Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation?

  • L. Maini
  • A. Sharma
  • S. Jha
  • A. Sharma
  • A. Tiwari
Original Article



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.


Acetabulum 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.


  1. 1.
    Rommens PM, Hessmann MH. Acetabulum fractures. Unfallchirurg. 1999;102:591–610.CrossRefPubMedGoogle Scholar
  2. 2.
    Brown GA, Willis M, Firoozbakhsh K, Barmada A. Computed tomography image guided surgery in complex acetabular fracture. Clin Orthop Relat Res. 2000;370:219–26.CrossRefGoogle Scholar
  3. 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. 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
  5. 5.
    Brown GA, Milner B, Firoozbakhsh K. Application of computer-generated stereolithography and interpositioning template in acetabular fractures: a report of eight cases. J Orthop Trauma. 2002;16:347–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Citak M, Gardner MJ, Kendoff D, Tarte S, Krettek C, Nolte LP, et al. Virtual 3D planning of acetabular fracture reduction. J Orthop Res. 2008;26:547–52.CrossRefPubMedGoogle Scholar
  7. 7.
    Tile M, Helfet D, Kellam J. Fratures of pelvis and acetabulum. Philadelphia: Lippincott Williams and Wilkins; 2003.Google Scholar
  8. 8.
    Ricchetti ET, DeMola PM, Roman D, Abboud JA. The use of precontoured humeral locking plates in the management of displaced proximal humeral fractures. J Am Acad Orthop Surg. 2009;17(9):582–90.CrossRefPubMedGoogle Scholar
  9. 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. 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. 11.
    Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop. 1988;230:83–97.Google Scholar
  12. 12.
    Heeg M, Henk J, Henk JK. Conservative treatment of acetabular fractures: the role of the weight bearing dome and anatomic reduction in the ultimate results. J Trauma. 1987;27:555–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Mohsen AM, Phillips R. Letter of the reviewers–—update on CAOS projects. Injury 2004; 35(Suppl 1): S-A2–5.Google Scholar
  14. 14.
    Citak M, Gardner MJ, Kendoff D, Tarte S, Krettek C, Nolte LP, Hufner T. Virtual 3D planning of acetabular fracture reduction. J Orthop Res. 2008;26:547–52.CrossRefPubMedGoogle Scholar
  15. 15.
    Cimerman M, Kristan A. Preoperative planning in pelvic and acetabular surgery: the value of advanced computerised planning modules. Injury. 2007;38:442–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Munjal S, Leopold SS, Kornreich D, et al. CT-generated 3-dimensional models for complex acetabular reconstruction. J Arthroplast. 2000;15:644–53.CrossRefGoogle Scholar
  17. 17.
    Brown GA, Firoozbakhsh K, Gehlert RJ. Three-dimensional CT modeling versus traditional radiology techniques in treatment of acetabular fractures. Iowa Orthop J. 2001;21:20–4.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Fornaro J, Keel M, Harders M, Marincek B, Székely G, Frauenfelder T. An interactive surgical planning tool for acetabular fractures: initial results. J Orthop Surg Res. 2010;5:50.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 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. 20.
    Rosen JM, Soltanian H, Redett RJ, Laub DR. Evolution of virtual reality. IEEE Engng Med. Biol. 1996, 16–22.Google Scholar
  21. 21.
    Brown GA, Firoozbakhsh K, DeCoster TA, Reyna JR, Moneim M. Rapid prototyping: the future of trauma surgery? J Bone Joint Surg Am. 2003;85:49–55.CrossRefPubMedGoogle Scholar
  22. 22.
    Bagaria V, Deshpande S, Rasalkar DD, Kuthe A, Paunipagar BK. Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures. Eur J Radiol. 2011;80:814–20.CrossRefPubMedGoogle Scholar
  23. 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. 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
  25. 25.
    Letournel E, Judet R. Fractures of the acetabulum. New York: Springer; 1981.CrossRefGoogle Scholar
  26. 26.
    O’Shea K, Quinlan JF, Waheed K, Brady OH. The usefulness of computed tomography following open reduction and internal fixation of acetabular fractures. J Orthop Surg (Hong Kong). 2006;14(2):127–32.CrossRefGoogle Scholar
  27. 27.
    Borrelli J Jr, Peelle M, McFarland E, et al. Computer-reconstructed radiographs are as good as plain radiographs for assessment of acetabular fractures. Am J Orthop. 2008;37:455–60.PubMedGoogle Scholar
  28. 28.
    Roser SM et al. The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results. J Oral Maxillofacial Surg. 2010;68(11):2824–32.CrossRefGoogle Scholar
  29. 29.
    Meena UK, Tripathy SK, Sen RK, Aggarwal S, Behera P. Predictors of postoperative outcome for acetabular fractures. Orthop Traumatol Surg Res. 2013;99(8):929–35.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • L. Maini
    • 1
  • A. Sharma
    • 1
    • 3
  • S. Jha
    • 2
  • A. Sharma
    • 1
  • A. Tiwari
    • 1
  1. 1.Maulana Azad Medical CollegeDelhiIndia
  2. 2.Indian Institute of TechnologyDelhiIndia
  3. 3.GhaziabadIndia

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