Purpose or Case Report: Arthrogryposis multiplex congenita is a clinical finding that includes congenital contractures affecting 2 or more areas of the body and is a component of over 300 disorders. Treatments goals are joint mobilization, splinting for improved function and position, and therapy for improved strength. Limb deformities that restrict motion may be treated surgically with understanding of unique patient joint alignment, bone morphology, and muscle and ligament integrity required for adequate surgical planning. We discuss 3 cases in which advanced imaging techniques including CT, MRI and 3D model printing were used for improved understanding of complex patient anatomy and dysmorphology.
Methods & Materials: All patients underwent preoperative imaging with CT or MRI with acquisition of 3D data sets. Autmoated 3D segmentation was performed with CT data and manual, hand drawn segmentation was performed with MRI data for immature epiphyses. Commercially available segmentation software (TeraRecon or Mimics) was utilized, and 3D prints were made for use in preoperative planning, patient and familty education, and/or intraoperative reference.
Results: While CT was utilized for more mature bones, MRI was helpful for identification of severely hypoplastic or aplastic muscles and for assessment of immature, incompletely ossified epiphyses. Patients with arthrogryposis have multiplanar deformities which can exist in multiple bones; femur, tibia, and foot, for example. The 3D models subjectively improved the understanding of complex deformities to enable more complete preoperative plans, anticipate instrumentation issues, and decrease operative time. Preoperatively, the models also enhanced the education of the patients and their families prior to surgery. Having a 3D model in the operating room facilitated the understanding of 2D imaging.
Conclusions: Overall, 3D imaging and model printing were felt to be a positive addition to the care of the skeletally immature arthrogrypotic patient for surgical planning, education, and intraoperative reference. As 3D modeling becomes more cost efficient, we can continue to improve patient-specific care. More study is needed to quantify the improvements in surgical outcomes and decreases in operating room time.