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International Orthopaedics

, Volume 43, Issue 8, pp 1969–1976 | Cite as

Pre-operative virtual simulation and three-dimensional printing techniques for the surgical management of acetabular fractures

  • Chun-Liang Hsu
  • Yu-Ching Chou
  • Yuan-Ta Li
  • Jia-En Chen
  • Chun-Chi Hung
  • Chia-Chun Wu
  • Hsain-Chung Shen
  • Tsu-Te YehEmail author
Original Paper

Abstract

Purpose

Surgical treatment of acetabular fractures with plate fixation is challenging for orthopaedic surgeons because of variations of the surface curvature and complex fracture patterns of the acetabulum. We present our experience with pre-operative computer-assisted virtual simulation and three-dimensional (3D) printing techniques for the surgical treatment of acetabular fractures, especially in terms of operative time and surgical outcomes.

Methods

Twenty-nine patients with acetabular fractures treated with locking plates were included in this retrospective study (conventional locking plate fixation, n = 17; 3D-printing-assisted precontoured locking plate fixation, n = 12). Fracture types were classified according to the Letournel-Judet classification. Surgical duration, instrumentation time, blood loss, post-operative fracture reduction quality, and complication rates were compared between the two surgical groups.

Results

The 3D-printing group had a significantly shorter total surgical duration and instrumentation time for fractures with posterior wall or posterior column involvement (222.75 ± 48.12 and 35.75 ± 9.21 minutes, respectively; P < 0.05) and significantly shorter instrumentation time and less blood loss for fractures with anterior column involvement (43.40 ± 10.92 minutes and 433.33 ± 317.28 mL, respectively; P < 0.05) than those in the control group. The post-operative radiological results (assessed by consensus) were similar for both groups (good/fair: 14/3 vs. 11/1; P = 0.622). The complication rate was lower in the 3D-printing group than in the conventional group (16.67 vs. 29.41%).

Conclusions

The 3D printing is a reliable method for treating acetabular fractures, and can reduce the surgical duration, instrumentation time, and blood loss.

