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Farid AR, Comtesse S, Sagi HC, Frosch KH, Weaver MJ, Yoon RS, von Keudell A. Enabling Technology in Fracture Surgery: State of the Art. J Bone Joint Surg Am 2025:00004623-990000000-01468. [PMID: 40424369 DOI: 10.2106/jbjs.24.00938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2025]
Abstract
➢ Three-dimensional (3D) printing and virtual modeling, using computed tomographic (CT) scans as a base for the 3D-printed model, help surgeons to visualize relevant anatomy, may provide a better understanding of fracture planes, may help to plan surgical approaches, and can possibly simulate surgical fixation options.➢ Navigation systems create real-time 3D maps of patient anatomy intraoperatively, with most literature in orthopaedic trauma thus far demonstrating efficacy in percutaneous screw placement using preoperative imaging data or intraoperative markers.➢ Augmented reality and virtual reality are new applications in orthopaedic trauma, with the former in particular demonstrating the potential utility in intraoperative visualization of implant placement.➢ Use of 3D-printed metal implants has been studied in limited sample sizes thus far. However, early results have suggested that they may have good efficacy in improving intraoperative measures and postoperative outcomes.
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Affiliation(s)
- Alexander R Farid
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Simon Comtesse
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - H Claude Sagi
- Department of Orthopedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
| | - Michael J Weaver
- Harvard Orthopaedic Trauma Initiative, Boston, Massachusetts
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard S Yoon
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center/Saint Barnabas Medical Center-RWJBarnabas Health, Livingston/Jersey City, New Jersey
| | - Arvind von Keudell
- Harvard Orthopaedic Trauma Initiative, Boston, Massachusetts
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen, Denmark
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Bruns N, Omar M. [3D printing/implants in traumatology]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2025; 128:329-336. [PMID: 40064703 DOI: 10.1007/s00113-025-01546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/28/2025] [Indexed: 03/19/2025]
Abstract
The use of 3D printing offers numerous application possibilities in traumatology, including anatomic models, repositioning and drilling guides as well as patient-specific implants. The greatest challenge lies in the rapid availability as many procedures require an immediate intervention. Anatomic models support surgical planning by complementing visual impressions with tactile ones. Printed models not only help in the establishment of surgical strategies but also enhance patient clarification. Studies demonstrate that these models significantly reduce the operating time, duration of fluoroscopy and blood loss, particularly for joint fractures. Repositioning and drilling guides simplify complex procedures and improve outcomes; however, they require precise planning and critical evaluation by the surgeon. Intraoperative guides are helpful, for instance, in accurately placing screws, especially in difficult to access areas or in metaphyseal fractures lacking clear references. Individualized implants play a lesser role in acute care but are useful for posttraumatic defects or corrective osteotomy. In the conservative segment, such as customized splints, 3D printing is being tested but with mixed results. Key requirements for 3D printing in traumatology include high-resolution computed tomography (CT), precise data processing and swift production. Regulatory hurdles and lack of reimbursement currently limit the widespread use. An optimized collaboration between technology and medicine, along with standardized processes, are essential for effectively integrating this technology into practice.
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Affiliation(s)
- Nico Bruns
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
| | - Mohamed Omar
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
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van Luit RJ, Rijntjes J, Hekman E, Govaert L, Hollman F, Schröder FF, Veen EJ. Development of a virtual surgical plan for reverse shoulder arthroplasty as a treatment for complex proximal humerus fracture in an elderly patient. JSES REVIEWS, REPORTS, AND TECHNIQUES 2025; 5:92-96. [PMID: 39872343 PMCID: PMC11764555 DOI: 10.1016/j.xrrt.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2025]
Affiliation(s)
- Roelof J. van Luit
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Jessie Rijntjes
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
- Medical 3D Lab, Medical Spectrum Twente, Enschede, The Netherlands
- Technical Medicine, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Edsko Hekman
- Faculty of Engineering Technology, Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Lonneke Govaert
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Freek Hollman
- Department of Orthopaedic Surgery, Viecuri Medical Centre, Venlo, The Netherlands
| | - Femke F. Schröder
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
- Medical 3D Lab, Medical Spectrum Twente, Enschede, The Netherlands
- Faculty of Engineering Technology, Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Egbert J.D. Veen
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
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Liang H, Chen B, Duan S, Yang L, Xu R, Zhang H, Sun M, Zhou X, Liu H, Wen H, Cai Z. Treatment of complex limb fractures with 3D printing technology combined with personalized plates: a retrospective study of case series and literature review. Front Surg 2024; 11:1383401. [PMID: 38817945 PMCID: PMC11137251 DOI: 10.3389/fsurg.2024.1383401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND In recent years, 3D printing technology has made significant strides in the medical field. With the advancement of orthopedics, there is an increasing pursuit of high surgical quality and optimal functional recovery. 3D printing enables the creation of precise physical models of fractures, and customized personalized steel plates can better realign and more comprehensively and securely fix fractures. These technologies improve preoperative diagnosis, simulation, and planning for complex limb fractures, providing patients with better treatment options. PATIENTS AND METHODS Five typical cases were selected from a pool of numerous patients treated with 3D printing technology combined with personalized custom steel plates at our hospital. These cases were chosen to demonstrate the entire process of printing 3D models and customizing individualized steel plates, including details of the patients' surgeries and treatment procedures. Literature reviews were conducted, with a focus on highlighting the application of 3D printing technology combined with personalized custom steel plates in the treatment of complex limb fractures. RESULTS 3D printing technology can produce accurate physical models of fractures, and personalized custom plates can achieve better fracture realignment and more comprehensive and robust fixation. These technologies provide patients with better treatment options. CONCLUSION The use of 3D printing models and personalized custom steel plates can improve preoperative diagnosis, simulation, and planning for complex limb fractures, realizing personalized medicine. This approach helps reduce surgical time, minimize trauma, enhance treatment outcomes, and improve patient functional recovery.
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Affiliation(s)
- Hairui Liang
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Beibei Chen
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Siyu Duan
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Lei Yang
- School of Pharmacy, Inner Mongolia Medical University, Inner Mongolia Autonomous Region, Shenyang, China
| | - Rongda Xu
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - He Zhang
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Ming Sun
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Xueting Zhou
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Hanfei Liu
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Hang Wen
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
| | - Zhencun Cai
- Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, Liaoning, China
- Key Laboratory of Human Ethnic Specificity and Phenomics of Critical Illness in Liaoning Province, Shenyang Medical College, Shenyang, China
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Miao K, Wang J, Yu K, Hong J, Lu X. Percutaneous reduction and cannulated screw fixation assisted by 3D printing technology of calcaneal fractures in children. J Orthop Sci 2024; 29:236-242. [PMID: 36550014 DOI: 10.1016/j.jos.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Percutaneous reduction and cannulated screw fixation (PR + CSF) for treatment of calcaneal fractures in pediatric patients has been proven to achieve satisfactory outcomes with few complications. But it is also a difficult technology due to the limited exposure and surgeons are unable to reduce articular surface under direct vision. The purpose of this study was to analyze the outcomes of applying 3D printing technology to preoperative preparation and Intraoperative operating for the treatment of calcaneal fractures in children. METHODS Pediatric patients with calcaneal fractures from January 2010 to December 2018 were reviewed during study period. Preoperative radiographs and computed tomography scans were collected to classify the fractures, reconstruct 3D printed model and evaluate postoperative outcomes. The blood loss, operative time, number of fluoroscopies, surgeon and patient satisfaction were used to assess the effectiveness, feasibility and safety of 3D printing technology. Functional results were measured by American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. RESULT 12 patients (10 boys and 2 girls) with 17 fractures were involved in our study. There were significant differences in the average Böhler angle before operation compared with that after operation and at last follow-up (P < 0.001). Similarly, the calcaneal height and length postoperatively and at the end of follow-up time were proved to have significant difference (P < 0.05) compared to preoperative. CT scan showed good reduction of the posterior facet according to Goldzak index. The average subjective AOFAS hindfoot score was 94.1. Both patients and surgeon made sense of the 3D printed model that can help them getting more information about the factures and making preoperative plans. No wound complication was found in this study. CONCLUSION This study indicated that percutaneous reduction and cannulated screw fixation (PR + CSF) assisted by 3D printing technology in the treatment of calcaneal fractures in pediatric patients achieve good outcomes, with specific preoperative preparation, satisfactory functional recovery and fewer complications. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Keze Miao
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
| | - Jianshun Wang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
| | - Kehe Yu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
| | - Jianjun Hong
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
| | - Xiaolang Lu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Department of Orthopaedics Surgery, China.
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Yasen Z, Robinson AP, Woffenden H. Advanced Preoperative Planning Techniques in the Management of Complex Proximal Humerus Fractures. Cureus 2024; 16:e51551. [PMID: 38313919 PMCID: PMC10835086 DOI: 10.7759/cureus.51551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
This review evaluates the current literature on the recent advances of preoperative planning in the management of complex proximal humerus fractures (PHF). PHFs can pose a considerable challenge for orthopaedic surgeons due to their diversity in presentation and complexity. Poor preoperative planning can lead to prolonged operations, increased blood loss, higher risk of complications, and increased stress on the surgical team. Recent advances have seen the evolution of preoperative planning from conventional methods to computer-assisted virtual surgical technology (CAVST) and three-dimensional (3D) printing, which have been highlighted as transformative tools for improving preoperative planning and postoperative outcomes. CAVST allows the creation of 3D renderings of patient-specific anatomy, clearly demonstrating fracture patterns and facilitating detailed planning for arthroplasty or surgical fixation. The early studies show promising outcomes however the literature calls for more high-quality randomised controlled trials. Using 3D printing for high-fidelity simulation involving patient-specific physical models offers an immersive experience for surgical planning. Preoperative planning with 3D printing reduces operative time, blood loss and use of fluoroscopy. The technology's potential to produce customisable surgical implants further improves its versatility. There is a need for a cost analysis for the use of these technologies within the orthopaedic field, particularly considering the high expense of 3D printing materials and extended hospital stays until the printed models are available. CAVST and 3D printing also show promising applications within high-fidelity simulation surgical training, with CAVST offering possibilities in virtual reality and haptic-enhanced simulations and 3D printing providing physical models for trainee surgeons to hone their skills. Moving forward, a reduction in the cost of 3D printing and the advancement of CAVST using artificial intelligence would lead to future improvement. In conclusion, preoperative planning supported by these innovative technologies will play a pivotal role in improving surgical outcomes and training for complex PHF cases.
