Pre-operative simulation using a three-dimensional printing model for surgical treatment of old and complex tibial plateau fractures

Abstract

To investigate the clinical efficacy of pre-operative simulation using a three-dimensional (3D) printing model for surgical treatment of old and complex tibial plateau fractures. Forty-two patients with old and complex tibial plateau fractures were retrospectively reviewed from January 2014 to January 2018, which were divided into a conventional planning group (n = 22) and a planning with 3D printing group (n = 20). In the planning with 3D printing group, preoperative equal-ratio fracture models prepared using the 3D printing technique were used to perform pre-operative simulation and guide the real surgical operation. In the conventional planning group, the operation was performed based on pre-operative computed tomography (CT) images. Surgery duration, blood loss and the number of fluoroscopy during operations were recorded. During follow-up, the quality of fracture reduction and complications were also recorded. Knee functions were evaluated using the hospital for special surgery (HSS) scoring system. The operation time, blood loss and the number of fluoroscopy during operation in the planning with 3D printing group were less than that in the conventional planning group (P < 0.01). All patients were followed up for mean of 24.38 ± 7.62 months. The rate of excellent fracture reduction in the planning with 3D printing group and conventional planning group was 75% and 45.45%, respectively (P = 0.05). The complication rate was 15% in the planning with 3D printing group and 31.82% in the conventional planning group. At the final follow-up evaluation, the mean HSS score was 86.05 ± 7.67 in the planning with 3D printing group and 79.09 ± 6.75 in the conventional planning group (P = 0.003). The rate of excellent results in the planning with 3D printing group was 70% and in the conventional planning group was 45.45% (P = 0.083). In conclusion, pre-operative simulation using a 3D printing model may be helpful for the treatment of old and complex tibial plateau fractures, which may be conducive to the pre-operative planning and to making the surgical procedure accurate and personalized. However, its clinical effectiveness need to be further assessed by a prospective randomized-controlled study. Complex tibial plateau fractures are mostly caused by high-energy injuries and are often accompanied with the collapse of the tibial plateau surface, displacement of the comminuted fragments and knee joint dislocation. If this type of fracture is not treated properly, complications such as postoperative wound infection, skin necrosis, joint deformity and traumatic arthritis are very likely to occur 1. If complex tibial plateau fractures develop into old fractures, they become more challenging for orthopedic surgeons to optimize the surgical procedures to improve the operation efficiency and to reduce postoperative complications 2. In general, for complex tibial plateau fractures, the surgical planning is mainly based on pre-operative X-ray and CT images. Although three-dimensional (3D)-CT can display the spatial position relations...

Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients

“…This technology was described in two of the included articles which also showed potential improvement in operation time, fracture reduction and patient outcome [18,25]. These studies, however, were pilot studies and, therefore, limited [24] 3D printed fracture models 34 38 85.2 ± 0.9 99.2 ± 1.0 < 0.001* Ozturk et al [27] 3D printed fracture models 10 10 89.5 ± 5.9 127 ± 14.5 < 0.05* Shen et al [29] 3D printed fracture models 20 22 127.3 ± 8.0 152.5 ± 29.6 0.001* Zhang et al [34] 3D virtual visualization 14 18 80.3 ± 4.8 90.7 ± 3 < 0.001*…”

“…Eventually, 22 articles were included for full-text screening of which two articles were excluded [14,15]. Twenty studies met the inclusion criteria of this systematic review [8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The review process is summarized in Fig.…”

“…Six studies reported on operation time [20,21,24,27,29,34], including one excellent quality, one good quality and 5 to −14.5) (Fig. 4).…”

Preoperative Placement of Rigid Markers for the Treatment of Tibial Fractures Using 3D Printed External Repositioning Model Combined With External Fixator

“…In recent years, 3D printing technology has been widely used in the eld of orthopaedic trauma, and this technology can transform two-dimensional images into solid models [15].3D images allow for more accurate pre-operative planning, simulation of surgery, and other operations, leading to a complete and personalized surgical plan [16,17].By creating a 3D model, the surgeon has a clearer understanding of the patient's fracture, which provides a basis for the selection and placement of xation and increases the likelihood of fracture reduction [18].Xie and Shen compared 3D printing with incisional internal xation in the treatment of tibial plateau fractures, and showed that 3D printing shortened operative time and fracture site healing time, and reduced operative bleeding [19,20].Ren, Jian et al tested a common plate and a new anatomically locked plate by 3D printing technology, respectively, and the newly designed xation material is stable and reliable, and more suitable for clinical application [21,22].However, there are no reports on the use of 3D printed fracture external repositioning models with preoperative placement of rigid markers.…”

The Use of Deep Learning and VR Technology in Film and Television Production From the Perspective of Audience Psychology

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