Complex Hand Surgery using 3D Printing



Shaare Zedek Medical Center has begun using PSI (Patient Specific Instrument) technology, for planning hand surgery using 3D printers.

According to the hospital, a new development from Synergy3DMed, which enables precise one-on-one 3D printing of limbs, is a real revolution in surgery and significantly raises success rates. These operations will include tumor removal and deformity correction.

The hospital reported an innovative surgery performed in the Hand Surgery Unit on a 13-year-old girl suffering from pain and restricted movement in her right hand, due to Madelung's Deformity. This disease causes distortion and limits movement due to the non-uniform growth of the distal radius, located near the wrist.

Dr. Gershon Zinger, Director of the Unit, who performed the surgery, describes the case: "The CT results showed deformities in two different places in the right arm, which were causing a lot of pain and restricting movement. Another deformity was also diagnosed in the left arm. The common surgery for treating these deformities includes one cut in the bone, re-placing the bone and fixing it in position. The problem is that the pain problem is usually solved but the bone does not always straighten out completely and the patient remains limited in movement. In contrast, the new method allows you to cut in a number of places and fix the bone in place with maximum precision."

He says that "the bone printing process occurs in three stages. First – imaging tests are loaded into an advanced 3D surgical planning system. The system allows the surgeon to see all angles of the bone, accurately locate the deformities and so plan the surgery accordingly. The second stage involves planning all stages of the surgery. This is then transferred to a company that specializes in printing limbs so they can develop an accessory specifically adapted for this patient. The printed accessory is then attached to the injured limb during the operation. The printed model is modular and contains all the necessary stages, connected by a magnet. In this way, we can simulate all stages of the surgery, including accurate incisions and putting the screws in to fix the bone."

The first use of this technology in Israel, using a printed model, was recorded at the Ichilov Hospital in Tel Aviv, by Dr. Shlomo Dadia, who used it to remove a cancerous tumor in a young girl's kidneys.

Following that case, Dr. Zinger decided to use the same technology to repair the congenital deformity in the girl's arm.  

"We made four cuts at very precise angles," said Dr. Zinger, "and laid three screws – perfectly compatible with no deviation whatsoever – onto the wrist or the cut, which would have been very hard to do without the printing. The operation was a success and the patient reported a significant improvement in her pain levels. The CT also showed that the bone had fused well."

The patient is due to undergo a similar operation for her left arm, after which it is expected she will be able to return to full and normal activity and to her school studies.