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Affiliation(s)
- Zaid Yasen
- Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, London, GBR
| | - Andrew P Robinson
- Trauma and Orthopaedics, Lewisham and Greenwich NHS Trust, London, GBR
| | - Hugo Woffenden
- General Surgery, HMS Nelson Medical Centre, Ministry of Defence, London, GBR
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Raghoebar II, Dubois L, de Lange J, Schepers T, Don Griot P, Essig H, Rozema F. The Effectiveness of Three-Dimensional Osteosynthesis Plates versus Conventional Plates for the Treatment of Skeletal Fractures: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4661. [PMID: 37510776 PMCID: PMC10380957 DOI: 10.3390/jcm12144661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To assess the difference between preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates for the treatment of skeletal fractures in terms of anatomical reduction, operation time, approach, patient outcomes, and complications. MATERIAL AND METHODS MEDLINE (1950 to February 2023), EMBASE (1966 to February 2023), and the Cochrane Central Register of Controlled Trials (inception to February 2023) databases were searched. Eligible studies were randomised clinical trials, prospective controlled clinical trials, and prospective and retrospective cohort studies (n ≥ 10). Inclusion criteria were studies reporting the outcomes of preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates after treating skeletal fractures. Outcome measures included anatomical reduction, stability, operation time, hospitalisation days, patients' outcomes, and complications. Two independent reviewers assessed the abstracts and analysed the complete texts and methodologies of the included studies. RESULTS In total, 21 out of the 5181 primarily selected articles matched the inclusion criteria. A meta-analysis revealed a significant difference in operation time in favour of the preformed anatomical plates and patient-specific implants versus conventional plates. Significant differences in operation time were found for the orbital (95% CI: -50.70-7.49, p = 0.008), upper limb (95% CI: -17.91-6.13, p < 0.0001), and lower limb extremity groups (95% CI: -20.40-15.11, p < 0.00001). The mean difference in the rate of anatomical reduction in the lower limb extremity group (95% CI: 1.04-7.62, p = 0.04) was also in favour of using preformed anatomical plates and patient-specific implants versus conventional plates. CONCLUSIONS This systematic review showed a significant mean difference in surgery time favouring the use of preformed anatomical plates and patient-specific implants for orbital, upper, and lower limb extremity fractures. Additionally, preformed anatomical plates and patient-specific implants in the lower limb group result in a significantly higher rate of anatomical reduction versus conventional flat plates.
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Affiliation(s)
- Iva Ilse Raghoebar
- Academic Center for Dentistry (ACTA), University of Amsterdam, 1012 WX Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Peter Don Griot
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Harald Essig
- Department of Oral and Maxillofacial Surgery, University Hospital Zuerich, Frauenklinikstrasse 24, 8091 Zürich, Switzerland
| | - Frederik Rozema
- Academic Center for Dentistry (ACTA), University of Amsterdam, 1012 WX Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Masada KM, Cristino DM, Dear KA, Hast MW, Mehta S. 3-D Printed Fracture Models Improve Resident Performance and Clinical Outcomes in Operative Fracture Management. JOURNAL OF SURGICAL EDUCATION 2023; 80:1020-1027. [PMID: 37198080 DOI: 10.1016/j.jsurg.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/30/2022] [Accepted: 04/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To determine if preoperative examination of patient additive manufactured (AM) fracture models can be used to improve resident operative competency and patient outcomes. DESIGN Prospective cohort study. Seventeen matched pairs of fracture fixation surgeries (for a total of 34 surgeries) were performed. Residents first performed a set of baseline surgeries (n = 17) without AM fracture models. The residents then performed a second set of surgeries randomly assigned to include an AM model (n = 11) or to omit it (n = 6). Following each surgery, the attending surgeon evaluated the resident using an Ottawa Surgical Competency Operating Room Evaluation (O-Score). The authors also recorded clinical outcomes including operative time, blood loss, fluoroscopy duration, and patient reported outcome measurement information system (PROMIS) scores of pain and function at 6 months. SETTING Single-center academic level one trauma center. PARTICIPANTS Twelve orthopaedic residents, between postgraduate year (PGY) 2 and 5, participated in this study. RESULTS Residents significantly improved their O-Scores between the first and second surgery when they trained with AM models for the second surgery (p = 0.004, 2.43 ± 0.79 versus 3.73 ± 0.64). Similar improvements were not observed in the control group (p = 0.916, 2.69 ± 0.69 versus 2.77 ± 0.36). AM model training also significantly improved clinical outcomes, including surgery time (p = 0.006), fluoroscopy exposure time (p = 0.002), and patient reported functional outcomes (p = 0.0006). CONCLUSIONS Conclusions: Training with AM fracture models improves the performance of orthopaedic surgery residents during fracture surgery.
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Affiliation(s)
- Kendall M Masada
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Danielle M Cristino
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kayley A Dear
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael W Hast
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samir Mehta
- McKay Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Grinčuk A, Petryla G, Masionis P, Sveikata T, Uvarovas V, Makulavičius A. Short-term results and complications of the operative treatment of the distal radius fracture AO2R3 C type, planned by using 3D-printed models. Prospective randomized control study. J Orthop Surg (Hong Kong) 2023; 31:10225536231195127. [PMID: 37620284 DOI: 10.1177/10225536231195127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
PURPOSE 3D-printed models rapidly evolving in orthopaedic. Studies show that 3D-printed models used for preoperative planning improve a better understanding of fracture morphology and reduce operative time, blood loss and frequency of fluoroscopy, but there are no studies that investigated possible advantages in the outcomes and complications for the treatment of distal radius fracture (DRF). Our study aims to evaluate short-term functional results and complications between two groups treated DRF using 3D-printed models for preoperative planning and without. We hypothesize that the addition of 3D-printed models would improve functional outcomes and reduce complication rates. METHODS 66 randomized cases of DRF AO/OTA C type were enrolled and divided into "Control group" (n = 33) and "3D-printed model group" (n = 33). Personalized 3D-printed models were created. The primary outcomes were: Patient-Rated Wrist Evaluation questionnaire, Quick Disabilities of the Arm, Shoulder and Hand Score questionnaire, and complications. The secondary outcomes were: measurement of the range of motions, grip strength, radiological evaluation, and the visual analogue scale. Assessments were measured at 6 weeks, 3 months, and 6 months intervals. RESULTS We found that the integration of the 3D-printed model in preoperative planning decreased complication incidence significantly - from 30.3% in the "Control group" to 6.1% in the "3D-printed model group", p = .022. But we did not find a difference in functional and radiological outcomes. CONCLUSION The 3D-printed models for preoperative planning surgically treating DRF AO/OTA C type can help minimize the complication rate, however, they can't improve functional outcomes in the short-term results. LEVEL OF EVIDENCE Level I randomized controlled study.
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Affiliation(s)
- Aleksandr Grinčuk
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedrius Petryla
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Povilas Masionis
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Sveikata
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Valentinas Uvarovas
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aleksas Makulavičius
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Wu RJ, Zhang W, Lin YZ, Fang ZL, Wang KN, Wang CX, Yu DS. Influence of preoperative simulation on the reduction quality and clinical outcomes of open reduction and internal fixation for complex proximal humerus fractures. BMC Musculoskelet Disord 2023; 24:243. [PMID: 36997961 PMCID: PMC10061994 DOI: 10.1186/s12891-023-06348-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Proximal humerus fractures (PHFs) are common. With the development of locking plates, open reduction and internal fixation (ORIF) of the proximal humerus can provide excellent clinical outcomes. The quality of fracture reduction is crucial in the locking plate fixation of proximal humeral fractures. The purpose of this study was to determine the impact of 3-dimensional (3D) printing technology and computer virtual technology assisted preoperative simulation on the reduction quality and clinical outcomes of 3-part and 4-part proximal humeral fractures. METHOD A retrospective comparative analysis of 3-part and 4-part PHFs undergoing open reduction internal fixation was performed. Patients were divided into 2 groups according to whether computer virtual technology and 3D printed technology were used for preoperative simulation: the simulation group and the conventional group. Operative time, intraoperative bleeding, hospital stay, quality of fracture reduction, Constant scores, American Society for Shoulder and Elbow Surgery (ASES) scores, shoulder range of motion, complications, and revision surgeries were assessed. RESULTS This study included 67 patients (58.3%) in the conventional group and 48 patients (41.7%) in the simulation group. The patient demographics and fracture characteristics were comparable in these groups. Compared with the conventional group, the simulation group had shorter operation time and less intraoperative bleeding (P < 0.001, both). Immediate postoperative assessment of fracture reduction showed a higher incidence of greater tuberosity cranialization of < 5 mm, neck-shaft angle of 120° to 150°, and head shaft displacement of < 5 mm in the simulation group. The incidence of good reduction was 2.6 times higher in the simulation group than in the conventional group (95% CI, 1.2-5.8). At the final follow-up, the chance of forward flexion > 120° (OR 5.8, 95% CI 1.8-18.0) and mean constant score of > 65 (OR 3.4, 95% CI 1.5-7.4) was higher in the simulation group than the conventional group, as well as a lower incidence of complications in the simulation group was obtained (OR 0.2, 95% CI 0.1-0.6). CONCLUSIONS This study identified that preoperative simulation assisted by computer virtual technology and 3D printed technology can improve reduction quality and clinical outcomes in treatment of 3-part and 4-part PHFs.
