Advances in Pediatric Orthopedic Surgery: 3D Calcium-Density Models for Humerus Deformity.

Abstract

BACKGROUND Preoperative planning is crucial for orthopedic interventions, particularly in the correction of severe deformities. Correct implant selection, positioning, and osteotomy planning are essential to achieving optimal surgical outcomes. Recent advancements in 3D printing technology, including the development of calcium-density models, have enhanced visualization and surgical precision. This case study demonstrates the application of this innovative approach in managing a complex proximal humerus deformity in a pediatric patient. CASE REPORT We describe the case of an 8-year-old girl with a severe proximal humerus varus deformity secondary to epiphysiolysis. Her condition was characterized by a cervico-diaphyseal angle of 68° and limited shoulder abduction to 60°. A 3D calcium-density model was employed for meticulous preoperative planning, enabling precise assessment of the deformity, optimization of implant positioning, and accurate osteotomy execution. The surgical procedure consisted of a 15-mm wedge valgus osteotomy using an iliac crest graft and fixation with a PediLoc® plate. This approach achieved a correction of the cervico-diaphyseal angle to 140°, restored shoulder abduction to 180°, and limited the overall surgical time to 2 hours. CONCLUSIONS The use of 3D printing with calcium carbonate-enhanced polylactic acid (PLA) provided superior visualization, radiographic assessment capabilities, and preoperative plate contouring, enhancing surgical efficiency and improving clinical outcomes. The radiopaque properties of the material facilitated intraoperative radiological verification, ensuring precision and safety. This case underscores the potential of this technology to streamline complex pediatric orthopedic surgeries, minimize intraoperative challenges, and improving patient outcomes. Further research is warranted to validate its broader application in orthopedic practice.