My Story, My Dream
By Tsuyoshi Murase, MD
There are not many recent changes to the field of hand surgery of which I am not a fan. Instead, I will talk about a fairly recent technological advancement that has motivated me greatly.
Twenty years ago, as a young hand surgeon, I was treating a large number of cases on a daily basis at one of the leading hospitals in western Japan. One day, a teenager was referred to me. He had received conservative treatment from his previous physician for a diaphyseal fracture of the radius. Radiographs showed a typical malunion, and he complained of restriction of forearm supination. I performed corrective osteotomy. After the correction was confirmed several times during the operation by fluoroscopy, the plate was applied. Postoperative radiographs showed no apparent problems.
However, when the postoperative range of motion was measured, there was no improvement at all and I was shocked. What was wrong? Was it a rotational deformity, a slight angular deformity, or a length discrepancy that could not be detected with the radiographs?
This was a problem that could not be solved merely by being skilled in the operative procedure, and I realized that a technological breakthrough was required.
Subsequently, I began working at the university hospital. At that time, I became involved in research on three-dimensional evaluation of joint kinematics with data from computed tomography and magnetic resonance imaging. After some time, I wanted to use this technology more directly in surgery; however, my question was: if accurate anatomical correction is possible through the use of three-dimensional technology, will the clinical result be greatly improved?
My team and I worked on the development of theory and software technology to efficiently simulate accurate three-dimensional correction of malunion deformities. In addition, we devised a method to use a custom-made osteotomy guide that accurately fitted each bone shape. The guide was manufactured using a three-dimensional printer and was used to replicate the preoperative simulation in the actual operation. With this technological breakthrough, I performed a corrective osteotomy on a boy with a malunion of a radial shaft fracture, that was similar to my previous patient. Although there was an apparent angular deformity on a plain radiograph, a simple rotational correction on an oblique osteotomy plane was successfully performed with a custom guide. The postoperative result was excellent.
Eventually, I was able to obtain large public grants, hire a dedicated computer engineer, and work with companies to commercialize this method. A series of our works were published in academic journals, including JHS and JBJS, and public health insurance was applicable in Japan after a clinical trial.
To be honest, it is still difficult to make a profit with this method as a business. However, as a doctor, I was fortunate enough to be able to develop a new technology-based treatment that gave hope to patients who could not be helped through conventional surgical methods.
I was able to gain this valuable experience because I had clinical questions on a daily practice and had an opportunity to be in an environment where I could be exposed to advanced technology.
“The goal is to connect our daily medical needs with constantly advancing technological seeds.” I dream that young surgeons with such ideas will grow and open up the future of hand surgery.