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Affiliation(s)
- Rui-Ji Wu
- Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- The Second Affiliated College of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Wei Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yan-Ze Lin
- Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- The Second Affiliated College of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Zhang-Lu Fang
- Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- The Second Affiliated College of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Kang-Nan Wang
- Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- The Second Affiliated College of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Chang-Xing Wang
- The Second Affiliated College of Zhejiang Chinese Medicine University, Hangzhou, China
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dong-Sheng Yu
- Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
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11
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Uchida DT, Bruschi ML. 3D Printing as a Technological Strategy for the Personalized Treatment of Wound Healing. AAPS PharmSciTech 2023; 24:41. [PMID: 36698047 PMCID: PMC9876655 DOI: 10.1208/s12249-023-02503-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Wound healing is a dynamic process which involves stages of hemostasis, inflammation, proliferation and remodeling. Any error in this process results in abnormal wound healing, generating financial burdens for health systems and even affecting the physical and mental health of the patient. Traditional dressings do not meet the complexities of ideal treatment in all types of wounds. For this reason, in the last decades, different materials for drug delivery and for the treatment of wounds have been proposed reaching novel level of standards, such as 3D printing techniques. The use of natural or synthetic polymers, and the correct design of these printed products loaded with cells and/or combined with active compounds, can generate an effective system for the treatment of wounds, improving the healing process and generating customized dressings according to the patient needs. This manuscript provides a comprehensive review of different types of 3D printing techniques, as well as its use in wound healing and its different stages, including the advantages and limitations of additive manufacturing and future perspectives.
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Affiliation(s)
- Denise Tiemi Uchida
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Research and Development of Drug Delivery Systems, Department of Pharmacy, State University of Maringa, Avenida Colombo, n. 5790, K68, S05, 87020-900, Maringa, PR, Brazil
| | - Marcos Luciano Bruschi
- Postgraduate Program in Pharmaceutical Sciences, Laboratory of Research and Development of Drug Delivery Systems, Department of Pharmacy, State University of Maringa, Avenida Colombo, n. 5790, K68, S05, 87020-900, Maringa, PR, Brazil.
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Robb H, Scrimgeour G, Boshier P, Przedlacka A, Balyasnikova S, Brown G, Bello F, Kontovounisios C. The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review. Surg Endosc 2022; 36:5907-5920. [PMID: 35277766 PMCID: PMC9283150 DOI: 10.1007/s00464-022-09176-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND 3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research. METHODS A scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated. RESULTS A total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found. CONCLUSION The use of 3D reconstruction is in its infancy in oesophagogastric surgery. The quality of evidence is low and key themes, such as patient engagement and education, remain unexplored. Without high quality research evaluating the application and benefits of 3D modelling, oesophagogastric surgery may be left behind.
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Affiliation(s)
- Henry Robb
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Piers Boshier
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Anna Przedlacka
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Gina Brown
- Imperial College London, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Christos Kontovounisios
- Imperial College London, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
- Chelsea Westminster NHS Foundation Trust, London, UK.
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Handoll HH, Elliott J, Thillemann TM, Aluko P, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 2022; 6:CD000434. [PMID: 35727196 PMCID: PMC9211385 DOI: 10.1002/14651858.cd000434.pub5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Fractures of the proximal humerus, often termed shoulder fractures, are common injuries, especially in older people. The management of these fractures varies widely, including in the use of surgery. This is an update of a Cochrane Review first published in 2001 and last updated in 2015. OBJECTIVES To assess the effects (benefits and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trial registries, and bibliographies of trial reports and systematic reviews to September 2020. We updated this search in November 2021, but have not yet incorporated these results. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that compared non-pharmacological interventions for treating acute proximal humeral fractures in adults. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected studies, assessed risk of bias and extracted data. We pooled data where appropriate and used GRADE for assessing the certainty of evidence for each outcome. We prepared a brief economic commentary for one comparison. MAIN RESULTS We included 47 trials (3179 participants, mostly women and mainly aged 60 years or over) that tested one of 26 comparisons. Six comparisons were tested by 2 to 10 trials, the others by small single-centre trials only. Twelve studies evaluated non-surgical treatments, 10 compared surgical with non-surgical treatments, 23 compared two methods of surgery, and two tested timing of mobilisation after surgery. Most trials were at high risk of bias, due mainly to lack of blinding. We summarise the findings for four key comparisons below. Early (usually one week post injury) versus delayed (after three or more weeks) mobilisation for non-surgically-treated fractures Five trials (350 participants) made this comparison; however, the available data are very limited. Due to very low-certainty evidence from single trials, we are uncertain of the findings of better shoulder function at one year in the early mobilisation group, or the findings of little or no between-group difference in function at 3 or 24 months. Likewise, there is very low-certainty evidence of no important between-group difference in quality of life at one year. There was one reported death and five serious shoulder complications (1.9% of 259 participants), spread between the two groups, that would have required substantive treatment. Surgical versus non-surgical treatment Ten trials (717 participants) evaluated surgical intervention for displaced fractures (66% were three- or four-part fractures). There is high-certainty evidence of no clinically important difference between surgical and non-surgical treatment in patient-reported shoulder function at one year (standardised mean difference (SMD) 0.10, 95% confidence interval (CI) -0.07 to 0.27; 7 studies, 552 participants) and two years (SMD 0.06, 95% CI -0.13 to 0.25; 5 studies, 423 participants). There is moderate-certainty evidence of no clinically important between-group difference in patient-reported shoulder function at six months (SMD 0.17, 95% CI -0.04 to 0.38; 3 studies, 347 participants). There is high-certainty evidence of no clinically important between-group difference in quality of life at one year (EQ-5D (0: dead to 1: best quality): mean difference (MD) 0.01, 95% CI -0.02 to 0.04; 6 studies, 502 participants). There is low-certainty evidence of little between-group difference in mortality: one of the 31 deaths was explicitly linked with surgery (risk ratio (RR) 1.35, 95% CI 0.70 to 2.62; 8 studies, 646 participants). There is low-certainty evidence of a higher risk of additional surgery in the surgery group (RR 2.06, 95% CI 1.21 to 3.51; 9 studies, 667 participants). Based on an illustrative risk of 35 subsequent operations per 1000 non-surgically-treated patients, this indicates an extra 38 subsequent operations per 1000 surgically-treated patients (95% CI 8 to 94 more). Although there was low-certainty evidence of a higher overall risk of adverse events after surgery, the 95% CI also includes a slightly increased risk of adverse events after non-surgical treatment (RR 1.46, 95% CI 0.92 to 2.31; 3 studies, 391 participants). Open reduction and internal fixation with a locking plate versus a locking intramedullary nail Four trials (270 participants) evaluated surgical intervention for displaced fractures (63% were two-part fractures). There is low-certainty evidence of no clinically important between-group difference in shoulder function at one year (SMD 0.15, 95% CI -0.12 to 0.41; 4 studies, 227 participants), six months (Disability of the Arm, Shoulder, and Hand questionnaire (0 to 100: worst disability): MD -0.39, 95% CI -4.14 to 3.36; 3 studies, 174 participants), or two years (American Shoulder and Elbow Surgeons score (ASES) (0 to 100: best outcome): MD 3.06, 95% CI -0.05 to 6.17; 2 studies, 101 participants). There is very low-certainty evidence of no between-group difference in quality of life (1 study), and of little difference in adverse events (4 studies, 250 participants) and additional surgery (3 studies, 193 participants). Reverse total shoulder arthroplasty (RTSA) versus hemiarthroplasty There is very low-certainty evidence from two trials (161 participants with either three- or four-part fractures) of no or minimal between-group differences in self-reported shoulder function at one year (1 study) or at two to three years' follow-up (2 studies); or in quality of life at one year or at two or more years' follow-up (1 study). Function at six months was not reported. Of 10 deaths reported by one trial (99 participants), one appeared to be surgery-related. There is very low-certainty evidence of a lower risk of complications after RTSA (2 studies). Ten people (6.2% of 161 participants) had a reoperation; all eight cases in the hemiarthroplasty group received a RTSA (very low-certainty evidence). AUTHORS' CONCLUSIONS There is high- or moderate-certainty evidence that, compared with non-surgical treatment, surgery does not result in a better outcome at one and two years after injury for people with displaced proximal humeral fractures. It may increase the need for subsequent surgery. The evidence is absent or insufficient for people aged under 60 years, high-energy trauma, two-part tuberosity fractures or less common fractures, such as fracture dislocations and articular surface fractures. There is insufficient evidence from randomised trials to inform the choices between different non-surgical, surgical or rehabilitation interventions for these fractures.
