How 3D is Transforming Pediatric Orthopedic Surgery

For decades, orthopedic surgeons relied on two-dimensional X-rays to repair three-dimensional problems. While effective for simple broken bones, this traditional approach can be like trying to solve a Rubik’s Cube while only looking at one side.

New technology is changing pediatric limb reconstruction.

A January 2026 article published in Orthopedic Clinics showed how a Yale team can create a precise virtual replica of a child’s bone, map out the surgery virtually, and use custom-printed tools to execute the plan with unprecedented precision thanks to advances in 3D planning and patient-specific instrumentation.

Children present a unique challenge in orthopaedics. Their bones are still growing, and their joints are governed by delicate growth plates. Damaging these areas during surgery can lead to lifelong complications.

"Digital modeling allows us to see the hidden complexities of a child's anatomy," says David Frumberg, MD, associate professor of orthopaedics and rehabilitation at Yale School of Medicine and the study's principal investigator. “The process involves taking high-resolution CT scans and converting them into digital 3D models. We can then determine the best way to perform surgery on a computer multiple times before the patient even enters the operating room.”

This enables orthopedic surgeons to find the best angle in an osteotomy, for example, a procedure where a bone is cut and reshaped to correct a deformity.

Once a virtual plan is perfected, engineers use medical-grade 3D printers to create patient-specific instrumentation. These are custom surgical guides designed to precisely fit onto a specific patient’s bone.

These guides tell the surgeon exactly where to cut and where to place screws, removing guesswork and margins for error that can come with freehand techniques.

According to Frumberg, research shows that this level of accuracy leads to:

• Shorter operative times: In some cases, surgery time was cut in half because the major decisions were made during the planning phase.
• Less radiation: Because the guides provide a roadmap, surgeons need fewer intra-operative X-rays to check their work.
• Better outcomes: Custom guides help ensure that the limb is aligned perfectly, which is critical for long-term joint health.

The power of this technology is best seen in complex cases where standard methods might not be enough. The case documented by Frumberg and his team in the paper highlights a 13-year-old boy with a severe deformity in his lower tibia caused by a rare medical condition.

“Traditional options for surgical correction might have otherwise required fusing his ankle joint—a move that would stop the pain but severely limit his mobility,” Frumberg says. “Instead, we used 3D planning to create a joint-preserving strategy. By using 3D-printed guides, we were able to reshape the inside of the ankle joint and restore its natural alignment. As a result, the young patient regained mobility and returned to the activities he loved.”

Having a pre-printed "step-by-step" visual guide helps the entire surgical team stays in sync, making the procedure safer and more predictable, says Frumberg. Beyond the clinical results, he adds, studies also suggest that reducing time in the operating room can save thousands of dollars per case.

While 3D printing in medicine began with simple plastic models, it has evolved into a sophisticated multidisciplinary field. At leading institutions like Yale, surgeons and engineers work side-by-side and in new ways to solve the toughest cases.

“As the technology becomes more accessible, it is expected to move from a specialized tool for complex deformities to a standard of care for many orthopedic procedures,” Frumberg says. “The goal of using 3D surgical planning is simple: improving the lives of children through better technology. More broadly speaking, it means a surgery is less about ‘one size fits all’ and more about a custom-tailored path to an individual’s recovery.”