Use of a real-size 3D-printed model as a preoperative and intraoperative tool for minimally invasive plating of comminuted midshaft clavicle fractures

Abstract

BackgroundOpen reduction and plate fixation is the standard operative treatment for displaced midshaft clavicle fracture. However, sometimes it is difficult to achieve anatomic reduction by open reduction technique in cases with comminution.MethodsWe describe a novel technique using a real-size three dimensionally (3D)-printed clavicle model as a preoperative and intraoperative tool for minimally invasive plating of displaced comminuted midshaft clavicle fractures. A computed tomography (CT) scan is taken of both clavicles in patients with a unilateral displaced comminuted midshaft clavicle fracture. Both clavicles are 3D printed into a real-size clavicle model. Using the mirror imaging technique, the uninjured side clavicle is 3D printed into the opposite side model to produce a suitable replica of the fractured side clavicle pre-injury.ResultsThe 3D-printed fractured clavicle model allows the surgeon to observe and manipulate accurate anatomical replicas of the fractured bone to assist in fracture reduction prior to surgery. The 3D-printed uninjured clavicle model can be utilized as a template to select the anatomically precontoured locking plate which best fits the model. The plate can be inserted through a small incision and fixed with locking screws without exposing the fracture site. Seven comminuted clavicle fractures treated with this technique achieved good bone union.ConclusionsThis technique can be used for a unilateral displaced comminuted midshaft clavicle fracture when it is difficult to achieve anatomic reduction by open reduction technique.Level of evidence V.

The Feasibility of 3D Printing Technology on the Treatment of Pilon Fracture and Its Effect on Doctor-Patient Communication

“…Therefore, the surgeon can accurately make surgical plans and simulate the surgical procedures before the procedure, which can highly increase the accuracy of reduction and the stability of the fixation [ 21 ]. The 3D printing also was used in ankle fractures and clavicular fractures, which showed its unique advantages, reducing the operation time, intraoperative blood loss, and the plasticity of plate [ 22 , 23 ].…”

The precision and reliability evaluation of 3-dimensional printed damaged bone and prosthesis models by stereo lithography appearance

“…The application of 3D printing technology in medicine provides a new way to solve the problem. However, with the wide application of the 3D printed models, [ 9 , 11 , 13 – 16 , 18 , 19 ] the precision and reliability of model have also been questioned. Previous studies have reported on CT image dimensional errors ranging from 0.9 to 2.16% [ 12 ] ; when images are converted to STL format, the surface of the model is converted into a large number of refined triangles that can improve the quality of image and add precision to the image-reslicing algorithm.…”

Surgical applications of three-dimensional printing: a review of the current literature & how to get started

“…In orthopedic surgery, published examples of pre-shaping titanium plates with anatomic models include use of a calcaneus model in planning for calcaneal fracture reduction (83) and clavicular models for clavicle fracture reduction (84,85).…”