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Affiliation(s)
- Helen Hg Handoll
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
- Department of Orthopaedics and Trauma, The University of Edinburgh, Edinburgh, UK
| | - Joanne Elliott
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Theis M Thillemann
- Department of Orthopaedics, Shoulder and Elbow Unit, Aarhus University Hospital, Aarhus N, Denmark
| | - Patricia Aluko
- National Institute for Health Research (NIHR) Innovation Observatory, Newcastle University, Newcastle upon Tyne, UK
| | - Stig Brorson
- Centre for Evidence-Based Orthopaedics, Zealand University Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abstract
The 3D printing technology is a relatively new procedure with a high potential, especially in the field of shoulder surgery. The 3D printing procedures are increasingly being developed and also gaining new users. Principally, 3D printing procedures can be applied preoperatively in planning the surgical procedure, patient clarification and in teaching; however, the technology is increasing being used intraoperatively. In addition to intraoperative visualization of the models, 3D printing permits the use of individual and specific instruments and implants. This allows the precise transfer of the preoperative planning to the surgical procedure. Inaccuracies are mainly caused by soft tissues. The 3D printing can be beneficial in the fields of arthroplasty, shoulder instability as well as orthopedic trauma. The literature shows promising results in relation to duration of surgery, blood loss and clinical results of the procedure. On the other hand, it is still unclear which indications warrant the use of 3D printing. Other aspects that raise questions are the time of planning, the production time and the additional cost that the use of 3D printing entails. Nonetheless, 3D printing represents a meaningful enhancement of the portfolio of surgeons, which becomes highly beneficial and useful in complex situations. Furthermore, this procedure enables a certain amount of flexibility when reacting to certain circumstances.
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Fidanza A, Perinetti T, Logroscino G, Saracco M. 3D Printing Applications in Orthopaedic Surgery: Clinical Experience and Opportunities. APPLIED SCIENCES 2022; 12:3245. [DOI: 10.3390/app12073245] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Three-dimensional (3D) printing is a technology capable of creating solid objects based on the reproduction of computerised images. This technology offers revolutionary impacts on surgical practice, especially in prosthetic and traumatological surgery. Methods: 20 patients with proximal humeral fractures were divided into two groups, one of which involved the processing of a 3D model. The model made it possible to plan the positioning and dimensions of the implants. The results were then compared with those obtained according to the usual procedures. We also reported the irreparable case of a custom revision implants acetabular bone loss treated with a 3D-printed, custom-made implant. Results: In the processed 3D proximal humeral fracture series, in the face of time and costs expenses, surgical and X-ray times were shorter than in the control group. On the other hand, there were no differences in terms of blood loss. The patient who underwent acetabular re-prosthetic surgery in a 3B Paprosky bone loss was managed and solved with a 3D-printed, custom-made implant and reported excellent outcomes at a 1 year follow-up. Conclusion: Three-dimensional printing made it possible to create better pre-operative planning in traumatology in order to optimise surgical procedures and outcomes. It also made it possible to deal with large losses of bone stock in prosthetic revision surgery, even when reconstruction may have appeared impossible with traditional implants.
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Affiliation(s)
- Andrea Fidanza
- Mininvasive Orthopaedic Surgery, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Tullio Perinetti
- Department of Civil, Construction-Architectural and Environmental Engineering, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giandomenico Logroscino
- Mininvasive Orthopaedic Surgery, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Michela Saracco
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Kim H, Chung YG, Jang JS, Kim Y, Park SB, Song HS. Why locking plates for the proximal humerus do not fit well. Arch Orthop Trauma Surg 2022; 142:219-226. [PMID: 33170353 DOI: 10.1007/s00402-020-03676-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We compared the angle of the humerus and plate and to assess compatibility of a plate to the proximal humerus using three-dimensional (3D) printed models. MATERIALS AND METHODS A total of 120 cases were included, who underwent anteroposterior shoulder radiographs. From these, 30 cases with 3D shoulder computed tomography scans were randomly selected to print 3D model. The lateral angle between the lateral cortex of the humeral shaft and lateral border of the greater tuberosity (GT), neck-shaft angle, and height from the most proximal point of the GT to the angular point were measured. When the plates were applied on the 3D models, the gap from the most proximal point of the GT to the proximal rim of the plate was measured. RESULTS The mean lateral angle in plain radiographs was 12.9 ± 2.2° and height from the most proximal point of the GT to the angular point was 44.4 ± 4.7 mm. The bending angles of the three plates were 8° and 10°. Height from the proximal rim of the plate to the bending point was 42.4, 42.0 and 43.8 mm. In 98% of cases, the lateral angle of the humerus was larger than all three plates. In 43% of cases, height of the GT was smaller than height of plates. When plates were applied to the 3D model, the mean gap from GT to plate was 4.8 ± 2.8 mm. CONCLUSIONS There was large variation in the lateral angle of the proximal humerus, which was not correlated with the neck-shaft angle. The lateral angle of the humerus was larger than the plates and prone to varus reduction and medial collapse. LEVEL OF EVIDENCE OR CLINICAL RELEVANCE Basic science study.
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Affiliation(s)
- Hyungsuk Kim
- Department of Orthopedic Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Yang-Guk Chung
- College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Seok Jang
- Department of Orthopedic Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Yongdeok Kim
- Department of Orthopedic Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Soo Bin Park
- Department of Orthopedic Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Hyun Seok Song
- Department of Orthopedic Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
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Cocco LF, Aihara AY, Lopes FPPL, Werner H, Franciozi CE, dos Reis FB, Luzo MVM. Three-dimensional printing models increase inter-rater agreement for classification and treatment of proximal humerus fractures. Patient Saf Surg 2022; 16:5. [PMID: 35057844 PMCID: PMC8772160 DOI: 10.1186/s13037-021-00312-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Proximal humerus fractures (PHF) are frequent, however, several studies show low inter-rater agreement in the diagnosis and treatment of these injuries. Differences are usually related to the experience of the evaluators and/or the diagnostic methods used. This study was designed to investigate the hypothesis that shoulder surgeons and diagnostic imaging specialists using 3D printing models and shoulder CT scans in assessing proximal humerus fractures. METHODS We obtained 75 tomographic exams of PHF to print three-dimensional models. After, two shoulder surgeons and two specialists in musculoskeletal imaging diagnostics analyzed CT scans and 3D models according to the Neer and AO/OTA group classification and suggested a treatment recommendation for each fracture based on the two diagnostic methods. RESULTS The classification agreement for PHF using 3D printing models among the 4 specialists was moderate (global k = 0.470 and 0.544, respectively for AO/OTA and Neer classification) and higher than the CT classification agreement (global k = 0.436 and 0.464, respectively for AO/OTA and Neer). The inter-rater agreement between the two shoulder surgeons were substantial. For the AO/OTA classification, the inter-rater agreement using 3D printing models was higher (k = 0.700) than observed for CT (k = 0.631). For Neer classification, inter-rater agreement with 3D models was similarly higher (k = 0.784) than CT images (k = 0.620). On the other hand, the inter-rater agreement between the two specialists in diagnostic imaging was moderate. In the AO/OTA classification, the agreement using CT was higher (k = 0.532) than using 3D printing models (k = 0.443), while for Neer classification, the agreement was similar for both 3D models (k = 0.478) and CT images (k = 0.421). Finally, the inter-rater agreement in the treatment of PHF by the 2 surgeons was higher for both classifications using 3D printing models (AO/OTA-k = 0.818 for 3D models and k = 0.537 for CT images). For Neer classification, we saw k = 0.727 for 3D printing models and k = 0.651 for CT images. CONCLUSION The insights from this diagnostic pilot study imply that for shoulder surgeons, 3D printing models improved the diagnostic agreement, especially the treatment indication for PHF compared to CT for both AO/OTA and Neer classifications On the other hand, for specialists in diagnostic imaging, the use of 3D printing models was similar to CT scans for diagnostic agreement using both classifications. TRIAL REGISTRATION Brazil Platform under no. CAAE 12273519.7.0000.5505.
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Affiliation(s)
- Luiz Fernando Cocco
- Department of Orthopedic, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital Samaritano Higienópolis Américas Serviços Médicos, São Paulo, Brasil
| | - André Yui Aihara
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | | | | | - Carlos Eduardo Franciozi
- Department of Orthopedic, Orthopaedic Surgeon, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Fernando Baldy dos Reis
- Department of Orthopedic, Orthopaedic Surgeon, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Marcus Vinicius Malheiros Luzo
- Department of Orthopedic, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital Samaritano Higienópolis Américas Serviços Médicos, São Paulo, Brasil
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Li K, Liu Z, Li X, Wang J. 3D printing-assisted surgery for proximal humerus fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 48:3493-3503. [PMID: 34997257 DOI: 10.1007/s00068-021-01851-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
AIM This study aimed to assess the efficacy of three-dimensional (3D) printing to conventional surgeries in proximal humerus fractures (PHFs). METHODS Eight databases were comprehensively searched for data on clinical characteristics and outcomes, including operation time, time to bone healing, blood loss volume, number of intraoperative fluoroscopies, the reduction rate of anatomic proximal humeri, Constant scores, Neer rating, loss of humeral head height, and complications. These data were compared between 3D printing-assisted versus conventional surgeries to learn the efficacy of 3D printing-assisted surgery. RESULTS 3D printing-assisted surgery outperformed conventional procedures in operation time, blood loss volume, time to the union of PHFs, number of fluoroscopies, the reduction rate of anatomic proximal humeri, Constant scores, Neer rating, and complications. CONCLUSION 3D printing-assisted surgery improves operation time, anatomic healing, pain, and motion, with less harm to patients.
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Affiliation(s)
- Kai Li
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Zhendong Liu
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Xiaolei Li
- Department of Orthopaedics, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
| | - Jingcheng Wang
- Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China.
