3D Printed replica of articular fractures for surgical planning and patient consent: a two years multi-centric experience (original) (raw)
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Value of three-dimensional printing of fractures in orthopaedic trauma surgery
Journal of International Medical Research, 2019
Information technology-based innovation is playing an increasingly key role in healthcare systems. The use of three-dimensional (3D)-printed bone fracture replicas in orthopaedic clinical practice could provide a new tool for fracture simulations and treatment, and change the interaction between patient and surgeon. We investigated the additional value of 3D-printing in the preparation and execution of surgical procedures and communication with patients, as well as its teaching and economic implications. Methods: Fifty-two patients with complex articular displaced fractures of the calcaneus, tibial plateau, or distal radius were enrolled. 3D-printed real-size models of the fractured bone were obtained from computed tomography scans and exported to files suitable for 3D-printing. The models were handled by trauma surgeons, residents, and patients to investigate the potential advantages and procedural improvements. The patients' and surgeons' findings were recorded using specific questionnaires. Results: 3D-printed replicas of articular fractures facilitated surgical planning and preoperative simulations, as well as training and teaching activities. They also strengthening the informed consent process and reduced surgical times and costs by about 15%. Conclusion: 3D-printed models of bone fractures represent a significant step towards morepersonalized medicine, with improved education and surgeon-patient relationships.
2018
Treating complex fractures or deformities has been a challenge, especially those involving articular surfaces, such as acetabulum, tibial plateau, distal radius and the ankle joints. Fractures of these parts require anatomical reductions to restore the articular surface of the joint for good and long-term function and for a better quality of life. Even an experienced surgeon who’ve performed many similar surgical procedures still needs a precisely designed preoperative plan when facing such cases. Conventional imaging like X-ray and computed tomography (CT) scan have their own limits in providing detailed information about the affected bones and unable to carry out measurements which are necessary for the pre-operative planning. However, with the help of 3D printing technique, surgeons can use a real-size physical model of the fractured bone to make diagnoses; to improve their understanding of the nature of complex fractures; and to simulate the surgical procedure on it directly. In...
Journal of Investigative Surgery
Calcaneal fractures are amongst the most complex injuries known to man. Their intricate anatomy and extensive damage after trauma make them difficult to understand and treat. Most surgeons specialized in foot and ankle trauma agree that in most patients surgical managements yields the best result. Functional outcome is largely dependent on preventing complications and restoring anatomy. Reconstruction of height and suntalar joint congruency for example are both associated with improved outcome. Over the years insight in the complex (patho-)anatomy has increased. First by conventional radiographs, later with computed tomography. Recently 3D scans and prints have been added to this armamentarium. The study in the current issue of the Journal of Investigative Surgery explores the use of 3D printed calcaneal fractures and the effect on restoring anatomy and functional outcome. An invited short commentary was provided.
3D Printing Applications in Orthopaedic Surgery: Clinical Experience and Opportunities
Applied Sciences
Background: Three-dimensional (3D) printing is a technology capable of creating solid objects based on the reproduction of computerised images. This technology offers revolutionary impacts on surgical practice, especially in prosthetic and traumatological surgery. Methods: 20 patients with proximal humeral fractures were divided into two groups, one of which involved the processing of a 3D model. The model made it possible to plan the positioning and dimensions of the implants. The results were then compared with those obtained according to the usual procedures. We also reported the irreparable case of a custom revision implants acetabular bone loss treated with a 3D-printed, custom-made implant. Results: In the processed 3D proximal humeral fracture series, in the face of time and costs expenses, surgical and X-ray times were shorter than in the control group. On the other hand, there were no differences in terms of blood loss. The patient who underwent acetabular re-prosthetic sur...
