Improved accuracy of 3D-printed navigational template during complicated tibial plateau fracture surgery

Abstract

This study was aimed to improve the surgical accuracy of plating and screwing for complicated tibial plateau fracture assisted by 3D implants library and 3D-printed navigational template. Clinical cases were performed whereby complicated tibial plateau fractures were imaged using computed tomography and reconstructed into 3D fracture prototypes. The preoperative planning of anatomic matching plate with appropriate screw trajectories was performed with the help of the library of 3D models of implants. According to the optimal planning, patient-specific navigational templates produced by 3D printer were used to accurately guide the real surgical implantation. The fixation outcomes in term of the deviations of screw placement between preoperative and postoperative screw trajectories were measured and compared, including the screw lengths, entry point locations and screw directions. With virtual preoperative planning, we have achieved optimal and accurate fixation outcomes in the real clinical surgeries. The deviations of screw length was 1.57 ± 5.77 mm, P > 0.05. The displacements of the entry points in the x-, y-, and z-axis were 0.23 ± 0.62, 0.83 ± 1.91, and 0.46 ± 0.67 mm, respectively, P > 0.05. The deviations of projection angle in the coronal (x-y) and transverse (x-z) planes were 6.34 ± 3.42° and 4.68 ± 3.94°, respectively, P > 0.05. There was no significant difference in the deviations of screw length, entry point and projection angle between the ideal and real screw trajectories. The ideal and accurate preoperative planning of plating and screwing can be achieved in the real surgery assisted by the 3D models library of implants and the patient-specific navigational template. This technology improves the accuracy and efficiency of personalized internal fixation surgery and we have proved this in our clinical applications.

Surgical applications of three-dimensional printing: a review of the current literature & how to get started

“…Not only did 3D printing enable the fabrication of the device, but also a quick turnaround for improvements in design. In orthopedic surgery, patient-specific surgical guiding templates have been printed for the precise resection of an osteosarcoma (138), corrective osteotomy in treatment of a pronation deformity (139), for unicompartmental knee arthroplasties (140), and to guide midcervical pedicle screw insertion (25), screw trajectory for complicated tibial plateau fracture fixation (141), and lumbar pedicle screw fixation (26). The use of 3D printed surgical guides in orthopedic application has resulted in shortened operating time and less intra-operative blood loss.…”

X-ray computed tomography and additive manufacturing in medicine: a review

“…The combined use of XCT and AM technologies is also now becoming more prevalent in the field of surgical guidance in production of patient specific guides to ensure correct placement of surgical screws or to inform surgeons of correct drill-hole angle and placement [88][89][90][91][92][93][94][95]. These guides are very commonly used in cranio-maxillofacial surgery, particularly in the placement of AM dental implants primarily through the use of SLA with XCT.…”

Challenges in creating dissectible anatomical 3D prints for surgical teaching

“…), surgical teaching (Cohen & Reyes, ; Huang et al. ; Scawn et al. ) and simulator training (Benet et al.…”

“…Three-dimensional (3D) printing is now a widely used tool in pre-operative planning (Arvier et al 1994;Berry et al 1997;Potamianos et al 1998;Petzold et al 1999;Chang et al 2003;Seitz et al 2004;Mahaisavariya et al 2006;Jacobs et al 2008;Singare et al 2009;Honiball, 2010;Giovinco et al 2012;Krishnan et al 2012;Tam et al 2012;Klein et al 2013;Zein et al 2013;Duncan et al 2015;Huang et al 2015;Rose et al 2015b), surgical teaching (Cohen & Reyes, 2015;Huang et al 2015;Scawn et al 2015) and simulator training (Benet et al 2015;Ryan et al 2015Ryan et al , 2016, and attitudes toward image donation for 3D printing in anatomy education as oppposed to body donation may be more favourable (Abouhashem et al 2017). Creating multi-material 3D prints that mechanically resemble real tissues is a primary focus within these educational domains (Mori et al 2010;Hochman et al 2013Hochman et al , 2015aLipton et al 2014;Rose et al 2015a,b), yet models that precisely match the biomechanical and visual qualities of human tissue do not currently exist.…”