61-year-old Zhang Dama lives in a remote area. A few years ago, she suffered from a ulnar bone defect due to a car accident. Since then, her ulnar-radial joint and wrist-ulnar joint have lacked bone support, leading to instability. Over time, her wrist joint has been compressed and deformed, causing her severe pain even when using chopsticks to eat, greatly affecting her daily life.Whenever she sees her children busy, Zhang Dama feels helpless and guilty; she does not want to become a burden to them.She and her family have visited several local hospitals, but the doctors recommended joint fusion surgery to alleviate the joint pain. However, the cost of the surgery means her wrist joint would be permanently fixed, and she would no longer be able to use it flexibly.This was undoubtedly a heavy blow for Zhang Dama, and she could not accept such an outcome.
Recently, through the introduction of friends, she came to the Hand Surgery Department at Dalian Central Hospital seeking better treatment options. After a detailed examination and imaging assessment, Deputy Director Ren Yuanfei indicated that a personalized 3D-printed distal ulnar prosthesis could be used to replace Zhang Dama’s wrist joint. This treatment plan not only alleviates the patient’s joint pain but also reconstructs wrist joint function, improving her quality of life. Director Ren’s words gave Zhang Dama hope for recovery.
Preoperative ulnar bone defect
Prosthesis implantation fills the bone defect
After sufficient preoperative preparation, the surgery officially began. Director Ren first used an arthroscope to explore the internal joint, clean the patient’s synovial membrane, and repair the triangular fibrocartilage complex, clearing the ulnar remnant and implanting a personalized 3D prosthesis, replacing the damaged joint with brand new ‘parts’, while reconstructing the distal ulnar ligament and fixing the distal ulnar bone. With the seamless cooperation of the surgical team, the operation was declared successful, and the patient is currently recovering well and will soon be discharged.
Surgical team
Director Ren Yuanfei stated, the difficulty of this surgery lies not only in the precise implantation of the prosthesis but also in how to connect the prosthesis tightly with the surrounding complex soft tissues. It is like weaving a fine net, which requires using the autologous palmaris longus tendon as this ‘thread’, skillfully reweaving the ligaments around the distal ulnar joint, where every knot must be precise, and every ‘thread’ must be perfectly interwoven. However, due to the complexity of the soft tissue structures around the joint and the many ligaments, reweaving these ligaments requires profound anatomical knowledge and superb surgical skills. A slight mistake could lead to surgical failure, causing irreparable losses to the patient. The difficulty of the surgery for experts is akin to ‘a hammer’s final blow’, allowing only success with no chance of failure.With close cooperation and exquisite skills from the surgical team, they pursued perfection in every detail, ultimately achieving success.
Hand bones and joints
What? 3D printing technology is really applied in clinical practice?
Can printed bones really replace the ‘original’ ones?
The editor exclaimed: It’s eye-opening!
So what exactly is ‘personalized 3D printing’?
How does it cleverly replace ‘original’ bones?
Preoperative 3D model design
Experts say that personalized 3D printing is like a puzzle; if a piece is missing, print a piece to fill it. By scanning the patient’s bones through imaging examinations, imaging data is obtained, and the defective bone part is printed as a physical model, which is then implanted into the defect site. The advantage of this technology is that it can import CT, MRI, and other imaging data from different patients into modeling software for personalized digital modeling, where designers can create the best prosthesis model based on the data. Additionally, by converting medical images into three-dimensional models, doctors can better understand the location, shape, and size of the lesions, providing more precise guidance for surgery and treatment. It is worth mentioning that most of these tailor-made prostheses are made of titanium alloy, which has good biocompatibility, rarely causing rejection reactions in human tissues, and this material is strong and lightweight, allowing it to integrate with human bones and exist stably within the body for a long time.It is reported that the Hand Surgery Department has successfully performed multiple personalized 3D printing surgeries, including printing of the navicular bone of the foot, scaphoid bone of the hand, and reconstruction of the radial head elbow joint.
The road ahead is long and arduous. Looking back, the Hand Surgery Department has completed China’s first case of limb replantation, the first case of ultra-thin free flap repair in southern Liaoning, free latissimus dorsi muscle flap repair, and other high-difficulty microsurgical operations, as well as TRAM and DIEP breast reconstruction surgeries after breast cancer, applying various advanced technologies and concepts clinically, filling multiple gaps in southern Liaoning.The successful implementation of the nation’s first personalized 3D printed distal ulnar prosthesis replacement surgery not only marks a solid step forward for the hospital’s Hand Surgery Department in the application of personalized 3D printing technology, but also signifies its leading position in wrist joint replacement and functional reconstruction in the country. In the future, the Hand Surgery team will continue to explore advanced technology fields for diseases, achieving breakthroughs in more areas, while healing patients’ ailments and constantly improving their quality of life, bringing health benefits to more patients.
Expert Introduction
Zhang Tiehui
Chief physician, Director of the Hand Surgery Department. Leader of the Osteomyelitis Prevention and Treatment Group of the Infection and Injury Prevention and Control Professional Committee of the Chinese Preventive Medicine Association, Executive Committee Member of the same committee, and member of the Microsurgery Branch of the Liaoning Medical Association. Specializes in the diagnosis and treatment of upper limb, foot and ankle deformities, trauma, degenerative diseases, complex tissue free flap repair of soft tissue defects, and breast reconstruction.Consultation time: Wednesday morning
Ren Yuanfei
Ph.D., Chief physician, Deputy Director of the Hand Surgery Department, Master’s supervisor, Associate professor. Youth committee member of the Foot and Ankle Surgery Group of the Orthopedics Branch of the Chinese Medical Association, member of the Rehabilitation Medicine Association of China, member of the Bone Complications Committee of the China Medical Education Association, and expert in medical accident and work injury assessment in Dalian. Specializes in limb preservation therapy, correction of hallux valgus and polydactyly, endoscopic release of peripheral nerves, minimally invasive treatment of wrist and ankle joints, and treatment of chronic wounds like diabetic foot.Consultation time: Tuesday morning, Wednesday afternoonText | Hand Surgery Department, Zhong Sheng Cultural Promotion Department, Wu DiPlanning and Editing | Cultural Promotion Department, Wu DiProofreading and Review | Cultural Promotion Department, Ma RonghuiEditing and Review | Cultural Promotion Department, Zou Xia