The Value of 3D Printed Models in Understanding Acetabular Fractures
3D Printing and Additive Manufacturing
Acetabular fractures are complex and difficult to classify. Although the Judet-Letournel classification is designed to increase the understanding of acetabular fractures, it remains prone to error when using conventional medical imaging. We hypothesize that three-dimensional (3D) printing, as a new diagnostic imaging tool, will lead to an increased understanding and knowledge of acetabular fractures and an optimal surgical approach. Digital data (DICOM) of 20 acetabular fractures were converted into 3D files [standard tessellation language (STL) data]. These STL files were used to prepare 3D prints of life-size hemipelvic models with acetabular fractures. Seven senior trauma surgeons specializing in pelvic and acetabular surgery, 5 young fellowshiptrained trauma surgeons, 5 senior surgical residents, 5 junior surgical residents, and 5 interns classified 20 acetabular cases using X-ray/two-dimensional (2D) computed tomography (CT), 3D reconstructions, and 3D printed models according to the Judet-Letournel classification. Furthermore, all junior and senior surgeons were instructed to evaluate their surgical approach and the positioning of the patient during operation. Time to classify each case was recorded. Calculations were done using Fleiss' j statistics. Only slight and fair interobserver agreements for senior surgeons (j = 0.33) and interns (j = 0.16) were found when using X-ray/2D CT. However, 3D printed models showed moderate and substantial interobserver agreements for senior surgeons (j = 0.59), junior surgeons (j = 0.56), senior surgical residents (j = 0.66), junior surgical residents (j = 0.51), and interns (j = 0.61). Compared with X-ray/2D CT, the interobserver agreement regarding the surgical approach for junior surgeons using 3D printed models increased by j = 0.04 and j = 0.23, respectively. Except for the interns, a significant time difference for classification was found between X-ray/2D CT and 3D CT and 3D printed models for junior and senior surgical residents and junior and senior surgeons (p < 0.001). 3D printing is of added value in the understanding, classification, and surgical evaluation of acetabular fractures. We recommend the implementation of 3D printed models in trauma surgery training.
3D printing: clinical applications in orthopaedics and traumatology
EFORT open reviews, 2016
Advances in image processing have led to the clinical use of 3D printing technology, giving the surgeon a realistic physical model of the anatomy upon which he or she will operate.Relying on CT images, the surgeon creates a virtual 3D model of the target anatomy from a series of bi-dimensional images, translating the information contained in CT images into a more usable format.3D printed models can play a central role in surgical planning and in the training of novice surgeons, as well as reducing the rate of re-operation. Cite this article: Auricchio F, Marconi S. 3D printing: clinical applications in orthopaedics and traumatology. EFORT Open Rev 2016;1:121-127. DOI: 10.1302/2058-5241.1.000012.
Comparison of 3D printed anatomical model qualities in acetabular fracture representation
Annals of Translational Medicine
Background: Acetabular fractures account for 10% of pelvis injuries, which are especially difficult to treat in developing countries with less access to resources. 3D printing has previously been shown to be a beneficial method of surgical planning, however the steep initial costs associated with purchasing a 3D printer may prevent some facilities form utilizing this technique. The purpose of this study was to develop 3D printed models for acetabular surgery using methodologies of varying cost to determine differences in model accuracy and overall quality. Methods: Five acetabular fracture models were developed from de-identified CT data using (I) proprietary and open-source segmentation software and (II) fused deposition modeling (FDM) and stereolithography (SLA) 3D printing methods. The distance between the posterior inferior iliac spine (PIIS) and the ischial spine as well as a unique fracture fragment for each model was compared between the different printing methodologies. The models were then given to 5 physicians and assessed on their overall accuracy compared to traditional 2D images. Results: Printing methodology did not affect the distance from PIIS to ischial spine (P=0.263). However, fracture fragment representation differed across 3D printed models, with the most accurate model produced by the high-end resin-based printer (P=0.007). The survey analysis showed that the low-cost printing methods produced models that were not as accurate in their representation of the fractured region (P=0.008). Conclusions: The differences between models developed using traditional methods and low-cost methods have slight differences but may still provide useful information when developing a surgical plan.
