3D printing method for next-day acetabular fracture surgery using a surface filtering pipeline: feasibility and 1-year clinical results

Abstract

Introduction In orthopedic surgery, 3D printing is a technology with promising medical applications. Publications show promising results in acetabular fracture surgery over the last years using 3D printing. However, only little information about the workflow and circumstances of how to properly derive the 3D printed fracture model out of a CT scan is published. Materials and methods We conducted a retrospective analysis of patients with acetabular fractures in a level 1 trauma center. DICOM data were preoperatively used in a series of patients with acetabular fractures. The 3D mesh models were created using 3D Slicer (https://www.slicer.org) with a newly introduced surface filtering method. The models were printed using PLA material with FDM printer. After reduction in the printed model, the acetabular reconstruction plate was bent preoperatively and sterilized. A clinical follow-up after 12 months in average was conducted with the patients. Results In total, 12 patients included. Mean printing time was 8:40 h. The calculated mean printing time without applying the surface filter was 25:26 h. This concludes an average printing time reduction of 65%. Mean operation time was 3:16 h, and mean blood loss was 853 ml. Model creation time was about 11 min, and mean printing time of the 3D model was 8:40 h, preoperative model reduction time was 5 min on average, and preoperative bending of the plate took about 10 min. After 12 months, patients underwent a structured follow-up. Harris Hip Score was 75.7 points, the Modified Harris Hip Score 71.6 points and the Merle d’Aubigne Score 11.1 points on average. Conclusions We presented the first clinical practical technique to use 3D printing in acetabular fracture surgery. By introducing a new surface filtering pipeline, we reduced printing time and cost compared to the current literature and the state of the art. Low costs and easy handling of the 3D printing workflow make it usable in nearly every hospital setting for acetabular fracture surgery.

A Systematic Review and Meta-Analysis of 3D Printing Technology for the Treatment of Acetabular Fractures

“…In this review, few studies examined the time used for preoperative planning (e.g., printing time). Recent evidence suggests the benefits of developing a 3D printing workflow [ 66 , 67 ]. As such, more studies of this type are warranted.…”

Surgical Drill Guide for Insertion of an Infra-Acetabular Screw Based on an Anatomically Precontoured Plate System: A Cadaveric Study

“…We did not observe any deflection of the plate at level of the platedrill-guide interface leading to a mismatch or deviation of the drill. There is also a trend towards personalized [27,32,33]. Although this procedure is time consuming and costly, this may become the standard of care making a bending of the plate evitable.…”

“…There is also a trend towards personalized medicine. Several pilot studies have proven advantages of preoperative 3D model-based plate bending for acetabulum fractures [ 27 , 32 , 33 ]. Although this procedure is time consuming and costly, this may become the standard of care making a bending of the plate evitable.…”

Cerebrospinal fluid hemoglobin drives subarachnoid hemorrhage-related secondary brain injury

“…Based on the initial CT scan, the volume of the subarachnoid hematoma was manually delineated using 3DSlicer 4.11.0 (42) . The preprocessing prior to delineation consisted of brain extraction whereby the largest cavity from a 200 HU thresholded skull mask was extracted (43) . Subsequently, the brain mask was multiplied with the original CT scan and median filtered with a 5×5×3 kernel (Supplementary Fig.…”