French woman suffering from gunshot wound receives 3D printed 'reverse shoulder prosthesis'

Sep 30, 2017 | By Julia

One lucky patient in France has become one of the first to sport a 3D printed shoulder implant following an almost deadly accident. Nathalie Dufaut Danjon was shot with a hunting rifle a little over two years ago, a near-fatal accident that saw a bullet penetrate her shoulder joint through the front, and exit through the back of her shoulder blade. Needless to say, Danjon’s shoulder anatomy was completely destroyed. The upshot was that her nerves were left intact, yet this meant the subsequent pain proved almost unbearable.

Danjon was hard-pressed to find a solution. Over the course of six months, she visited a total of 12 doctors, only to be greeted with the same response: a traditional implant wouldn’t be possible due to the extreme damage of Danjon’s shoulder, which left very little to work with. In other words, there was not enough bone left to support an implant. Danjon’s inquiries into 3D printed implants were likewise met with resistance. “3D printing is a gadget, a work in progress. It’s not something for you,” the doctors told her.

It was only once she turned to the Centre Hospitalier Universitaire in Dijon that Danjon started making progress. A friend introduced her to the Hospital’s chief of maxillofacial surgery, Professor Narcisse Zwetyenga, who then referred Danjon to orthopedic surgeon Dr. Brice Viard. In a breath of fresh air, Zwetyenga and Viard were optimistic about Danjon’s injury, and confirmed that yes, something could be done.

But that doesn’t mean it was an easy fix. In fact, as Viard explains, it was quite the opposite. “The patient’s humerus had no proximal articular surface and was severely deformed,” he says. The joint destruction was very advanced, with deep lesions in Danjon’s shoulder. 3D scans also showed loose bone fragments stuck to the inner side of the deltoid muscle, and embedded in a fibrous membrane.

It immediately became clear to Viard that current practices wouldn’t be up to the job. “As standard implants are designed for the standard population,” he says, “special cases like this one don’t leave room for good reconstruction. It was impossible to obtain osseous fixation on the scapula.”

A 3D printed implant proved to be the only possible solution. Viard worked closely with engineers and designers at 3D printing company Materialise during his preoperative planning. Together, the team came up with “a reverse shoulder prosthesis”, as Viard calls it, complete with 3D printed implants on both the humeral and glenoid sides of Danjon’s shoulder. It’s an entirely innovative solution to a never-before-seen problem, but that’s exactly where 3D printing is most useful.

Today, almost a year since the surgery, Danjon is doing very well. Viard reports that most of her articular mobility has been regained, and she couldn’t be happier with the results. While it’s still too early to tell whether the bone is growing properly within the implant, Viard says, short and mid-term results are very promising.

Posted in 3D Printing Application

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