Accuracy of Patient-Specific Drilling Guides in Acetabular Fracture Surgery: A Human Cadaver Study

Meesters, Anne M. L.; Assink, Nick; Duis, Kaj ten; Fennema, Eelco M; Kraeima, Joep; Witjes, Max J. H.; Vries, Jean‐Paul P.M. de; Stirler, Vincent; IJpma, Frank F. A.

doi:10.3390/jpm11080763

Cited by 8 publications

(9 citation statements)

References 32 publications

(34 reference statements)

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“…Patient-specific drilling guides can be used as an adjunct to conventional implants in acetabular fracture surgery, to translate the virtual surgical planning to the operation. The use of patient-specific guides allows for the accurate placement of column screws [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Entry Point Variation in the Osseous Fixation Pathway of the Anterior Column of the Pelvis—A Three-Dimensional Analysis

Dupuis

Ginkel

Verhamme

et al. 2022

JPM

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Fractures of the superior pubic ramus can be treated with screw insertion into the osseous fixation pathway (OFP) of the anterior column (AC). The entry point determines whether the screw exits the OFP prematurely. This can be harmful when it enters the hip joint or damages soft tissues inside the lesser pelvis. The exact entry point varies between patients and can be difficult to ascertain on fluoroscopy during surgery. The aim of this study was to determine variation in the location of the entry point. A retrospective single center study was performed at a level 1 trauma center in the Netherlands. Nineteen adult patients were included with an undisplaced fracture of the superior pubic ramus on computer tomography (CT)-scan. Virtual three-dimensional (3D) models of the pelvises were created. Multiple screws were placed per AC and the models were superimposed. A total of 157 screws were placed, of which 109 did not exit the OFP prematurely. A universally reproducible entry point could not be identified. A typical crescent shaped region of entry points did exist and was located more laterally in females when compared to males. Three-dimensional virtual surgery planning can be helpful to identify the ideal entry points in each case.

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Section: Discussionmentioning

confidence: 99%

Entry Point Variation in the Osseous Fixation Pathway of the Anterior Column of the Pelvis—A Three-Dimensional Analysis

Dupuis

Ginkel

Verhamme

et al. 2022

JPM

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“…It could be caused by the interference of residual soft tissue. Meesters et al [19] conducted a cadaveric study with 3D-printed drill guides for 4.5 mm posterior column screw. He found that the deviation of its entry point is ranging from 2 mm to 5 mm.…”

Section: Clinical Discussionmentioning

confidence: 99%

The use of a 3D-printed personalised drill guide for posterior column lag screw fixation in displaced transverse acetabular fracture: A case report

Phuoc

Hoang

2021

International Journal of Surgery Case Reports

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Introduction and importance Anterior column plate combined with posterior column screws have been effectively used for treatment of displaced transverse acetabular fractures. This article presents the use of 3D-printed technology for customising a guide template to appropriately place posterior column screw. Case presentation A 50-year-old female suffered displaced juxtatectal fracture of the right acetabulum. A personalised guide for antegrade posterior column screw placement was designed based on the data of her pelvic CT-scan. This guide and a prototype of her right acetabulum - created by mirroring the intact left acetabulum - were 3D-printed for preoperative evaluation and pre-contouring of reconstruction plate. Modified Stoppa approach and additional lateral window were used for direct reduction, anterior column plate and posterior column lag screw fixation. Post-operative CT-scan showed good reduction and nearly ideal screw position. Clinical discussion Anterior column plate and antegrade posterior column screw could provide joint stability and early mobilisation for displaced transverse acetabular fractures. However, determination of optimal entry point, direction and length for screw insertion is still technically demanding. The 3-D reconstruction images of hemipelvic specimen allowed us to identify the safe bone corridor, design a drill guide to put the proper guide pin and conduct preoperative trial. All those resulted in appropriate real screw fixation with reduction of soft tissue damage, X-ray exposure and time of operation. Conclusion The use of 3D-printed personalised guide for posterior column screw fixation is a promising alternative option for treatment of displaced transverse acetabular fracture where 3D-navigation system is not available.

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“…9 Recently, we developed an innovative workflow for the clinical application of 3D-printed drilling guides which envelop conventional 'off-the-shelf' implants to aim the screws in the predetermined directions. 9 This personalized surgical approach enabled execution of the preoperative plan and helped to attain predetermined osteosynthesis plate and screw positions. In this study, our concept of surgical guides will be applied in combination with VA-LCP proximal tibia plates, potentially ensuring optimal screw placement.…”

Section: Introductionmentioning

confidence: 99%

3D surgical planning including patient-specific drilling guides for tibial plateau fractures

Assink,

ten Duis,

de Vries

et al. 2024

Bone Jt Open

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AimsProper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery.MethodsA prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group.ResultsA total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026).ConclusionThe use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort.Cite this article: Bone Jt Open 2024;5(1):46–52.

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Accuracy of Patient-Specific Drilling Guides in Acetabular Fracture Surgery: A Human Cadaver Study

Cited by 8 publications

References 32 publications

Entry Point Variation in the Osseous Fixation Pathway of the Anterior Column of the Pelvis—A Three-Dimensional Analysis

Entry Point Variation in the Osseous Fixation Pathway of the Anterior Column of the Pelvis—A Three-Dimensional Analysis

The use of a 3D-printed personalised drill guide for posterior column lag screw fixation in displaced transverse acetabular fracture: A case report

3D surgical planning including patient-specific drilling guides for tibial plateau fractures

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