Application of 3D printing rapid prototyping-assisted percutaneous fixation in the treatment of intertrochanteric fracture

Abstract

The aim of the present study was to investigate the application of 3D printing (3DP) rapid prototyping (RP) technique-assisted percutaneous fixation in the treatment of femoral intertrochanteric fracture (ITF) using proximal femoral nail anti-rotation (PFNA). A total of 39 patients with unstable ITF were included in the current study. Patients were divided into two groups: 19 patients were examined using computed tomography scanning and underwent PFNA with SDP-RP whereas the other 20 patients underwent conventional PFNA treatment. Anatomical data were converted from the Digital Imaging and Communications in Medicine format to the stereolithography format using M3D software. The 3DP-RP model was established using the fused deposition modeling technique and the length and diameter of the main screw blade was measured during the simulation. The postoperative femoral neck-shaft angle (NSA), surgery duration, intraoperative and postoperative blood loss, and the duration of hospital stay were recorded and compared with the corresponding values in conventional surgery. No significant differences were observed in mean PFNA size between the implants used and the preoperative planning estimates. It was demonstrated that the 3DP-RP assisted procedure resulted in more effective reduction of the NSA. Furthermore, patients undergoing 3DP-RP experienced a significant reduction in duration of surgery (P<0.01), as well as reductions in intraoperative (P=0.02) and postoperative (P=0.03) blood loss, compared with conventional surgery. At 6 months post-surgery, no cases of hip varus/vague deformities or implant failure were observed in patients that underwent either the 3DP-RP-assisted or conventional procedure. The results of the present study suggest that the 3DP-RP technique is able to create an accurate model of the ITF, which facilitates surgical planning and fracture reduction, thus improving the efficiency of PFNA surgery for ITFs.

Three‐dimensional printing in orthopaedic preoperative planning improves intraoperative metrics: a systematic review

“…Across the board, the case–control studies showed that using 3D printed models as a part of the perioperative plan showed consistent improvements in intraoperative metrics but did not significantly affect the surgical outcome. All studies which measured operating time showed a clinically significant if not statistically significant reduction in operating time compared to the control cohorts . In the studies which measured blood loss volume and fluoroscopy time, the results were similar, with most finding statistically significant reductions in these metrics (two studies showed similar levels of intraoperative blood loss).…”

“…Two studies found a slight improvement in post‐operative results but neither was statistically significant. Length of hospital stay was investigated in two studies which found no significant difference between groups, although Zheng et al . found a statistically significant reduction in time to ambulation of 2 days in the group using 3D printed models for preoperative planning.…”

“…The case-control studies [6][7][8][9][10][11][12][13][14][15][16] focused on objective measures of benefit when using 3D printed models during the preoperative phase of the procedures. The workflow to create the model was very similar in all studies, with the patient's medical image data processed in segmentation software prior to printing on a 3D printer.…”

“…The sample sizes of these studies were insufficient to provide statistical significance to some of their results . While the papers managed to demonstrate that the intraoperative benefits were significant, the surgical outcomes were insufficiently powered to demonstrate any surgical improvement or decrease in complication rate .…”

“…A comprehensive cost–benefit analysis of 3D printing in orthopaedic surgery is yet to be established and will vary between intended application, health systems and countries. The workflow from medical image to the completed model can take upward of 50 h depending on the size of the model and 3D printing technology utilized . The time required for the current workflow also makes the technology unsuitable for emergency procedures requiring urgent intervention .…”