Clinical outcomes of the use of 3D printing models in fracture management: a meta-analysis of randomized studies

Yammine, Kaissar; Karbala, Jad; Maalouf, Anthony; Daher, Jimmy; Assi, Chahine

doi:10.1007/s00068-021-01758-1

Cited by 17 publications

(25 citation statements)

References 25 publications

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“…The results of the present review are consistent with existing literature; when investigating its use in acetabular fractures, a recent systematic review identified that 3D printing for pre-operative planning significantly improved surgery in terms of surgical time, blood loss, quality of reduction and clinical outcomes [23]. These results are echoed in further reviews exploring various fracture types [26,28,29,39].…”

Section: Discussionsupporting

confidence: 87%

Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis

Wood

Ahmed

2022

Eur J Trauma Emerg Surg

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Purpose The systematic review aims to establish the value of using 3D printing-assisted pre-operative planning, compared to conventional planning, for the operative management of foot and ankle fractures. Methods The systematic review was performed according to PRISMA guidelines. Two authors performed searches on three electronic databases. Studies were included if they conformed to pre-established eligibility criteria. Primary outcome measures included intraoperative blood loss, operation duration, and fluoroscopy time. The American orthopaedic foot and ankle score (AOFAS) was used as a secondary outcome. Quality assessment was completed using the Cochrane RoB2 form and a meta-analysis was performed to assess heterogeneity. Results Five studies met the inclusion and exclusion criteria and were eventually included in the review. A meta-analysis established that using 3D printed models for pre-operative planning resulted in a significant reduction in operation duration (mean difference [MD] = − 23.52 min, 95% CI [− 39.31, − 7.74], p = 0.003), intraoperative blood loss (MD = − 30.59 mL, 95% CI [− 46.31, − 14.87], p = 0.0001), and number of times fluoroscopy was used (MD = − 3.20 times, 95% CI [− 4.69, − 1.72], p < 0.0001). Using 3D printed models also significantly increased AOFAS score results (MD = 2.24, 95% CI [0.69, 3.78], p = 0.005), demonstrating improved ankle health. Conclusion The systematic review provides promising evidence that 3D printing-assisted surgery significantly improves treatment for foot and ankle fractures in terms of operation duration, intraoperative blood loss, number of times fluoroscopy was used intraoperatively, and improved overall ankle health as measured by the AOFAS score.

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Section: Discussionsupporting

confidence: 87%

Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis

Wood

Ahmed

2022

Eur J Trauma Emerg Surg

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“…The positive effects of 3D planning and surgical guides on patients’ outcome in orthopaedic trauma care have been previously described. 7,17 The 3D workflow as described in the current study requires some efforts including segmentation of the bone fragments, virtual fracture reduction, planning of the implants and screws, and finally the design of the surgical guides. Therefore, it requires several multidisciplinary moments in which the (3D) surgical plan is discussed before surgery, potentially leading to an improved understanding of the fracture morphology and treatment strategy.…”

Section: Discussionmentioning

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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“…The existing works on 3D printing fracture plates can be largely divided into tactile modeling and mirroring of the normal contralateral bone. Recent reports of tactile modeling techniques have involved real-size 3D printing of the fractured bone for pre-practicing of the surgery and pre-contouring of the plate [ 22 , 23 , 24 ]. Although tactile modeling reduces intraoperative time, blood loss, and fluoroscopies [ 25 ], the overall procedure still entails manual reduction of the tactile model and bending and twisting of the plate by the operator.…”

Section: Discussionmentioning

confidence: 99%

Does a Customized 3D Printing Plate Based on Virtual Reduction Facilitate the Restoration of Original Anatomy in Fractures?

Shin

Kim²,

Yoon³

et al. 2022

JPM

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The purpose of this study was to evaluate the restoration of original anatomy after fixation of sawbone fractures using case-specific 3D printing plates based on virtual reduction (VR). Three-dimensional models of 28 tibia sawbones with cortical marking holes were obtained. The sawbones were fractured at various locations of the shaft and 3D models were obtained. The fractured models were reduced virtually and customized non-locking metal plates that fit the reduced model were produced via 3D printing. The fractured sawbones were actually fixed to the customized plate with nonlocking screws and 3D models were generated. With the proximal fragments of the 3D models overlapped, the changes in length, 3D angulation, and rotation of the distal fragment were evaluated. Compared to the intact model (IN), the virtual reduction model (VR) and the actual fixation model (AF) showed no significant differences in length. Compared to the IN, the VR and the AF had mean 3D angulations of 0.39° and 0.64°, respectively. Compared to the IN model, the VR and the AF showed mean rotations of 0.89° and 1.51°, respectively. A customized plate based on VR facilitates the restoration of near-original anatomy in fractures of tibial sawbone shaft.

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Clinical outcomes of the use of 3D printing models in fracture management: a meta-analysis of randomized studies

Cited by 17 publications

References 25 publications

Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis

Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis

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

Does a Customized 3D Printing Plate Based on Virtual Reduction Facilitate the Restoration of Original Anatomy in Fractures?

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