Intercarpal surgical implant
A surgical implant for a proximal carpal row replacement surgery employs a scanned image of each of the scaphoid, lunate and triquetrum bones for generating a unitary, homogeneous model defining a fused shape for implantation as the proximal carpal row. The implant utilizes a contralateral image of healthy bones of the patient for generating the replacement model, and employs shrink-wrap and smoothing processing to generate the unitary replacement. The resulting implant replaces the intercalary bone structures of the scaphoid, lunate and triquetrum with a single appliance, and is slideably engaged with the distal carpal row via a surgical tunnel and tethered by a resectioned tendon, ligament, or other connective member. The implant facilitates wrist function since the unitary implant replaces skeletal structures that are encapsulated by adjacent bones and frequently move as a unit, while eliminating gaps, voids and ligaments between the intercalary structure.
1. A method of fabricating a surgical implant, comprising:
receiving a scanned image of a plurality of adjacent skeletal structures designated for replacement, the plurality of adjacent skeletal structures defining a proximal carpal row (PCR) including an ordered arrangement of a scaphoid, lunate and triquetrum;
receiving a contralateral scan of each of the adjacent skeletal structures designated for replacement;
comparing the scanned image of each of the adjacent skeletal structures of the plurality of skeletal structures to the respective contralateral scan and a healthy image depicting an uncompromised skeletal structure of the respective skeletal structure;
generating, based on the scanned image, the healthy image and an inversion of the contralateral scan of each of the adjacent skeletal structures, a model of an implant corresponding to each of the adjacent skeletal structures;
fusing the models of each of the adjacent skeletal structures into a unitary, homogeneous model defined by a continuous combined shape based on an aggregation area between the adjacent skeletal structures resulting from a smoothing of the surfaces and planar shapes of the adjacent skeletal structures, the unitary, homogeneous model for implantation as replacement to the scaphoid, lunate and triquetrum and adapted for 3D printing for rendering the surgical implant configured for replacement of the adjacent skeletal structures; and
forming a surgical tunnel through the surgical implant for insertion of a surgical tether therethrough, the surgical tunnel extending linearly from an opening on a radial scaphoid side and longitudinally extending to an opening on an ulnar triquetrum side.
2. The method of claim 1 wherein the surgical implant is adapted for implantation and engagement with the adjacent skeletal structures.
3. The method of claim 2 wherein the surgical implant has anatomical features of each of the replaced adjacent skeletal structures.
4. The method of claim 1 wherein the surgical implant is adapted for securement by slideable engagement through an orifice in communication with the surgical tunnel in the surgical implant with the surgical tether for forming a tethered attachment to one or more of the proximate skeletal structures.
5. The method of claim 4 wherein the surgical tunnel is adapted to receive a bifurcated flexor carpi radialis tendon for passage through the tunnel and attachment to a proximate skeletal structure.
6. The method of claim 1 further comprising forming the unitary, homogeneous model by applying a circumferential contour processing technique and a smoothing filter to the generated models of each of the adjacent skeletal structures.
7. The method of claim 1 further comprising comparing the scanned image of each of the adjacent skeletal structures to an inversion of a contralateral scan of the corresponding skeletal structure of an opposed wrist, and
selecting anatomical features of one of the contralateral scan and healthy image for the model of the implant for each of the skeletal structures.
8. The method of claim 7 further comprising
forming the unitary, homogeneous model by filling surface areas in adjacent skeletal structures by an aggregation zone defined by an augmented void between the adjacent skeletal structures, the augmented void based on an outward most points forming a smoothed perimeter around the unitary, homogeneous model.