Keywords

Acetabulum fracture Pre-operative virtual simulation Three-dimensional (3D) printing Precontoured 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of our Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Gross BC, Erkal JL, Lockwood SY, Chen C, Spence DM (2014) Evaluation of 3D printing and its potential impact on biotechnology and the chemical sciences. Anal Chem 86:3240–3253CrossRefGoogle Scholar
  2. 2.
    Jammalamadaka U, Tappa K (2018) Recent advances in biomaterials for 3D printing and tissue engineering. J Funct Biomater 9:E22CrossRefGoogle Scholar
  3. 3.
    Cimerman M, Kristan A (2007) Preoperative planning in pelvic and acetabular surgery: the value of advanced computerised planning modules. Injury 38:442–449CrossRefGoogle Scholar
  4. 4.
    Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 78:1632–1645CrossRefGoogle Scholar
  5. 5.
    Gao YS, Zhou ZB, Tang MJ, Yu XW, Chen S, Zhang CQ, Sun YQ (2015) Late surgery for acetabular fractures in a Chinese level I trauma Centre: surgical experience and outcomes. Int Orthop 39:1865–1871CrossRefGoogle Scholar
  6. 6.
    Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, Llinias A (2002) Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am 84-A:1259–1271CrossRefGoogle Scholar
  7. 7.
    Ragnarsson B, Mjöberg B (1992) Arthrosis after surgically treated acetabular fractures. Acta Orthop Scand 63:511–514CrossRefGoogle Scholar
  8. 8.
    Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA (2006) Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma 20:739–744CrossRefGoogle Scholar
  9. 9.
    Munjal S, Leopold SS, Kornreich D, Shott S, Finn HA (2000) CT-generated 3-dimensional models for complex acetabular reconstruction. J Arthroplast 15:644–653CrossRefGoogle Scholar
  10. 10.
    Fuller SM, Butz DR, Vevang CB, Makhlouf MV (2014) Application of 3-dimensional printing in hand surgery for production of a novel bone reduction clamp. J Hand Surg 39:1840–1845CrossRefGoogle Scholar
  11. 11.
    Rankin TM, Giovinco NA, Cucher DJ, Watts G, Hurwitz B, Armstrong DG (2014) 3D printing surgical instruments: are we there yet? J Surg Res 189:193–197CrossRefGoogle Scholar
  12. 12.
    Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am 46:1615–1646CrossRefGoogle Scholar
  13. 13.
    Boudissa M, Ruatti S, Kerschbaumer G, Milaire M, Merloz P, Tonetti J (2016) Part 2: outcome of acetabular fractures and associated prognostic factors-a ten-year retrospective study of one hundred and fifty-six operated cases with open reduction and internal fixation. Int Orthop 40:2151–2156CrossRefGoogle Scholar
  14. 14.
    Sebaaly A, Riouallon G, Zaraa M, Upex P, Marteau V, Jouffroy P (2018) Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification. Int Orthop 42:1957–1965CrossRefGoogle Scholar
  15. 15.
    Wang H, Wang F, Newman S, Lin Y, Chen X, Xu L, Wang Q (2016) Application of an innovative computerized virtual planning system in acetabular fracture surgery: a feasibility study. Injury 47:1698–1701CrossRefGoogle Scholar
  16. 16.
    Martelli N, Serrano C, van den Brink H, Pineau J, Prognon P, Borget I, El Batti S (2016) Advantages and disadvantages of 3-dimensional printing in surgery: a systematic review. Surgery 159:1485–1500CrossRefGoogle Scholar
  17. 17.
    Hu Y, Li H, Qiao G, Liu H, Ji A, Ye F (2011) Computer-assisted virtual surgical procedure for acetabular fractures based on real CT data. Injury 42:1121–1124CrossRefGoogle Scholar
  18. 18.
    Upex P, Jouffroy P, Riouallon G (2017) Application of 3D printing for treating fractures of both columns of the acetabulum: benefit of pre-contouring plates on the mirrored healthy pelvis. Orthop Traumatol Surg Res 103:331–334CrossRefGoogle Scholar
  19. 19.
    Maini L, Sharma A, Jha S, Sharma A, Tiwari A (2018) Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation? Eur J Trauma Emerg Surg 44:215–224CrossRefGoogle Scholar
  20. 20.
    Guimarães JAM, Martin MP 3rd, da Silva FR, Duarte MEL, Cavalcanti ADS, Machado JAP, Mauffrey C, Rojas D (2018) The obturator oblique and iliac oblique/outlet views predict most accurately the adequate position of an anterior column acetabular screw. Int Orthop.  https://doi.org/10.1007/s00264-018-3989-5
  21. 21.
    Chui KH, Chan CCD, Ip KC, Lee KB, Li W (2018) Three-dimensional navigation-guided percutaneous screw fixation for nondisplaced and displaced pelvi-acetabular fractures in a major trauma Centre. Int Orthop 42:1387–1395CrossRefGoogle Scholar
  22. 22.
    Wu X (2018) A biomechanical comparison of different fixation techniques for fractures of the acetabular posterior wall. Int Orthop 42:673–679CrossRefGoogle Scholar
  23. 23.
    Richter H, Hutson JJ, Zych G (2004) The use of spring plates in the internal fixation of acetabular fractures. J Orthop Trauma 18:179–181CrossRefGoogle Scholar
  24. 24.
    Lee C, Johnson EE (2018) Use of spring plates in fixation of comminuted posterior wall acetabular fractures. J Orthop Trauma 32:S55–S59CrossRefGoogle Scholar
  25. 25.
    Hutt JR, Ortega-Briones A, Daurka JS, Bircher MD, Rickman MS (2015) The ongoing relevance of acetabular fracture classification. Bone Joint J 97-B:1139–1143CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryTri-Service General Hospital and National Defense Medical CenterTaipeiTaiwan, Republic of China
  2. 2.School of Public Health, National Defense Medical CenterTaipei CityTaiwan, Republic of China
  3. 3.Graduate Institute of Aerospace and Undersea MedicineDivision National Defense Medical CenterTaipei CityTaiwan, Republic of China

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