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Gruson KI. CORR Insights®: 3D-printed Handheld Models Do Not Improve Recognition of Specific Characteristics and Patterns of Three-part and Four-part Proximal Humerus Fractures. Clin Orthop Relat Res 2022; 480:160-162. [PMID: 34673664 PMCID: PMC8673958 DOI: 10.1097/corr.0000000000002017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/27/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Konrad I Gruson
- Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York, USA
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Wong RMY, Wong PY, Liu C, Chung YL, Wong KC, Tso CY, Chow SKH, Cheung WH, Yung PSH, Chui CS, Law SW. 3D printing in orthopaedic surgery: a scoping review of randomized controlled trials. Bone Joint Res 2021; 10:807-819. [PMID: 34923849 PMCID: PMC8696518 DOI: 10.1302/2046-3758.1012.bjr-2021-0288.r2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS The use of 3D printing has become increasingly popular and has been widely used in orthopaedic surgery. There has been a trend towards an increasing number of publications in this field, but existing literature incorporates limited high-quality studies, and there is a lack of reports on outcomes. The aim of this study was to perform a scoping review with Level I evidence on the application and effectiveness of 3D printing. METHODS A literature search was performed in PubMed, Embase, and Web of Science databases. The keywords used for the search criteria were ((3d print*) OR (rapid prototyp*) OR (additive manufactur*)) AND (orthopaedic). The inclusion criteria were: 1) use of 3D printing in orthopaedics, 2) randomized controlled trials, and 3) studies with participants/patients. Risk of bias was assessed with Cochrane Collaboration Tool and PEDro Score. Pooled analysis was performed. RESULTS Overall, 21 studies were included in our study with a pooled total of 932 participants. Pooled analysis showed that operating time (p < 0.001), blood loss (p < 0.001), fluoroscopy times (p < 0.001), bone union time (p < 0.001), pain (p = 0.040), accuracy (p < 0.001), and functional scores (p < 0.001) were significantly improved with 3D printing compared to the control group. There were no significant differences in complications. CONCLUSION 3D printing is a rapidly developing field in orthopaedics. Our findings show that 3D printing is advantageous in terms of operating time, blood loss, fluoroscopy times, bone union time, pain, accuracy, and function. The use of 3D printing did not increase the risk of complications. Cite this article: Bone Joint Res 2021;10(12):807-819.
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Affiliation(s)
- Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Pui Yan Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Chaoran Liu
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yik Lok Chung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kwok Chuen Wong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chi Yin Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Chun Sing Chui
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sheung Wai Law
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hong Kong, Hong Kong
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Preoperative Planning Using 3D Printing Technology in Orthopedic Surgery. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7940242. [PMID: 34676264 PMCID: PMC8526200 DOI: 10.1155/2021/7940242] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
The applications of 3D printing technology in health care, particularly orthopedics, continue to broaden as the technology becomes more advanced, accessible, and affordable worldwide. 3D printed models of computed tomography (CT) and magnetic resonance image (MRI) scans can reproduce a replica of anatomical parts that enable surgeons to get a detailed understanding of the underlying anatomy that he/she experiences intraoperatively. The 3D printed anatomic models are particularly useful for preoperative planning, simulation of complex orthopedic procedures, development of patient-specific instruments, and implants that can be used intraoperatively. This paper reviews the role of 3D printing technology in orthopedic surgery, specifically focusing on the role it plays in assisting surgeons to have a better preoperative evaluation and surgical planning.
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González-Alonso M, Hermida-Sánchez M, Martínez-Seijas P, Ruano-Ravina A. Application of 3D printing in the treatment of appendicular skeleton fractures: Systematic review and meta-analysis. J Orthop Res 2021; 39:2083-2092. [PMID: 33280162 DOI: 10.1002/jor.24939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
The objective of this study is to evaluate, through a systematic review of the scientific literature and meta-analysis, the applications of three-dimensional (3D) printing in the surgical treatment of complex fractures of the appendicular skeleton, mainly in terms of effectiveness and safety. A systematic review of the scientific literature was conducted in MEDLINE (PubMed) and the Cochrane Library combining different keywords. A specific methodological assessment scale was developed and applied to included papers. Ten studies were included; all of them were controlled trials, except for one retrospective observational cohort study. We observed statistically significant differences between the group that used 3D printing and the control group in terms of reduction in surgical time, reduction in the volume of blood lost during surgery and reduction in the number of intraoperative fluoroscopies, in favor of the 3D printing group. No statistically significant differences were observed in terms of fracture healing time, postoperative joint function, or postoperative complications. Meta-analysis revealed more favorable results for 3D-printing compared with conventional surgery, with the greatest difference observed for the number of intraoperative fluoroscopies. 3D printing might be considered effective and safe in the surgical treatment of anatomically complex appendicular skeleton fractures, in terms of reducing surgical time, lost blood volume, and radiation exposure of surgeons and patients.
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Affiliation(s)
- María González-Alonso
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Miguel Hermida-Sánchez
- Orthopaedic Surgery and Traumatology Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Pedro Martínez-Seijas
- Oral and Maxillofacial Surgery Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBER de EpidemiologíaySaludPública (CIBERESP), Santiago de Compostela, Galicia, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Galicia, Spain
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23
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Yang S, Lin H, Luo C. Meta-Analysis of 3D Printing Applications in Traumatic Fractures. Front Surg 2021; 8:696391. [PMID: 34532337 PMCID: PMC8439573 DOI: 10.3389/fsurg.2021.696391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Traumatic fracture is a common orthopaedic disease, and application of 3D printing technology in fracture treatment, which entails utilisation of pre-operative printed anatomic fracture model, is increasingly gaining popularity. However, effectiveness of 3D printing-assisted surgery lacks evidence-based findings to support its application. Materials and Methods: Embase, PubMed and Cochrane Library databases were systematically searched until October, 2020 to identify relevant studies. All randomised controlled trials (RCTs) comparing efficacy of 3D printing-assisted surgery vs. conventional surgery for traumatic fractures were reviewed. RevMan V.5.3 software was used to conduct meta-analysis. Results: A total of 12 RCTs involving 641 patients were included. Pooled findings showed that 3D printing-assisted surgery had shorter operation duration [standardised mean difference (SMD) = −1.52, 95% confidence interval (CI) – 1.70 ~ −1.34, P < 0.00001], less intraoperative blood loss (SMD = 1.34, 95% CI 1.74 ~ 0.94, P < 0.00001), fewer intraoperative fluoroscopies (SMD = 1.25, 95% CI 1.64 ~ 0.87, P < 0.00001), shorter fracture union time (SMD = −0.15, 95% CI −0.25 ~ −0.05, P = 0.003), and higher rate of excellent outcomes (OR = 2.40, 95% CI 1.07 ~ 5.37, P = 0.03) compared with conventional surgery. No significant differences in complication rates were observed between the two types of surgery (OR = 0.69, 95% CI 0.69 ~ 1.42, P = 0.32). Conclusions: Indicators including operation duration, intraoperative blood loss, number of intraoperative fluoroscopies, fracture union time, and rates of excellent outcomes showed that 3D printing-assisted surgery is a superior alternative in treatment of traumatic fractures compared with conventional surgery. Moreover, the current study did not report significant differences in incidence of complications between the two approaches. Systematic Review Registration: CRD42021239507.
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Affiliation(s)
- Sha Yang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Huapeng Lin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong Luo
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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A Systematic Review and Meta-Analysis of 3D Printing Technology for the Treatment of Acetabular Fractures. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5018791. [PMID: 34458367 PMCID: PMC8387177 DOI: 10.1155/2021/5018791] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/01/2021] [Accepted: 08/06/2021] [Indexed: 01/20/2023]
Abstract
Purpose Three-dimensional (3D) printing technology has been widely used in orthopedics surgery. However, its efficacy in acetabular fractures remains unclear. The aim of this systematic review and meta-analysis was to examine the effect of using 3D printing technology in the surgery for acetabular fractures. Methods The systematic review was performed following the PRISMA guidelines. Four major electronic databases were searched (inception to February 2021). Studies were screened using a priori criteria. Data from each study were extracted by two independent reviewers and organized using a standardized table. Data were pooled and presented in forest plots. Results Thirteen studies were included in the final analysis. Four were prospective randomized trials, and nine used a retrospective comparative design. The patients aged between 32.1 (SD 14.6) years and 51.9 (SD 18.9) years. Based on the pooled analyses, overall, 3D printing-assisted surgery decreased operation time by 38.8 minutes (95% CI: -54.9, -22.8), intraoperative blood loss by 259.7 ml (95% CI: -394.6, -124.9), instrumentation time by 34.1 minutes (95% CI: -49.0, -19.1). Traditional surgery was less likely to achieve good/excellent function of hip (RR, 0.53; 95% CI: 0.34, 0.82) and more likely to have complications than 3D printing-assisted surgery (RR, 1.19; 95% CI: 1.07, 1.33). Conclusions 3D printing technology demonstrated efficacy in the treatment of acetabular fractures. It may improve surgery-related and clinical outcomes. More prospective studies using a rigorous design (e.g., randomized trial with blinding) are warranted to confirm the long-term effects of 3D printing technology in orthopedics surgeries.
