Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation?
Due to the complexity of acetabulum, achieving anatomical contouring intra-operatively is difficult for surgeon. A 3D (dimensional) real model can facilitate us both in contouring the plate pre-operatively and in better pre-operative planning. Patient-specific pre-contoured plate in acetabular fracture has been studied by few researchers but randomized case–control study was lacking. Hence, we conducted a case–control study to evaluate the accuracy of patient-specific pre-contoured plate.
Materials and methods
Prospective randomized case control study was conducted. 21 patients were included. 10 patients were distributed in “case” group and remaining 11 in “control” group. Inclusion criteria: Displaced acetabulum fractures with displacement of ≥3 mm in adults who reported within 3 weeks of injury. Exclusion criteria were: Open fractures, associated Morel-Lavallée lesion and patients with >3 weeks old fracture. In case group, patient-specific real 3D model of fractured acetabulum was generated using rapid prototyping technology and plates were contoured pre-operatively. Control group was treated using intra-operative contoured plates. Both the groups were compared using parameters: Blood loss, Surgery time, post-operative reduction on X-ray, post-surgical residual displacement and reduction achieved as evaluated by CT scan.
Reduced blood loss (100 ml less in case group) and surgical time (12 min less in case group) and better post-operative reduction were observed in case than control. In control group, 4 patients even had step of 2–3 mm, which was not seen in case group. All the pre-contoured plates fitted well to the pelvis intra-operatively. Reduction achieved as evaluated by CT was more in “case” group with statistically significant outcomes (p < 0.05).
Patient-specific pre-contoured plate made using 3D model is a better implant than intra-operatively contoured plate. Real-time 3D pelvis model is an accurate technique for pre-operative planning in acetabular fractures.
KeywordsAcetabulum fracture Patient specific Pre-contoured Three-dimensional printing Rapid prototyping Reconstruction plate
Compliance with ethical standards
Ethical clearance has been taken from the institutional ethical committee.
Conflict of interest
Dr. Lalit Maini, Dr. Amit Sharma, Dr. Sunil Jha, Dr. Ankur Sharma, Dr. Anurag Tiwari declare that they have no conflict of interest.
- 3.Hoppenfeld S, deBoer P. Surgical exposures in orthopaedics: the anatomic approach. 2nd ed. Philadelphia: JB Lippincott Company; 1984. p. 327–43.Google Scholar
- 4.Kahler DM. Early Experience with computer assisted technique for iliosacral screw placement in posterior pelvic ring disruptions. Comput Assist Orthop Surg. CAOS/USA Syllabus. 1998. p. 180–2.Google Scholar
- 7.Tile M, Helfet D, Kellam J. Fratures of pelvis and acetabulum. Philadelphia: Lippincott Williams and Wilkins; 2003.Google Scholar
- 9.Tile M. Fractures of the acetabulum. In: Schatzker J, Tile M, editors. The rationale of operative fracture care. 3rd ed. 2005; p. 291–340.Google Scholar
- 10.Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. J Bone Joint Surg. 1964; 46-A: 1615–46.Google Scholar
- 11.Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop. 1988;230:83–97.Google Scholar
- 13.Mohsen AM, Phillips R. Letter of the reviewers–—update on CAOS projects. Injury 2004; 35(Suppl 1): S-A2–5.Google Scholar
- 19.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 Cars. 2012;10:21–32.Google Scholar
- 20.Rosen JM, Soltanian H, Redett RJ, Laub DR. Evolution of virtual reality. IEEE Engng Med. Biol. 1996, 16–22.Google Scholar
- 23.Matta JM. Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg. 1996; 78-A: 1632–45.Google Scholar
- 24.Mayo KA. Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures. Clin Orthop. 1994;305:31–7.Google Scholar