Preoperative Plan with 3D Printing in Internal and External Fixation for Complex Tibial Plateau Fractures

Wu, Wei-Yong; Xu, Weiguo; Wan, Chunyou; Fang, Min

doi:10.1111/os.12466

Cited by 26 publications

(29 citation statements)

References 36 publications

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“…Amongst out patients with pilon fractures, 1/9 (11.1%) developed infection. Another study utilized 3D-printed ABS models to facilitate fixation of complex tibial plateau fractures in 69 patients [16]. A total of 6/69 (8.7%) suffered from SSIs, whilst within our cohort none of the six cases did.…”

Section: Discussionmentioning

confidence: 88%

A review of the manufacturing process and infection rate of 3D-printed models and guides sterilized by hydrogen peroxide plasma and utilized intra-operatively

Shea

et al. 2020

3D Print Med

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3D printing in the context of medical application can allow for visualization of patient-specific anatomy to facilitate surgical planning and execution. Intra-operative usage of models and guides allows for real time feedback but ensuring sterility is essential to prevent infection. The additive manufacturing process restricts options for sterilisation owing to temperature sensitivity of thermoplastics utilised for fabrication. Here, we review one of the largest single cohorts of 3D models and guides constructed from Acrylonitrile butadiene styrene (ABS) and utilized intra-operatively, following terminal sterilization with hydrogen peroxide plasma. We describe our work flow from initial software rendering to printing, sterilization, and on-table application with the objective of demonstrating that our process is safe and can be implemented elsewhere. Overall, 7% (8/114 patients) of patients developed a surgical site infection, which was not elevated in comparison to related studies utilizing traditional surgical methods. Prolonged operation time with an associated increase in surgical complexity was identified to be a risk factor for infection. Low temperature plasma-based sterilization depends upon sufficient permeation and contact with surfaces which are a particular challenge when our 3D-printouts contain diffusion-restricted luminal spaces as well as hollows. Application of printouts as guides for power tools may further expose these regions to sterile bodily tissues and result in generation of debris. With each printout being a bespoke medical device, it is important that the multidisciplinary team involved in production and application understand potential pitfalls to ensuring sterility as to minimize infection risk.

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Section: Discussionmentioning

confidence: 88%

A review of the manufacturing process and infection rate of 3D-printed models and guides sterilized by hydrogen peroxide plasma and utilized intra-operatively

Shea

et al. 2020

3D Print Med

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show abstract

“…The pressure of the balloon-type tourniquet on the affected limb was set to 450 mmHg, and the mean arterial blood pressure (MAP) was maintained at 60-70 mmHg. This surgical technique has been described previously 13,14 . Briefly, a medial and lateral double incision approach, combined with double locking steel plates, was used to fix the fracture block.…”

Section: Surgical Methods and Postoperative Managementmentioning

confidence: 99%

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang¹,

Yupu²,

Wang³

et al. 2020

Preprint

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Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedics. However, no study has investigated TXA in complex tibial plate surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of IV (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the IV group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution before 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared for the three groups. Results Baseline data were comparable for all groups. The IV group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 29.4 ml, 219.3 ± 33.4 ml, respectively, all p values < 0.001). The topical group performed excellently with regard to postoperative vascular events, wound complications, and adverse reactions, but there was no statistical significant in the incidence of these between the groups. Conclusion This study presents the first information to show that both IV TXA and topical TXA are safe and effective for complex tibial plateau fractures. The IV regimen effectively reduced blood loss during the perioperative period, whereas the topical regimen had a better safety profile.

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“…The pressure of the balloon-type tourniquet on the affected limb was set to 450 mmHg, and the mean arterial blood pressure (MAP) was maintained at 60-70 mmHg. This surgical technique has been described previously 13,14 . Brie y, a medial and lateral double incision approach, combined with double locking steel plates, was used to x the fracture block.…”

Section: Surgical Methods and Postoperative Managementmentioning

confidence: 99%

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedics. However, no study has investigated TXA in complex tibial plate surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of IV (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the IV group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution before 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared for the three groups.The pain functional and quality of life (QoL) assessment based on their corresponding scoring system. Results Baseline data were comparable for all groups. The IV group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 29.4 ml, 219.3 ± 33.4 ml, respectively, all p values < 0.001). The topical group performed excellently with regard to postoperative vascular events, wound complications, and adverse reactions, but there was no statistical significant in the incidence of these between the groups.In addition, the topical group benefited in reducing postoperative pain and better QoL. Conclusion This study presents the first information to show that both IV TXA and topical TXA are safe and effective for complex tibial plateau fractures. The IV regimen effectively reduced blood loss during the perioperative period, whereas the topical regimen had a better safety profile and QoL.

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Preoperative Plan with 3D Printing in Internal and External Fixation for Complex Tibial Plateau Fractures

Cited by 26 publications

References 36 publications

A review of the manufacturing process and infection rate of 3D-printed models and guides sterilized by hydrogen peroxide plasma and utilized intra-operatively

A review of the manufacturing process and infection rate of 3D-printed models and guides sterilized by hydrogen peroxide plasma and utilized intra-operatively

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

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