Can Preoperative 3D Printing Change Surgeon’s Operative Plan for Distal Tibia Fracture?

Abstract

This study aimed to determine if 3D printing can affect surgeon’s selection of plate for distal tibia fracture surgery and to find out whether orthopedic surgeons consider this technology necessary and would use it in their practice. A total of 102 orthopedic surgeons were asked to choose anatomically contoured locking plates among 5 most commonly used types for one simple and one complex distal tibia fracture based on X-ray and CT images. Next, they were provided real-size 3D printed models of the same fractures, allowed to apply each of the 5 plates to these models, and asked if they would change their choice of plate. A 10-point numeric rating scale was provided to measure the extent of the help that 3D printing provided on preoperative planning. Finally, we asked the surgeons if they would use 3D printing in their practice. Seventy-four percent of inexperienced surgeons changed their selection of plate after using 3D printed models for the complex fracture. In contrast, only 9% of experienced surgeons changed their selection of plate for the simple fracture. Surgeons rated the extent of usefulness of the 3D models in preoperative planning as a mean of 4.84 ± 2.54 points for the simple fracture and 6.63 ± 2.54 points for the complex fracture. The difference was significant (p < 0.001). Eighty-six percent of inexperienced surgeons wanted to use 3D models for complex fractures. However, only 18% of experienced surgeons wanted to use 3D printed models for simple fractures. The use of a real-size 3D-printed model often changed surgeon’s preoperative selection of locking plates, especially when inexperienced surgeons evaluated a complex fracture. However, experienced surgeons did not find 3D models very useful when assessing simple fractures. Future applications of 3D models should focus on training beginners in fracture surgery, especially when complex fractures are concerned.

Application of 3D Printing in Preoperative Planning

“…One study demonstrated the benefit of 3D-printed models in optimizing the surgical approach for distal tibial fractures. They reported 74% of inexperienced surgeons altered their initial plate selection for distal tibial fracture surgery upon receiving a 3D-printed model of their patient’s anatomy; 9% of experienced surgeons switched plate selection [ 48 ]. Orthopedic applications of 3D printing also include the creation of oncologic models for tumor resection; these can facilitate tumor resection and accurately replicate the lesion of interest along with surrounding anatomy.…”

Three-dimensional Printing in Orthopaedic Surgery: Current Applications and Future Developments

“… 15 , 16 When more than 100 orthopaedic surgeons were asked to choose a locking plate for a complex tibial fracture after looking at radiograph and CT imaging or a 3D-printed model, surgeons classified as inexperienced, having operated on fewer than 15 similar fractures, changed their preoperative plan over 70% of the time after using the 3D model. 17 Although experienced surgeons did not change their selection as frequently, more than 70% supported the use of 3D models in their practice if they were available. 17 In addition to aiding in hardware selection, 3D models allow for prebending of selected plates before surgery.…”

“… 17 Although experienced surgeons did not change their selection as frequently, more than 70% supported the use of 3D models in their practice if they were available. 17 In addition to aiding in hardware selection, 3D models allow for prebending of selected plates before surgery. This technique permits the plate to fit the individual anatomy of patients to facilitate accurate reduction and has shown promise in the treatment of clavicle fractures.…”

From Patient to Procedure: The Process of Creating a Custom 3D-Printed Medical Device for Foot and Ankle Pathology

“…It becomes possible to see and feel what will be encountered in the operating room, which aids in hardware selection and allows prebending of hardware to optimize fit. 2 For example, in the treatment of clavicle fractures, these 3D printed models can be used to fit the plate to the patient's individual anatomy and facilitate a more accurate reduction. 3 Within hip and knee arthroplasty, this technology has introduced several new implant types.…”