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Dai G, Shao Z, Weng Q, Zheng Y, Hong J, Lu X. Percutaneous reduction, cannulated screw fixation and calcium sulfate cement grafting assisted by 3D printing technology in the treatment of calcaneal fractures. J Orthop Sci 2021; 26:636-643. [PMID: 32798112 DOI: 10.1016/j.jos.2020.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Percutaneous reduction, cannulated screw fixation and calcium sulfate cement grafting (PR + CSC) for treatment of displaced and intra-articular calcaneal fractures (DIACFs) is a difficult technique, because the minimally invasive treatment has limited exposure and cannot be used to reduce articular surface under direct vision. The goal of this study was to apply 3D printing technology to preoperative planning and surgery of DIACFs, and to evaluate its effectiveness, feasibility and safety in fracture repair. METHODS We enrolled 81 patients with DIACFs in the study from August 2015 to August 2017. Patients with DIACFs in our hospital were randomly divided into the 3D printing group (40 cases) and the conventional group (41 cases). The operation duration, blood loss volume and the number of fluoroscopy were compared. Radiological results were evaluated using radiographs and functional results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score. The complications were also assessed. In addition, we made a questionnaire to verify the usefulness of the 3D printed model for both doctors and patients. RESULTS The operation duration, blood loss volume and the number of fluoroscopy in 3D printing group were significantly less than that in the conventional group. Besides, 3D printing group achieved significantly better radiological results than conventional group both postoperatively and at the final follow-up except the calcaneal width at the final follow-up. The AOFAS score in the 3D printing group was significantly higher than that in the conventional group. In addition, the questionnaire from doctors and patients exhibited high scores of overall satisfaction of the 3D printed models. As for complications, there was no significant difference among the two groups. CONCLUSION This study suggested the clinical feasibility of PR + CSC assisted by 3D printing technology in the treatment of DIACFs. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Gaole Dai
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhenxuan Shao
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qihao Weng
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yijing Zheng
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jianjun Hong
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Xiaolang Lu
- Department of Orthopaedics, Key Laboratory of Orthopaedics of Zhejiang Province, The Second School of Medicine of Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Michiels C, Jambon E, Sarrazin J, Boulenger de Hauteclocque A, Ricard S, Grenier N, Faessel M, Bos F, Bernhard JC. [Comprehensive review of 3D printing use in medicine: Comparison with practical applications in urology]. Prog Urol 2021; 31:762-771. [PMID: 34154961 DOI: 10.1016/j.purol.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/17/2021] [Accepted: 04/02/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Over the past few years, 3D printing has evolved rapidly. This has resulted in an increasing number of scientific publications reporting on the medical use of 3D printing. These applications can range from patient information, preoperative planning, education, or 3D printing of patient-specific surgical implants. The objective of this review was to give an overview of the different applications in urology and other disciplines based on a selection of publications. METHODS In the current narrative review the Medline database was searched to identify all the related reports discussing the use of 3D printing in the medical field and more specifically in Urology. 3D printing applications were categorized so they could be searched more thoroughly within the Medline database. RESULTS Three-dimensional printing can help improve pre-operative patient information, anatomy and medical trainee education. The 3D printed models may assist the surgeon in preoperative planning or become patient-specific surgical simulation models. In urology, kidney cancer surgery is the most concerned by 3D printing-related publications, for preoperative planning, but also for surgical simulation and surgical training. CONCLUSION 3D printing has already proven useful in many medical applications, including urology, for patient information, education, pre-operative planning and surgical simulation. All areas of urology are involved and represented in the literature. Larger randomized controlled studies will certainly allow 3D printing to benefit patients in routine clinical practice.
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Affiliation(s)
- C Michiels
- Service de chirurgie urologique et transplantation rénale, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux cedex, France.
| | - E Jambon
- Service d'imagerie et radiologie interventionnelle, CHU Bordeaux, France.
| | - J Sarrazin
- Fablab et Technoshop Coh@bit, IUT, Université de Bordeaux, France.
| | - A Boulenger de Hauteclocque
- Service de chirurgie urologique et transplantation rénale, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux cedex, France.
| | - S Ricard
- Service de chirurgie urologique et transplantation rénale, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux cedex, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France
| | - N Grenier
- Service d'imagerie et radiologie interventionnelle, CHU Bordeaux, France
| | - M Faessel
- Fablab et Technoshop Coh@bit, IUT, Université de Bordeaux, France.
| | - F Bos
- Fablab et Technoshop Coh@bit, IUT, Université de Bordeaux, France.
| | - J C Bernhard
- Service de chirurgie urologique et transplantation rénale, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux cedex, France; Réseau français de recherche sur le cancer du rein UroCCR, Bordeaux, France.
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Bougher H, Buttner P, Smith J, Banks J, Na HS, Forrestal D, Heal C. Interobserver and intraobserver agreement of three-dimensionally printed models for the classification of proximal humeral fractures. JSES Int 2021; 5:198-204. [PMID: 33681838 PMCID: PMC7910723 DOI: 10.1016/j.jseint.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hypothesis This study aimed to examine whether three-dimensionally printed models (3D models) could improve interobserver and intraobserver agreement when classifying proximal humeral fractures (PHFs) using the Neer system. We hypothesized that 3D models would improve interobserver and intraobserver agreement compared with x-ray, two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) and that agreement using 3D models would be higher for registrars than for consultants. Methods Thirty consecutive PHF images were selected from a state-wide database and classified by fourteen observers. Each imaging modality (x-ray, 2D CT, 3D CT, 3D models) was grouped and presented in a randomly allocated sequence on two separate occasions. Interobserver and intraobserver agreements were quantified with kappa values (κ), percentage agreement, and 95% confidence intervals (CIs). Results Seven orthopedic registrars and seven orthopedic consultants classified 30 fractures on one occasion (interobserver). Four registrars and three consultants additionally completed classification on a second occasion (intraobserver). Interobserver agreement was greater with 3D models than with x-ray (κ = 0.47, CI: 0.44-0.50, 66.5%, CI: 64.6-68.4% and κ = 0.29, CI: 0.26-0.31, 57.2%, CI: 55.1-59.3%, respectively), 2D CT (κ = 0.30, CI: 0.27-0.33, 57.8%, CI: 55.5-60.2%), and 3D CT (κ = 0.35, CI: 0.33-0.38, 58.8%, CI: 56.7-60.9%). Intraobserver agreement appeared higher for 3D models than for other modalities; however, results were not significant. There were no differences in interobserver or intraobserver agreement between registrars and consultants. Conclusion Three-dimensionally printed models improved interobserver agreement in the classification of PHFs using the Neer system. This has potential implications for using 3D models for surgical planning and teaching.
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Affiliation(s)
- Hannah Bougher
- James Cook University, Mackay Clinical School, Mackay, QLD, Australia
| | | | | | - Jennifer Banks
- James Cook University, Mackay Clinical School, Mackay, QLD, Australia
| | - Hyun Su Na
- Mackay Base Hospital, Mackay, QLD, Australia
| | - David Forrestal
- Queensland University of Technology, Brisbane City, QLD, Australia
| | - Clare Heal
- James Cook University, Mackay Clinical School, Mackay, QLD, Australia
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Ferràs-Tarragó J, Sabalza-Baztán O, Sahuquillo-Arce JM, Angulo-Sánchez MÁ, Amaya-Valero J, De-La-Calva Ceinos C, Baixauli-García F. Security of 3D-printed polylactide acid piece sterilization in the operating room: a sterility test. Eur J Trauma Emerg Surg 2021; 48:3895-3900. [PMID: 33452547 DOI: 10.1007/s00068-020-01564-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/19/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION 3D-printing technology has become very popular the last 10 years, and their advantages have been widely proved. However, its safety in the operating room after sterilization has not been evaluated. Thus, the use of 3D printing is still questioned. The aim of this work is to evaluate the security of polylactic acid (PLA) to print surgical models after its sterilization. MATERIALS AND METHODS One hundred and eighty-six PLA plates and 6 negative controls without microorganisms were seeded. After 10 days of culture, the PLA plates were randomized into three groups: A, B, and C. Group A underwent a sterilization process using an autoclave program at 134 °C. Group B was seeded in different culture media and group C was used to make crystal violet stains on the biofilms formed on the PLA. Mechanical properties of PLA after autoclave sterilization including, the breaking load, deformation and breaking load per surface were calculated. RESULTS Hundred percent of the group B showed monomicrobial growth. Stains performed on group C PLA showed biofilms in all PLA pieces. After sterilization, no pathogen growth was observed in group A during the culture observation period showing 100% sterilization effectiveness. A filling percentage of 5% obtained a breaking load of 6.36 MPa, and its elastic limit occurred after an elongation of 167.4%. A 10% infill was mechanically safe. CONCLUSIONS Autoclave sterilization of PLA-printed pieces is safe for the patient and mechanically strong for the surgeon. This is the first 3D-printing protocol described and evaluated to implement 3D-printing technology safely in the operating room. SIGNIFICANCE AND IMPACT OF STUDY This is the first 3D-printing protocol described to print and sterilize 3D biomodels using an autoclave showing its biological safety and its mechanical resistance.
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Affiliation(s)
- Joan Ferràs-Tarragó
- Orthopaedic Surgery and Traumatology. Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain.
| | | | | | | | - Jose Amaya-Valero
- Orthopaedic Surgery and Traumatology. Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
| | | | - Francisco Baixauli-García
- Orthopaedic Surgery and Traumatology. Hospital La Fe, Av Fernando Abril Martorell 106, Valencia, Spain
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Ferràs-Tarragó J, Jordà-Gómez P, Català-de-las-Marinas J, Antequera-Cano JM, Barrés-Carsí M. A new universal 3D-printable device to prevent excessive drilling in orthopedic surgery. Eur J Trauma Emerg Surg 2020; 48:3887-3893. [DOI: 10.1007/s00068-020-01465-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
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Three-dimensional models increase the interobserver agreement for the treatment of proximal humerus fractures. Patient Saf Surg 2020; 14:33. [PMID: 32782476 PMCID: PMC7409687 DOI: 10.1186/s13037-020-00258-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background The agreement for the treatment of proximal humerus fractures is low. Interpretation of exams used for diagnosis can be directly associated with this limitation. This study proposes to compare the agreement between experts and residents in orthopedics for treatment indication of proximal humerus fractures, utilizing 3D-models, holography (augmented reality), x-rays, and tomography as diagnostic methods. Methods Twenty orthopedists (ten experts in shoulder and elbow surgery and ten experts in traumatology) and thirty resident physicians in orthopedics evaluated nine fractures of the proximal humerus, randomly distributed as x-rays, tomography, 3D-models and holography, using the Neer and AO / OTA Classifications. After, we evaluated the interobserver agreement between treatment options (conservative, osteosynthesis and arthroplasty) and whether the experience of the evaluators interfered with the results. Results The interobserver agreement analysis showed the following kappa-values: κ = 0.362 and κ = 0.306 for experts and residents (3D-models); κ = 0.240 and κ = 0.221 (X-ray); κ = 0.233 and κ = 0.123 (Tomography) and κ = 0.321 and κ = 0.160 (Holography), for experts and residents respectively. Moreover, residents and specialists were discordant in the treatment indication using Tomography as a diagnostic method (p = 0.003). The same was not seen for the other diagnostic methods (p > 0.05). Conclusions Three-dimensional models showed, overall, the highest interobserver agreement (experts versus residents in orthopedics) for the choice of treatment of proximal humerus fractures compared to X-ray, Tomography, and Holography. Agreement in the choice of treatment among experts that used Tomography and Holography as diagnostic methods were two times higher compared to residents. Trial registration Registered in Brazil Platform under no. CAAE 12273519.7.0000.5505.
