Abstract
Computed tomography (CT) scans with 3-dimensional (3D) reconstruction are the gold
standard of imaging for complex fractures. However, visualising CT imaging can be
challenging. With increasing access to 3D printing, we postulate that life-sized 3D
models can better assist in visualising CT images, aiding preoperative planning of
tibial plafond fractures. 3D models of 3 tibial plafond fractures of differing complexities
were printed. We approached surgeons in our institution who manage tibial plafond
fractures to complete a questionnaire on preoperative planning of the cases based
on CT scans. We then examined whether analysing the 3D models after that changed the
plan. This included ratings on the usefulness, accuracy, and ease of use of the models.
Six surgeons participated in the study. In the simple fracture model, median usefulness
was graded as 4.5 (range minimum to maximum: 0 to 7), accuracy 8 (4 to 10), and ease
of use 9 (7 to 10) with 0 being the lowest and 10 being the upper limit of how useful,
accurate, or easy to use the models were. For the intermediate fracture, median usefulness
was 6.5 (2 to 8), accuracy 7.5 (3 to 10), and ease of use 8.5 (7 to 10). For the complex
fracture, median usefulness was 6 (1 to 9), accuracy 7.5 (1 to 9), and ease of use
8.5 (0 to 9). We attribute these poorer scores to difficulty in processing the scans,
resulting in less accurate printing of the many fragments in complex impacted fractures.
In conclusion, 3D-printed models are easy to use and accurate in preoperative planning
of tibial plafond fractures. Most surgeons believe that 3D models and CT scans combined
were more useful than CT scans alone.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Rapid prototyping for orthopaedic surgery.Proc Inst Mech Eng H. 1998; 212: 383-393
- Three dimensional (3D) modeling and surgical planning in trauma and orthopaedics.Surgeon. 2014; 12: 328-333
- Fractures of the tibia plafond. The pilon fracture.Orthop Clin North Am. 1987; 18: 95-104
- Fractures of the tibial pilon.Clin Orthop Relat Res. 1988; 230: 68-82
- Pilon fractures of the distal tibia.Orthop Rev. 1993; 22: 987-996
- Manual of Internal Fixation. Techniques Recommended by The AO Group.Springer Verlag, Berlin1990
- Optimal number of response categories in rating scales: reliability, validity, discriminating power, and respondent preferences.Acta Psychologica. 2000; 104: 1-15
- Utility of 3D printing for complex distal tibial fractures and malleolar avulsion fractures: technical tip.Foot Ankle Int. 2015; 36: 1504-1510
- Preshaping plates for minimally invasive fixation of calcaneal fractures using a real-size 3D-printed model as a preoperative and intraoperative tool.Foot Ankle Int. 2014; 35: 1231-1236
- 3-Dimensional prebent plate fixation in corrective osteotomy of malunited upper extremity fractures using a real-sized plastic bone model prepared by preoperative computer simulation.J Hand Surg Am. 2013; 38: 909-919
- Additive manufacturing applications in orthopaedics: a review.J Clin Orthop Trauma. 2018; 9: 202-206
- Stryker orthopaedic modeling and analytics (SOMA): a review.Surg Technol Int. 2018; 32: 315-332
- A numeric approach for anatomic plate design.Injury. 2018; 49: 96-101
- Surgical applications of three-dimensional printing: a review of the current literature and how to get started.Ann Transl Med. 2016; 4: 456
- Preoperative planning in orthopaedic surgery: current practice and evolving applications.Bull Hosp Jt Dis. 2015; 73: 257-268
- A combination of three-dimensional printing and computer-assisted virtual surgical procedure for preoperative planning of acetabular fracture reduction.Injury. 2016; 47: 2223-2227
- Rapid prototyping: the future of trauma surgery?.J Bone Joint Surg Am. 2003; 85: 49-55
- Use of 3D printing in orthopaedic surgical planning.JAAOS Glob Res Rev. 2018; 2: e071
- The Effect of Sterilization on Plastics and Elastomers.3rd ed. Elsevier, NY2012: 85-92
- Custom-made cutting guide for total knee arthroplasty.in: Scott N Insall & Scott Surgery of the Knee. 5th ed. Churchill Livingstone, London2011: 1240-1254
- Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures.Injury. 2007; 38: 1158-1162
- Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures.Eur J Radiol. 2011; 80: 814-820
- Putting 3D modeling and 3D printing into practice: virtual surgery and preoperative planning to reconstruct complex post-traumatic skeletal deformities and defects.SICOT J. 2017; 3: 16
- 3D printing: clinical applications in orthopaedics and traumatology.EFORT Open Rev. 2016; 1: 121-127
- Overview of emerging technology in orthopedic surgery: what is the value in 3D modeling and printing?.Tech Orthop. 2016; 31: 143-152
- Three-dimensional printing of complex biological structures by freeform reversible embedding of suspended hydrogels.Sci Adv. 2015; 1e1500758
- Hybrid 3D printing: a game-changer in personalized cardiac medicine?.Expert Rev Cardiovasc Ther. 2015; 13: 1281-1284
- Three-dimensional printing model as a tool to assist in surgery for large mandibular tumour: a case report.J Oral Maxillofac Res. 2017; 8: e4
Article info
Publication history
Published online: May 10, 2019
Footnotes
Financial Disclosure: Author G.L.F discloses an AO Trauma Asia Pacific research grant (ref: AOTAP14-10).
Conflict of Interest: None reported.
Identification
Copyright
© 2018 by the American College of Foot and Ankle Surgeons. All rights reserved.
