degrees of motion for her in her forearm.
And you said she had surgery before, it didn’t heal properly. Was there any explanation for why it didn’t heal properly?
Dr. Simcock: She didn’t have surgery before. It was broken and she was put into a cast, right? And in that setting what happens is sometimes, unfortunately, the bone may not be perfect, right? Because there’s nothing holding it perfectly. And in addition, the bone, unfortunately, will heal itself in some ways and sometimes one side will heal more than the other and create a deformity. So, in her case, that’s what happened.
Could you also name some other type of surgeries that you could use this for?
Dr. Simcock: Specifically we’re using this a lot in malunion surgeries, which is where the bone heals incorrectly, but we’ve also used it for total joints. So, you know, if you’re planning to make sure that the joint is in the perfect axis, we can actually do the whole total joint on a 3D model.
And how can this impact a person’s quality of life when they have this? When a surgeon’s able to basically do a 3D model, envision the surgery, plan out the surgery before they even have the surgery, how can the impact of a person’s quality of life and their recovery?
Dr. Simcock: Well, for Bridget, it’s obvious, right? You’ve got a young girl with her whole life ahead of her and without being able to turn her hand, she has to move her arm out of the way. So, if you can imagine when you’re sitting next to your friends and in order just to grab something you’re knocking into them, it can be dramatic, right? The beauty for her is that to be able to predict accurately what you’re going to be able to improve their motion to be is very important. And so as opposed to guesswork being like, well, maybe we can improve it a little bit. They don’t know is it really worth going through the time and recovery of surgery as opposed to being able to say, hey, with some confidence, I think we’re going to be able to get almost all your motion back.
Anything that I didn’t ask you that you feel like people should know?
Dr. Simcock: So, unfortunately when Bridgette first came to me, she only had an ability to have her hand out straight like this. She could turn it open but she couldn’t close her hand down this way. In today’s world, it’s incredibly important to be able to type and so – you know or text or do other things where you can fully pronate the hand, which is what we call it. So, we talked about doing a surgery in order to improve her motion by correcting the bone and making it more anatomic.
And how was her recovery? Like, how long did it take her to fully get that after surgery – get that range of motion?
Dr. Simcock: So, what was remarkable is even right at the time of surgery she had full motion. Obviously, what she needed to do was heal. But it took her about six weeks for the bone to heal. And during that entire time, I had her in therapy in order to make sure she’d maintain that motion. So you could imagine that it’s very difficult living your life where if in order to be able to turn your hand flat instead of being able to turn your hand, you have to turn your whole elbow, right? And so, you can imagine knocking into somebody just putting out your elbow in order to grab something in front of you.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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