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Dauwe J, Mys K, Putzeys G, Schader JF, Richards RG, Gueorguiev B, Varga P, Nijs S. Advanced CT visualization improves the accuracy of orthopaedic trauma surgeons and residents in classifying proximal humeral fractures: a feasibility study. Eur J Trauma Emerg Surg 2020; 48:4523-4529. [PMID: 32761437 DOI: 10.1007/s00068-020-01457-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Osteosynthesis of proximal humeral fractures remains challenging with high reported failure rates. Understanding the fracture type is mandatory in surgical treatment to achieve an optimal anatomical reduction. Therefore, a better classification ability resulting in improved understanding of the fracture pattern is important for preoperative planning. The purpose was to investigate the feasibility and added value of advanced visualization of segmented 3D computed tomography (CT) images in fracture classification. METHODS Seventeen patients treated with either plate-screw-osteosynthesis or shoulder hemi-prosthesis between 2015 and 2019 were included. All preoperative CT scans were segmented to indicate every fracture fragment in a different color. Classification ability was tested in 21 orthopaedic residents and 12 shoulder surgeons. Both groups were asked to classify fractures using three different modalities (standard CT scan, 3D reconstruction model, and 3D segmented model) into three different classification systems (Neer, AO/OTA and LEGO). RESULTS All participants were able to classify the fractures more accurately into all three classification systems after evaluating the segmented three-dimensional (3D) models compared to both 2D slice-wise evaluation and 3D reconstruction model. This finding was significant (p < 0.005) with an average success rate of 94%. The participants experienced significantly more difficulties classifying fractures according to the LEGO system than the other two classifications. CONCLUSION Segmentation of CT scans added value to the proximal humeral fracture classification, since orthopaedic surgeons were able to classify fractures significantly better into the AO/OTA, Neer, and LEGO classification systems compared to both standard 2D slice-wise evaluation and 3D reconstruction model.
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Affiliation(s)
- Jan Dauwe
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland. .,Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Karen Mys
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Guy Putzeys
- Department of Orthopaedic and Trauma Surgery, AZ Groeninge, Kortrijk, Belgium
| | - Jana F Schader
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - R Geoff Richards
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Peter Varga
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
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Braun BJ, Grimm B, Hanflik AM, Marmor MT, Richter PH, Sands AK, Sivananthan S. Finding NEEMO: towards organizing smart digital solutions in orthopaedic trauma surgery. EFORT Open Rev 2020; 5:408-420. [PMID: 32818068 PMCID: PMC7407868 DOI: 10.1302/2058-5241.5.200021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
There are many digital solutions which assist the orthopaedic trauma surgeon. This already broad field is rapidly expanding, making a complete overview of the existing solutions difficult.The AO Foundation has established a task force to address the need for an overview of digital solutions in the field of orthopaedic trauma surgery.Areas of new technology which will help the surgeon gain a greater understanding of these possible solutions are reviewed.We propose a categorization of the current needs in orthopaedic trauma surgery matched with available or potential digital solutions, and provide a narrative overview of this broad topic, including the needs, solutions and basic rules to ensure adequate use in orthopaedic trauma surgery. We seek to make this field more accessible, allowing for technological solutions to be clearly matched to trauma surgeons' needs. Cite this article: EFORT Open Rev 2020;5:408-420. DOI: 10.1302/2058-5241.5.200021.
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Affiliation(s)
- Benedikt J Braun
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | | | | | - Meir T Marmor
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
| | - Peter H Richter
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Germany
| | - Andrew K Sands
- Weill Cornell Medical College, Foot and Ankle Surgery, Downtown Orthopedic Associates, New York Presbyterian Lower Manhattan Hospital, New York, USA
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Levesque JN, Shah A, Ekhtiari S, Yan JR, Thornley P, Williams DS. Three-dimensional printing in orthopaedic surgery: a scoping review. EFORT Open Rev 2020; 5:430-441. [PMID: 32818070 PMCID: PMC7407871 DOI: 10.1302/2058-5241.5.190024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Three-dimensional printing (3DP) has become more frequently used in surgical specialties in recent years. These uses include pre-operative planning, patient-specific instrumentation (PSI), and patient-specific implant production.The purpose of this review was to understand the current uses of 3DP in orthopaedic surgery, the geographical and temporal trends of its use, and its impact on peri-operative outcomesOne-hundred and eight studies (N = 2328) were included, published between 2012 and 2018, with over half based in China.The most commonly used material was titanium.Three-dimensional printing was most commonly reported in trauma (N = 41) and oncology (N = 22). Pre-operative planning was the most common use of 3DP (N = 63), followed by final implants (N = 32) and PSI (N = 22).Take-home message: Overall, 3DP is becoming more common in orthopaedic surgery, with wide range of uses, particularly in complex cases. 3DP may also confer some important peri-operative benefits. Cite this article: EFORT Open Rev 2020;5:430-441. DOI: 10.1302/2058-5241.5.190024.
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Affiliation(s)
- Jasmine N. Levesque
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - James R. Yan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Thornley
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dale S. Williams
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Campana V, Cardona V, Vismara V, Monteleone AS, Piazza P, Messinese P, Mocini F, Sircana G, Maccauro G, Saccomanno MF. 3D printing in shoulder surgery. Orthop Rev (Pavia) 2020; 12:8681. [PMID: 32913609 PMCID: PMC7459384 DOI: 10.4081/or.2020.8681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 10/25/2022] Open
Abstract
Three-dimensional (3D) printing is a novel modality with the potential to make a huge impact in the surgical field. The aim of this paper is to provide an overview on the current use of 3D printing in shoulder surgery. We have reviewed the use of this new method in 3 fields of shoulder surgery: shoulder arthroplasty, recurrent shoulder instability and orthopedic shoulder traumatology. In shoulder arthroplasty, several authors have shown that the use of the 3D printer improves the positioning of the glenoid component, even if longer clinical follow-up is needed to determine whether the cost of this system rationalizes the potential improved functional outcomes and decreases glenoid revision rates. In the treatment of anterior shoulder instability, the literature agrees on the fact that the use of the 3D printing can: enhance the dept and size of bony lesions, allowing a patient tailored surgical planning and potentially reducing operative times; allow the production of personalized implants to restore substantial bone loss; restore glenohumeral morphology and instability. In orthopedic trauma, the use of 3D printing can be helpful to increase the understanding of fracture patterns, facilitating a more personalized planning, and can be used for resident training and education. We can conclude the current literature regarding the use of 3D printed models in orthopedic surgery agrees finding objective improvements to preoperative planning and to the surgical procedure itself, by shortening the intraoperative time and by the possibility to develop custom-made, patient-specific surgical instruments, and it suggests that there are tangible benefits for its implementation.
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Affiliation(s)
- Vincenzo Campana
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Valentina Cardona
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Valeria Vismara
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | | | - Piero Piazza
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Piermarco Messinese
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Fabrizio Mocini
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giuseppe Sircana
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giulio Maccauro
- Orthopedic Institute, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
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Chen S, Zhang K, Jia X, Qiang M, Chen Y. Evaluation of the computer-assisted virtual surgical technology in preoperative planning for distal femoral fracture. Injury 2020; 51:443-451. [PMID: 31771786 DOI: 10.1016/j.injury.2019.10.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/15/2019] [Accepted: 10/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The application of computer-assisted virtual surgical technology in preoperative planning for distal femoral fractures has been rarely presented. This study aimed to evaluate the intra-operative realization of this technology and the clinical outcomes based on it for distal femoral fractures. METHODS Between February 2014 and May 2017, 32 patients with distal femoral fractures treated by open reduction and internal fixation were included and divided into 2 groups on the basis of preoperative planning methods: conventional (N = 17) and virtual surgical (N = 15). The time required for virtual segmentation, reduction, and fixation of the fracture fragments in virtual surgical group were analyzed. Operation time, intra-operative blood loss, times of fluoroscopy during operation and days of hospital stay in two groups were compared. Postoperative functional outcomes were assessed using the Knee Society Score (KSS), Short Form-36 (SF-36) scoring systems, and visual analogue scale (VAS) for pain. RESULTS Mean total planning time for 33-A, 33-B, and 33-C fractures in virtual surgical group were 43.0 ± 1.7, 23.0 ± 1.3, and 51.4 ± 3.7 min, respectively. Compared with the conventional group, Patients in virtual surgical group had lower blood loss, fewer fluoroscopic images, less operative time, and shorter days of hospital stay (P < 0.05). No significant difference could detected in the KSS, SF-36, or VAS scores between the two groups at the final follow-up (P > 0.05). CONCLUSIONS Computer-assisted virtual surgical technology could rapidly complete surgical treatment protocol, improve operative efficiency, and provide satisfying clinical and radiographic outcomes for distal femoral fractures.
