Abstract
Background
Open reduction and internal fixation is a standard treatment for displaced acetabular fractures using 3.5 mm reconstruction plates contoured intra-operatively. This process is difficult and time consuming hence resulting in increased surgical morbidity. Virtual surgical planning is now being commonly used worldwide to aid in management of such complex problems. Patient-specific reconstruction plate pre contoured using virtual surgical planning on contralateral intact hemipelvis will be helpful in achieving better surgical outcomes. Also, it has an added advantage of considerably reducing the time and effort spent in virtual pre-operative planning process.
Methodology
This study was performed in 30 patients with acetabulum fracture who were fixed posteriorly via Kocher-Langenbeck approach. Virtual planning was done on contralateral hemipelvis to prepare patient-specific pre-contoured plates and mirrored to the fractured side. The time required for virtual planning on fractured and normal side was recorded and compared. The efficiency of plates so prepared were accessed in terms of outcome variables like duration of surgery, blood loss, reduction obtained on X-ray as well as CT Scan.
Result
Time required for virtual planning was more on fractured side and lesser when it was done using normal hemipelvis with mean values of 81.83 (sd = 28.02) min and 15.67 (sd = 6.12) min, respectively. Values of blood loss, duration of surgery and reduction as accessed on X-ray and CT scan were comparable or even better than compared to other studies.
Conclusion
Contralateral normal pelvis can be used for virtual preoperative planning making the whole process easier and less time consuming.
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Abbreviations
- DICOM:
-
Digital imaging and communications in medicine
- STL:
-
Stereolithography
- PLA:
-
Polylactic acid
- CT:
-
Computed Tomography
- 3D:
-
3 Dimensional
- MIMICS:
-
Materialise Interactive Medical Image Control System
References
Laird A, Keating JF. Acetabular fractures: a 16-year prospective epidemiological study. J Bone Joint Surg. 2005;87(7):969–73.
Maini L, Sharma A, Jha S, Sharma A, Tiwari A. Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation? Eur J Trauma Emerg Surg. 2018;44(2):215–24.
Maini L, Verma T, Sharma A, Sharma A, Mishra A, Jha S. Evaluation of accuracy of virtual surgical planning for patient-specific pre-contoured plate in acetabular fracture fixation. Arch Orthop Trauma Surg. 2018;138(4):495–504.
Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within 3 weeks after the injury. J Bone Joint Surg Am. 1996;78(11):1632–45.
Shen F, Chen B, Guo Q, Qi Y, Shen Y. Augmented reality patient-specific reconstruction plate design for pelvic and acetabular fracture surgery. Int J Comput Assist Radiol Surg. 2013;8(2):169–79.
Upex P, Jouffroy P, Riouallon G. 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. 2017;103(3):331–4.
Coward TJ, Watson RM, Wilkinson IC. Fabrication of a wax ear by rapid-process modeling using stereolithography. Int J Prosthodont. 1999;12(1):20–7.
Kang HJ, Kim BS, Kim SM, Kim YM, Kim HN, Park JY, et al. Can preoperative 3D printing change surgeon’s operative plan for distal tibia fracture? BioMed Res Int. 2019;1:1–7.
Hannen EJ. Recreating the original contour in tumor deformed mandibles for plate adapting. Int J Oral Maxillofacial Surg. 2006;35(2):183–5.
Hsu CL, Chou YC, Li YT, Chen JE, Hung CC, Wu CC, et al. Pre-operative virtual simulation and three-dimensional printing techniques for the surgical management of acetabular fractures. Int Orthop. 2019;43(8):1969–76.
Mayo KA. Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures. Clin Orthop Relat Res. 1994;305:31–7.
Pantazopoulos T, Nicolopoulos CS, Babis GC, Theodoropoulos T. Surgical treatment of acetabular posterior wall fractures. Injury. 1993;24(5):319–23.
Moed BR, Carr SE, Watson JT. Open reduction and internal fixation of posterior wall fractures of the acetabulum. Clin Orthop Relat Res. 2000;377:57–67.
Mitsionis GI, Lykissas MG, Motsis E, Mitsiou D, Gkiatas I, Xenakis TA, et al. Surgical management of posterior hip dislocations associated with posterior wall acetabular fracture: a study with a minimum follow-up of 15 years. J Orthop Trauma. 2012;26(8):460–5.
Pascarella R, Cerbasi S, Politano R, Balato G, Fantasia R, Orabona G, Mariconda M (2017) Surgical results and factors influencing outcome in patients with posterior wall acetabular fracture. Injury 48(8):1819–1824
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This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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GA: conceptualization, methodology, software. AM: data curation, writing—original draft preparation. TV: visualization, investigation. LM: supervision. RK: writing—reviewing and editing. AM: writing—reviewing and editing.
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The patients have given their informed consent to be a part of the study.
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The author(s) declare that they have no competing interests.
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Agarwal, G., Mishra, A., Verma, T. et al. Virtual planning on contralateral hemipelvis for posteriorly fixed acetabular fractures. Eur J Trauma Emerg Surg 48, 1255–1261 (2022). https://doi.org/10.1007/s00068-021-01617-z
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DOI: https://doi.org/10.1007/s00068-021-01617-z