A feasibility study into the use of three-dimensional printer modelling in acetabular fracture surgery.
Bottom Line: There are a number of challenges associated with the operative treatment of acetabular fractures.This leads to a reduction in the associated soft tissue trauma, reduced intraoperative time and blood loss, minimal handling of the plate, and reduced fluoroscopic screening times.We feel that the use of this technology to customize implants, plates, and the operative procedure to a patient's unique anatomy can only lead to improved outcomes.
Affiliation: St Mary's Hospital, London W2 1NY, UK.
There are a number of challenges associated with the operative treatment of acetabular fractures. The approach used is often extensive, while operative time and perioperative blood loss can also be significant. With the proliferation of 3D printer technology, we present a fast and economical way to aid the operative planning of complex fractures. We used augmented stereoscopic 3D CT reconstructions to allow for an appreciation of the normal 3D anatomy of the pelvis on the fractured side and to use the models for subsequent intraoperative contouring of pelvic reconstruction plates. This leads to a reduction in the associated soft tissue trauma, reduced intraoperative time and blood loss, minimal handling of the plate, and reduced fluoroscopic screening times. We feel that the use of this technology to customize implants, plates, and the operative procedure to a patient's unique anatomy can only lead to improved outcomes.
No MeSH data available.
Related in: MedlinePlus
Mentions: In the supine position, the left leg was draped for traction to be applied by a surgical assistant. All 3 windows were developed and used. The intraoperative tactic involved identification of the anterior column fracture and removal of any loose bone fragments preventing reduction. Development of the middle window allowed visualisation of the quadrilateral plate and posterior column fragments. The medial subluxation and the anterior column fragments were reduced with use of traction and a Matta offset pelvic clamp to hold the reduction. This was temporarily augmented with 2 mm threaded wires. Concurrently an assistant used the 3D model to size a pelvic reconstruction plate (Synthes Inc., West Chester, USA) to place on the pelvic brim and contoured it appropriately. The plate was introduced onto to the anterior column via the medial window and moved into position using all 3 windows. No further contouring was required to enable it to sit on the pelvic brim appropriately; screws were inserted to hold the anterior column reduction. The posterior column/quadrilateral plate fragment was held using the previously planned screw trajectory on the 3D model (Figure 5) to provide absolute stability of fracture reduction. Fluoroscopic views were obtained to ensure that reduction was anatomical and there was no evidence of intra-articular screw penetration. The procedures took on average 146 minutes, with an average estimated blood loss of 450 mls. Use of a red cell saver in patient 2 allowed recovery and infusion of 162 mls of the patient's own blood.
No MeSH data available.