Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis

Abstract

Purpose The systematic review aims to establish the value of using 3D printing-assisted pre-operative planning, compared to conventional planning, for the operative management of foot and ankle fractures. Methods The systematic review was performed according to PRISMA guidelines. Two authors performed searches on three electronic databases. Studies were included if they conformed to pre-established eligibility criteria. Primary outcome measures included intraoperative blood loss, operation duration, and fluoroscopy time. The American orthopaedic foot and ankle score (AOFAS) was used as a secondary outcome. Quality assessment was completed using the Cochrane RoB2 form and a meta-analysis was performed to assess heterogeneity. Results Five studies met the inclusion and exclusion criteria and were eventually included in the review. A meta-analysis established that using 3D printed models for pre-operative planning resulted in a significant reduction in operation duration (mean difference [MD] = − 23.52 min, 95% CI [− 39.31, − 7.74], p = 0.003), intraoperative blood loss (MD = − 30.59 mL, 95% CI [− 46.31, − 14.87], p = 0.0001), and number of times fluoroscopy was used (MD = − 3.20 times, 95% CI [− 4.69, − 1.72], p < 0.0001). Using 3D printed models also significantly increased AOFAS score results (MD = 2.24, 95% CI [0.69, 3.78], p = 0.005), demonstrating improved ankle health. Conclusion The systematic review provides promising evidence that 3D printing-assisted surgery significantly improves treatment for foot and ankle fractures in terms of operation duration, intraoperative blood loss, number of times fluoroscopy was used intraoperatively, and improved overall ankle health as measured by the AOFAS score.

Efficacy of Three-Dimensional Printing in the Management of Frontal Bone Trauma

“…Compatible, multiple previous studies by Wood and Ahmed. [15], Zheng et al [16], Dai et al [17], Yammine et al [18] reported that in several fracture procedures, the operating time was shortened using 3D printing for preoperative planning.…”

A Meta-Review about Medical 3D Printing

“…Procedures include orthopedic surgery [25, 57–77, 95–97]. More precisely foot and ankle fracture fixation [76], tibial plateau fracture surgery [73, 74], open reduction and internal fixation surgery [75, 97], fracture surgery [57, 60–65, 69, 71, 72, 74, 95, 96], treatment of pelvic ring injuries [70], osteotomy [58, 66], total hip and knee arthroplasty [67]. Quinones and colleagues mention [77] complex enbloc resections of primary vertebral tumors, complex cran-iocervical junction surgeries, spinal deformity correction surgeries, fracture-dislocations of the thoracic and lumbar spine, minimally invasive surgery, disc replacement surgery.…”

“…Table 1 shows 3DP for non-invasive applications. It was mostly used for pre-operative planning [2, 5, 10, 13, 15, 18, 19, 21, 22, 36, 39, 41, 43, 44, 46–48, 52–54, 56, 57, 60, 61, 63, 64, 67, 69–76, 78, 90, 92, 96, 97, 102, 103]. Other combinations found were pre-operative planning and teaching [3, 4, 7–9, 12, 14, 20, 24, 25, 28, 34, 35, 37, 38, 51, 55, 58, 62, 77, 79, 84, 86, 88, 104], pre-operative planning, teaching and patient counseling [6, 11, 42, 59, 83, 85, 89, 91, 93–95, 98, 99, 101, 105, 106], teaching[1, 29–33, 80–82], pre-opertive planning and patient counseling [40, 50, 65, 66, 87, 100] and patient counseling [68].…”

“…These authors followed the PRISMA guidelines [1, 3, 5–7, 9, 13–19, 22–26, 28, 30–37, 39–45, 47, 49–79, 81–92, 94–106], were registered [4, 14, 16, 40, 47, 51, 53–55, 60, 63, 70, 72, 73, 84, 88, 90, 91, 95, 98, 99] and did a bias assessment [4, 5, 7, 14–18, 23, 29–31, 33, 39–41, 49, 51, 53–57, 60–62, 65, 67, 69, 71, 72, 74–76, 78, 82–84, 86, 90, 96, 97, 99, 100].…”

Transparency films: intraoperative templating to prevent limb deformity

“…Well-described injury patterns may only require standard radiographs and hardware sets; more complex and challenging injuries may dictate advanced imaging, fragment-specific hardware, and employment of digital planning software, 3D virtual or physical models to better assess and plan fracture fixation. [5][6][7] Together these form a comprehensive surgical plan that requires a step-by-step checklist to be executed in the operating room. 1,8 However, intraoperative modifications must be anticipated, as soft tissues, patient osseous anatomy and fracture comminution may affect the implementation of the preoperative plan, requiring alternate back-up plans.…”