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Automatic segmentation of the mandible from computed tomography scans for 3D virtual surgical planning using the convolutional neural network. Physics in Medicine and Biology, 64(17), [175020].

An innovative procedure for the development of 3D patient-specific implants with drilling guides for acetabular fracture surgery is presented. By using CT data and 3D surgical planning software, a virtual model of the fractured pelvis was created. During this process the fracture was virtually reduced. Based on the reduced fracture model, patient-specific titanium plates including polyamide drilling guides were designed, 3D printed and milled for intra-operative use. One of the advantages of this procedure is that the personalised plates could be tailored to both the shape of the pelvis and the type of fracture. The optimal screw directions and sizes were predetermined in the 3D model. The virtual plan was translated towards the surgical procedure by using the surgical guides and patient-specific osteosynthesis. Besides the description of the newly developed multi-disciplinary workflow, a clinical case example is presented to demonstrate that this technique is feasible and promising for the operative treatment of complex acetabular fractures.

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The high surgical accuracy of an executed 3D virtual plan provides tumor margin control during ablative surgery and the possibility of planned combined use of osseus free flaps and dental implants in the reconstruction in one surgical procedure. A thorough understanding of the effects of radiotherapy on the reconstruction, soft tissue management, and prosthetic rehabilitation is imperative in individual cases when deciding to use dental implants in patients who received radiotherapy.

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Key Points Question What is the feasibility of using a personalized approach for reconstruction of complex fractures? Findings In this case series study, 10 patients with severe acetabular fractures were surgically treated using 3-dimensional (3-D) surgical planning, patient-specific osteosynthesis plates, and drilling guides. These were designed, produced, sterilized and clinically applied within 4 days and were associated with an accurate reconstruction of the fractured articular surface and a good 1-year clinical outcome. Meaning These findings suggest that 3-D virtual surgical planning, manufacturing, and clinical application of patient-specific osteosynthesis plates and drilling guides were feasible and yielded good clinical outcomes.