Skip to main content

Advertisement

Log in

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

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

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.

Results

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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Rommens PM, Hessmann MH. Acetabulum fractures. Unfallchirurg. 1999;102:591–610.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  7. Tile M, Helfet D, Kellam J. Fratures of pelvis and acetabulum. Philadelphia: Lippincott Williams and Wilkins; 2003.

    Google Scholar 

  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.

    Article  PubMed  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.

  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.

  11. Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop. 1988;230:83–97.

    Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  13. Mohsen AM, Phillips R. Letter of the reviewers–—update on CAOS projects. Injury 2004; 35(Suppl 1): S-A2–5.

  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.

    Article  PubMed  Google Scholar 

  15. Cimerman M, Kristan A. Preoperative planning in pelvic and acetabular surgery: the value of advanced computerised planning modules. Injury. 2007;38:442–9.

    Article  PubMed  Google Scholar 

  16. Munjal S, Leopold SS, Kornreich D, et al. CT-generated 3-dimensional models for complex acetabular reconstruction. J Arthroplast. 2000;15:644–53.

    Article  CAS  Google Scholar 

  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.

    CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  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.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  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.

  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. Letournel E, Judet R. Fractures of the acetabulum. New York: Springer; 1981.

    Book  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Sharma.

Ethics declarations

Ethical clearance has been taken from the institutional ethical committee.

Funding

None.

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maini, L., Sharma, A., Jha, S. et al. Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation?. Eur J Trauma Emerg Surg 44, 215–224 (2018). https://doi.org/10.1007/s00068-016-0738-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-016-0738-6

Keywords

Navigation