The Value of 3D Printed Models in Understanding Acetabular Fractures

Abstract

Acetabular fractures are complex and difficult to classify. Although the Judet-Letournel classification is designed to increase the understanding of acetabular fractures, it remains prone to error when using conventional medical imaging. We hypothesize that three-dimensional (3D) printing, as a new diagnostic imaging tool, will lead to an increased understanding and knowledge of acetabular fractures and an optimal surgical approach. Digital data (DICOM) of 20 acetabular fractures were converted into 3D files [standard tessellation language (STL) data]. These STL files were used to prepare 3D prints of life-size hemipelvic models with acetabular fractures. Seven senior trauma surgeons specializing in pelvic and acetabular surgery, 5 young fellowshiptrained trauma surgeons, 5 senior surgical residents, 5 junior surgical residents, and 5 interns classified 20 acetabular cases using X-ray/two-dimensional (2D) computed tomography (CT), 3D reconstructions, and 3D printed models according to the Judet-Letournel classification. Furthermore, all junior and senior surgeons were instructed to evaluate their surgical approach and the positioning of the patient during operation. Time to classify each case was recorded. Calculations were done using Fleiss' j statistics. Only slight and fair interobserver agreements for senior surgeons (j = 0.33) and interns (j = 0.16) were found when using X-ray/2D CT. However, 3D printed models showed moderate and substantial interobserver agreements for senior surgeons (j = 0.59), junior surgeons (j = 0.56), senior surgical residents (j = 0.66), junior surgical residents (j = 0.51), and interns (j = 0.61). Compared with X-ray/2D CT, the interobserver agreement regarding the surgical approach for junior surgeons using 3D printed models increased by j = 0.04 and j = 0.23, respectively. Except for the interns, a significant time difference for classification was found between X-ray/2D CT and 3D CT and 3D printed models for junior and senior surgical residents and junior and senior surgeons (p < 0.001). 3D printing is of added value in the understanding, classification, and surgical evaluation of acetabular fractures. We recommend the implementation of 3D printed models in trauma surgery training.

Feasibility of Imaging-Based 3-Dimensional Models to Design Patient-Specific Osteosynthesis Plates and Drilling Guides

“… 18 Moreover, 3-D-printed pelvic models are used as templates for fitting and precontouring conventional osteosynthesis plates before the actual surgical procedure. 18 , 19 , 20 , 21 Several case series indicate that the use of 3-D-printed models in pelvic surgery are associated with reduced blood loss and shorter operation time. 22 , 23 , 24 , 25 , 26 Although the reported use of prebent plates, adapted to printed 3-D–models, show some benefits, little data are available on whether 3-D–printed models improve the quality of the reduction.…”

CT Conversion Workflow for Intraoperative Usage of Bony Models: From DICOM Data to 3D Printed Models

“…HTPLA by ProtoPasta, at the moment, is the only 3D printing filament capable of offering the easiness of printing of PLA combined with high temperature resistance. Finally, comparing to [12], our method diminishes the wastage of material since the model is printed in multiple pieces, minimizing the use of support pillars for unsupported areas. Furthermore, printing the model in multiple pieces speeds up the printing step.…”

Three-dimensional printing in orthopaedic surgery: a scoping review

“…Three dimensional printing of complex fracture patterns such as acetabular and calcaneal fractures has been shown to improve consistency in fracture classification and patient understanding of the fracture and surgical plan. 9 , 34 With the growing focus on minimizing patient harm and competency-based education, 3D printing has the potential to play a key role in the future of orthopaedic education.…”

“…Multiple studies have shown that the use of 3D-printed models based on real patient imaging improve the inter-rater reliability of complex acetabular fracture classification compared to the use of radiographs and cross-sectional imaging alone. 9 , 10 The use of 3D printing also has many clinical applications, including pre-operative planning, 11 – 13 manufacturing of patient-specific instrumentation (PSI), 14 – 16 and the manufacture of case-specific implants (e.g. plates and arthroplasty components).…”