Tech That's Beyond Hip

Tech that’s beyond hip: 3-D printing helps with surgical planning and teaching

It’s never easy to talk about surgery with parents. There are questions about how to prepare the child, concerns about the risks involved, what recovery entails, and, of course, parents will want to understand what, exactly, is being done to help their child. Some surgeries can be easily explained with a series of X-rays or MRIs. But what about surgeries attempting to fix something the eyes can’t see?

Jorge A. Fabregas, MD, met 16-year-old Allison after she’d been experiencing persistent hip and groin pain for two years. Allison thought she’d been injured during color guard practice. She was having difficulty twisting and putting weight on her hip. An MRI of her pelvis revealed a tumor. The tumor needed to be removed—and soon.

“I felt like this was a benign tumor,” Dr. Fabregas says. “A benign tumor can be quite locally aggressive. It doesn’t kill you, but it can continue to expand and kill the bone around it.” A CT scan showed that the tumor was the equivalent of 100 cubic centimeters of space. Because it was located on the groin, an area predisposed to hernias, removing the tumor would be challenging.

As Dr. Fabregas was discussing the case with colleagues, surgical resident, Aaron Morgenstein, MD, suggested printing a 3-D reconstruction of Allison’s pelvis. Not only would this help Dr. Fabregas’s surgical planning, it would also help explain the procedure to Allison’s parents. The model was built from Allison’s MRI and showed the healthy hip in comparison to the one with the tumor.

“Initially, I thought the model would help me during surgery, but soon I realized it was going to be even more helpful to the parents and their understanding of the severity of the tumor,” Dr. Fabregas says. Tumors aren’t visible. “If I’m explaining a tumor to a parent, there’s nothing tangible for them to hold and see,” Dr. Fabregas says. With the 3-D model, Allison and her parents saw exactly what the tumor looked like and where it was located. Evaluating the normal hip printed for comparison, they could envision the outcome of a successful surgery.

During the procedure, Dr. Fabregas discovered that her tumor was an aneurysmal bone cyst. The cyst had expanded enough to tear a hole in the acetabulum. “We don’t know what causes these tumors or why certain patients get them. That’s what makes treatment so hard,” Dr. Fabregas says. The treatment method is straightforward, but because there’s no clue as to what the underlying cause is, it can’t be addressed.

And that, unfortunately, is why these tumors can return. Allison faces a 30 percent chance the tumor will come back, so Dr. Fabregas continues to monitor her closely.

As for the 3-D pelvis, Dr. Fabregas is keeping that. It’s a great exhibit to share when he talks to other doctors about the benefits of creating 3-D models for surgery preparation and educating parents. “There’s a big push for 3-D imaging right now. It’s not just good for tumors, it’s good for fractures, facial reconstructions and spinal models,” Dr. Fabregas says.

3-D printing will be important for teaching residents and for surgical planning. While it’s an expensive and evolving technology, Dr. Fabregas attests from personal experience that 3-D-printed models can improve outcomes and education. “You can learn how to do something without sacrificing patient care, and it increases your accuracy in surgical planning.” It’s reasons like this that make Children’s an advanced and relevant place to learn how to provide the best pediatric care.

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