Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients

Assink, Nick; Reininga, Inge H. F.; Duis, Kaj ten; Doornberg, Job N.; Hoekstra, Harm; Kraeima, Joep; Witjes, Max J. H.; Vries, Jean‐Paul P.M. de; IJpma, Frank F. A.

doi:10.1007/s00068-021-01773-2

Cited by 25 publications

(32 citation statements)

References 41 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%

“…Increasing interest in 3D printing-assisted surgery has been accompanied by mounting evidence pointing towards its efficacy in pre-operative planning, with promising results being presented in the research of various musculoskeletal injuries [20][21][22], though much of this research has focussed on acetabular and tibial plateau fractures [23][24][25][26][27]. Existing reviews have investigated 3D printing-assisted surgery in calcaneal and pilon fractures in isolation [28,29], however, the aim of this systematic review was to determine the efficacy of 3D printing in the pre-operative planning of combined foot and ankle fractures.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

confidence: 99%

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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“…They thought that the 3D‐printed model was useful for communication with patients. Other reports 12–14 showed that the operation time, blood loss, and number of intra‐operative fluoroscopy for the 3D printing group exhibited statistically significant differences compared with the traditional surgery group in TPFs. A recent review 12 showed that a 3D‐assisted surgery resulted in reduced operation time (104.7 vs 126.4 min; p < 0.01), less blood loss (241 ml vs 306 ml; p < 0.01), and decreased frequency of fluoroscopy (5.8 vs 9.1 times; p < 0.01) in TPF.…”

Section: Discussionmentioning

confidence: 91%

The Efficacy of 3D Printing Model in the Intraarticular Osteotomy in the Treatment of Malunion of Tibial Plateau Fracture

Jiang

2022

Orthopaedic Surgery

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Objectives: Three-dimensional (3D) printing technology has shown potential advantages in accurate and efficient tibial plateau fracture (TPF) treatment. This technology can provide structural morphology to repair fracture fragments. Here, we summarize our experience with the use of 3D printing technology during intraarticular osteotomy in the treatment of the malunion of TPF. Methods:The patients who were treated with malunion of TPF in our hospital between January 2015 and December 2018 were retrospectively analyzed. These patients were divided into two groups: the conventional group without 3D-printed model application and the 3D printing group with 3D-printed model application. All patients received the intraarticular osteotomy during operation, and we compared the operation time (min), fracture healing time (months), postoperative knee Rasmussen scores (0-30 points), knee mobility range (0-140 ) (the independent t-test), fracture reduction evaluation (Biggi's method) (the chi-square test: Fisher's exact test), and postoperative complications of each group.Results: Twenty-six patients aged 18-65 years who underwent TPF revision operation were included in this study, including 18 patients in the conventional group, and eight patients in the 3D printing group. The followup time was 24-48 months, and the operation time was 185 min in the conventional group and 180 min in the 3D printing group. All patients received a bone union at the last follow-up. The healing time was 4.2 months in the conventional group and 3.75 months in the 3D printing group (p > 0.05). The respective postoperative Rasmussen scores were 24.6 and 26.2, and postoperative knee mobility was 103.5 and 118.5 in the conventional group and 3D printing group, respectively. Both the Rasmussen scores and degrees of mobility were significantly improved after surgery (p < 0.05), and the postoperative knee mobility was significantly better in the 3D printing group versus the conventional group (p < 0.05). Four patients still had a 2-mm collapse on the articular surface, and two patients still had slight valgus (<5 ) in the conventional group. Only one case in the 3D printing group suffered from an articular surface collapse. Superficial wound infections occurred in two patients in the conventional group. Conclusion:The results show that 3D printing technology is an effective preoperative preparation in the treatment of TPF malunion. This technology can facilitate accurate preoperative planning to select the optimal surgical approach, plan the implant placement, visualize the screw trajectory, and anticipate possible intraoperative difficulties.

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“…Previous reviews have focused on the description and technical details of the involved steps (Jiménez-Delgado et al, 2016) or on a specific type of fracture treatment, such as acetabular fracture surgery (Boudissa et al, 2018). Banierink et al (2021) and Assink et al (2021) have both reviewed whether '3D-assisted surgery' improves clinical outcomes when used for the planning of pelvic ring fractures and tibial plateau fractures, respectively. However, these reviews focus on different concepts of 3D-assisted surgery, including 3D virtual visualization, 3D printed hand-held fracture models, pre-contouring of osteosynthesis plates, 3D printed surgical guides, and intra-operative 3D imaging, rather than computer models to assist in planning.…”

Section: Rationalementioning

confidence: 99%

Computer-assisted preoperative planning of bone fracture fixation surgery: A state-of-the-art review

Moolenaar

Tümer

Checa

2022

Front. Bioeng. Biotechnol.

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Background: Bone fracture fixation surgery is one of the most commonly performed surgical procedures in the orthopedic field. However, fracture healing complications occur frequently, and the choice of the most optimal surgical approach often remains challenging. In the last years, computational tools have been developed with the aim to assist preoperative planning procedures of bone fracture fixation surgery.Objectives: The aims of this review are 1) to provide a comprehensive overview of the state-of-the-art in computer-assisted preoperative planning of bone fracture fixation surgery, 2) to assess the clinical feasibility of the existing virtual planning approaches, and 3) to assess their clinical efficacy in terms of clinical outcomes as compared to conventional planning methods.Methods: A literature search was performed in the MEDLINE-PubMed, Ovid-EMBASE, Ovid-EMCARE, Web of Science, and Cochrane libraries to identify articles reporting on the clinical use of computer-assisted preoperative planning of bone fracture fixation.Results: 79 articles were included to provide an overview of the state-of-the art in virtual planning. While patient-specific geometrical model construction, virtual bone fracture reduction, and virtual fixation planning are routinely applied in virtual planning, biomechanical analysis is rarely included in the planning framework. 21 of the included studies were used to assess the feasibility and efficacy of computer-assisted planning methods. The reported total mean planning duration ranged from 22 to 258 min in different studies. Computer-assisted planning resulted in reduced operation time (Standardized Mean Difference (SMD): -2.19; 95% Confidence Interval (CI): -2.87, -1.50), less blood loss (SMD: -1.99; 95% CI: -2.75, -1.24), decreased frequency of fluoroscopy (SMD: -2.18; 95% CI: -2.74, -1.61), shortened fracture healing times (SMD: -0.51; 95% CI: -0.97, -0.05) and less postoperative complications (Risk Ratio (RR): 0.64, 95% CI: 0.46, 0.90). No significant differences were found in hospitalization duration. Some studies reported improvements in reduction quality and functional outcomes but these results were not pooled for meta-analysis, since the reported outcome measures were too heterogeneous.Conclusion: Current computer-assisted planning approaches are feasible to be used in clinical practice and have been shown to improve clinical outcomes. Including biomechanical analysis into the framework has the potential to further improve clinical outcome.

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Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients

Cited by 25 publications

References 41 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

The Efficacy of 3D Printing Model in the Intraarticular Osteotomy in the Treatment of Malunion of Tibial Plateau Fracture

Computer-assisted preoperative planning of bone fracture fixation surgery: A state-of-the-art review

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