Techniques in Orthopaedics, 2016
Three-dimensional printing and modeling has evolved significantly since first introduced in the 1980s. In the last 5 years, this revolution in technology has become far more accessible and affordable, and is already mainstream in many areas of medicine. Nowhere is this more apparent than in orthopedics, and many surgeons already incorporate aspects of 3D modeling and virtual procedures in their routine clinical practice. However, this technology promises to become even more prevalent as creative applications continue to be developed, and further innovations are certain to come. There are important public policy aspects to consider, both economic and regulatory. Regulatory issues are currently still under development, but will need to take into account sterilization, quality assurance, and product liability. The mechanical integrity of 3D-printed implants is influenced by the unique characteristics of the print process, including the energy density of the laser, the resolution of the print, and the orientation of the print on the build platform. Introduction of expensive new technology should only be done after careful consideration of the costs associated, the potential benefits, and the value that can be derived. The value in 3D modeling and printing can be considered relative to the initial costs, the experience of a 3D modeling unit, the complexity of a particular case, and the clinical expertise of the surgeons involved. There is significant potential value derived from modeling most displaced intraarticular fractures, once a 3D modeling unit is established and proficient. However, the greatest value comes from modeling the most highly complex cases. When the pathology is most abnormal, 3D modeling/printing can be a valuable clinical adjunct for even the most expert and experienced surgeons. Although currently hospital-based 3D modeling/printing units are uncommon, they will soon become far more common. For surgeons in developing nations, 3D printing may currently be prohibitively expensive, but 3D modeling is relatively inexpensive and therefore far more accessible. As 3D printer prices continue to fall, the ability to rapidly manufacture prototypes and patient-specific models will inevitably spread through these regions as well. However, the future for 3D-printed medical models, devices, and implants will be limited unless we are able to document their clinical superiority and confirm their value with respect to patient outcomes. Level of Evidence: Level V-expert opinion.
Role of 3D printing in the management of complex acetabular fractures: a comparative study
European Journal of Trauma and Emergency Surgery, 2020
The aim of this study is to assess the role of 3D printing of actual size pelvis in the management and outcome of acetabular fractures. Methods Retrospective study with inclusion of acetabular fractures which were divided into two groups (traditional and 3D printing) was done over a 1 year period. The indices for comparison of both groups in this study were (a) operative time (from skin incision to suture), (b) intraoperative blood loss (noted from the anaesthetist notes), (c) times of intraoperative fluoroscopy, (d) postoperative complications, (e) quality of fracture reduction (good = < 2 mm displacement, fair = > 2 mm displacement) and (f) Harris hip score at final follow-up. Results 27 cases (traditional group = 15, 3D printing group = 12) meeting the study criteria were included in the study with a mean follow-up of 26.3 ± 11.2 months. There was a significant difference in the operative time, intraoperative blood loss and number of intraoperative fluoroscopy images. The mean operative time was shorter in the 3D printing group by 62 min. No difference was noted in the quality of reduction in either of the groups (p > 0.05). Conclusion 3D imaging and printing helps in better understanding of the anatomy of acetabular fractures. It leads to reduced operative time, blood loss as well as exposure to radiation intraoperatively. There is no difference in functional outcome at final follow-up between 3D printing and traditional groups.
2020
Background: Tibial plateau fracture is one of the common intra-articular fractures in clinic. And its accurate classification and treatment is a difficult problem for orthopedic surgeons. Our research aims to investigate the application value of 3D printing in the classification and preoperative planning of complex tibial plateau fractures.Methods: 28 cases of complex tibial plateau fractures diagnosed and treated in our hospital from January, 2017 to January, 2019.01 were analyzed. Preoperative spiral CT scan was performed and then DICOM data were input into the computer. We use Mimics to process data. And 3D printing technology was applied to print the 3D model of fracture (1:1). Combined with the 3D printed model, the tibial plateau fractures were subdivided into seven types according to the geometric plane of the tibial plateau. The surgical approach was determined on the 3D printed model. And then simulated operations such as accurate reduction of fracture and selection of plat...