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Affiliation(s)
- Song Chen
- Department of Orthopaedic Trauma, East Hospital, Tongji University, School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, East Hospital, Tongji University, School of Medicine, 150 Jimo Rd, 200120 Shanghai, China.
| | - Xiaoyang Jia
- Department of Orthopaedic Trauma, East Hospital, Tongji University, School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - Minfei Qiang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
| | - Yanxi Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China.
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Morgan C, Khatri C, Hanna SA, Ashrafian H, Sarraf KM. Use of three-dimensional printing in preoperative planning in orthopaedic trauma surgery: A systematic review and meta-analysis. World J Orthop 2020; 11:57-67. [PMID: 31966970 PMCID: PMC6960300 DOI: 10.5312/wjo.v11.i1.57] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/25/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in three-dimensional (3D) printing, there has been an increased interest in the concept. It has been shown that 3D models allow surgeons to better visualise anatomy, aid in planning and performing complex surgery. It is however not clear how best to utilise the technique and whether this results in better outcomes.
AIM To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.
METHODS We performed a comprehensive systematic review of the literature and a meta-analysis. Medline, Ovid and Embase were searched from inception to February 8, 2018. Randomised controlled trials, case-control studies, cohort studies and case series of five patients or more were included across any area of orthopaedic trauma. The primary outcomes were operation time, intra-operative blood loss and fluoroscopy used.
RESULTS Seventeen studies (922 patients) met our inclusion criteria and were reviewed. The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85% [95% confidence intervals (CI): (-22.99, -16.71)], intra-operative blood loss of 25.73% [95%CI: (-31.07, -20.40)], and number of times fluoroscopy was used by 23.80% [95%CI: (-38.49, -9.10)].
CONCLUSION Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time, intraoperative blood loss and the number of times fluoroscopy is used.
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Affiliation(s)
- Catrin Morgan
- Trauma and Orthopaedics, Imperial College NHS Trust, London W2 1NY, United Kingdom
| | - Chetan Khatri
- Trauma and Orthopaedics, Imperial College NHS Trust, London W2 1NY, United Kingdom
| | - Sammy A Hanna
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Khaled M Sarraf
- Trauma and Orthopaedics, Imperial College NHS Trust, London W2 1NY, United Kingdom
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Wang D, Jiang H, Pan B, Yang Q, He L, Sun H, Yu X, Lin L. Standardized measurement of auricle: A method of high-precision and reliability based on 3D scanning and Mimics software. Exp Ther Med 2019; 18:4575-4582. [PMID: 31807147 PMCID: PMC6878875 DOI: 10.3892/etm.2019.8159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/30/2019] [Indexed: 11/23/2022] Open
Abstract
Objective measurement is important for diagnosing congenital or acquired auricular abnormalities and the evaluation of therapeutic efficacy. However, methods applied in the past were mostly inaccurate and unreliable. The present study aimed to introduce five standardized indices for auricle measurement and present a highly precise and reliable methodology combining three-dimensional (3D) scanning techniques and the Materialise Mimics software for the evaluation of auricle sizes. A total of 20 normal ears were measured independently by four surgeons using the standardized digital method with 3D scanning technique and the traditional manual method. Parameters of the auricle, including the length and width, arc length, cranioauricular height and angle were measured using the Mimics software. Paired t-test, Wilcoxon signed rank test and intra-class correlation coefficients (ICC) were performed on the data to assess the precision, uniformity and observer independence of the method. Pearson's product moment correlation was calculated to assess the correlation between auricle length and width in addition to the correlation between cranioauricular height and angle. No significant differences were indicated between measurements of five auricular parameters made by two surgeons using the digital method. However, significant differences were found using the manual method (P<0.01). ICC values derived from digital measurements ranged from 0.901 to 0.987, whereas those derived from manual measurements ranged from 0.526 to 0.807. These results suggested that the standardized digital method was replicable and reliable compared with the traditional manual method. Pearson's coefficient analysis showed that there was a significant correlation between cranioauricular height and angle (P<0.05), but no correlations were found between the height and width of the auricle (P>0.05). Taken together, data from the present study suggested that measurements of the length and width, arch length, and cranioauricular height and angle of auricles using the standardized digital method combining 3D scanning with the Mimics software were comprehensive, precise, convenient, repeatable and reliable.
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Affiliation(s)
- Di Wang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Haiyue Jiang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Bo Pan
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Qinghua Yang
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Leren He
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Hengyun Sun
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Xiaobo Yu
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
| | - Lin Lin
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P.R. China
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Krettek C, Bruns N. [Current concepts and new developments of 3D printing in trauma surgery]. Unfallchirurg 2019; 122:256-269. [PMID: 30903248 DOI: 10.1007/s00113-019-0636-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The use of 3D printing (synonyms "rapid prototyping" and "additive manufacturing") has played an increasing role in the industry for many years and finds more and more interest and application in musculoskeletal surgery, especially orthopedic trauma surgery.In this article the current literature is systematically reviewed, presented and evaluated in a condensed and comprehensive way according to anatomical (upper and lower extremities) and functional aspects. As many of the publications analyzed were feasibility studies, the degree of evidence is low and methodological weaknesses are obvious and numerous; however, this pioneering work is extremely stimulating and important for further development because the technical, medical and economic potential of this technology is huge and interesting for all those involved in the treatment of musculoskeletal problems.
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Affiliation(s)
- C Krettek
- Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - N Bruns
- Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Chen K, Yang F, Yao S, Xiong Z, Sun T, Zhu F, Telemacque D, Drepaul D, Ren Z, Guo X. Application of computer-assisted virtual surgical procedures and three-dimensional printing of patient-specific pre-contoured plates in bicolumnar acetabular fracture fixation. Orthop Traumatol Surg Res 2019; 105:877-884. [PMID: 31300239 DOI: 10.1016/j.otsr.2019.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/18/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION With the rapid development of three-dimensional (3D) printing and computer technology, adopting computer-assisted virtual surgical procedures and 3D printing of patient-specific pre-contoured plates can greatly reduce surgical invasiveness and operative time and simplify the procedure. HYPOTHESIS Use of computer-assisted virtual surgical procedures and 3D printing of patient-specific pre-contoured plates reduce the operative time and blood loss in bicolumnar acetabular fracture fixation. METHODS A retrospective analysis was performed for 52 bicolumnar acetabular fracture cases treated surgically in our department from January 2013 to January 2017. According to the patients' willingness to accept 3D printing services, 52 patients were divided into groups A and B. In group A (28 patients), computer-assisted virtual surgical procedures and 3D printing of patient-specific pre-contoured plates were adopted. In group B (24 patients), the conventional method was adopted. Fracture type, operative blood loss, surgical time, complications, radiographic quality of reduction, and hip function were compared between groups. All patients were operated by the same surgeon. RESULTS The real surgical procedure of all patients in group A was almost identical to the preoperative virtual operation. Operative time and intraoperative blood loss were significantly reduced in group A than in group B (p<0.05), while the postoperative fracture reduction quality and hip function obtained slightly higher levels of satisfaction in group A. CONCLUSIONS Computer-assisted virtual surgical procedures, 3D printing technology and patient-specific pre-contoured plates can reduce the operative time and blood loss with less surgical invasiveness and ensure completely satisfactory clinical outcomes. However, promotion of this technology requires additional work. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Kaifang Chen
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Fan Yang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Sheng Yao
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Zekang Xiong
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Tingfang Sun
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Fengzhao Zhu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Dionne Telemacque
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Deepak Drepaul
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Zhengwei Ren
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Xiaodong Guo
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China.
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Xiong L, Li X, Li H, Chen Z, Xiao T. The efficacy of 3D printing-assisted surgery for traumatic fracture: a meta-analysis. Postgrad Med J 2019; 95:414-419. [DOI: 10.1136/postgradmedj-2019-136482] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 02/06/2023]
Abstract
BackgroundRecent years have witnessed a rapid development of three-dimensional (3D) printing technology applied in orthopaedic surgery. To be assisted by 3D printing is a potent method to realise accurate and individualised operation. The objective of this meta-analysis was to assess the efficacy of 3D printing technology in the management of trauma fractures.MethodsPubMed, Embase and the Cochrane Library were systematically searched up until January 2019 to identify relevant studies. All clinical studies comparing conventional surgery and 3D printing-assisted surgery in the management of orthopaedic trauma were obtained. The meta-analysis was performed with RevMan V.5.3 software.ResultsFour randomised controlled trials, four retrospective comparative studies and two prospective comparative studies involving 521 patients were included. Compared with conventional surgery, 3D printing-assisted surgery leads to shorter operation duration (mean difference (MD) −16.59 (95% CI −18.60 to –14.58), p<0.001), less intraoperative blood loss (standardised mean difference (SMD) −1.02 (95% CI –1.25 to –0.79), p<0.001) and fewer intraoperative fluroscopies (SMD −2.20 (95% CI –2.50 to –1.90), p<0.001). However, 3D printing-assisted surgery leads to longer hospital stay (MD 2.51 (95% CI 0.31 to –4.72), p=0.03). No significant results were found regarding fracture healing time, the rate of excellent and good outcomes, anatomical reduction and complications.ConclusionsThese results suggest that 3D printing-assisted surgery outperforms conventional surgery in the management of orthopaedic trauma fractures with shorter operation duration, less intraoperative blood loss and fewer intraoperative fluoroscopies.
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Cocco LF, Yazzigi JA, Kawakami EFKI, Alvachian HJF, Dos Reis FB, Luzo MVM. Inter-observer reliability of alternative diagnostic methods for proximal humerus fractures: a comparison between attending surgeons and orthopedic residents in training. Patient Saf Surg 2019; 13:12. [PMID: 30899332 PMCID: PMC6410505 DOI: 10.1186/s13037-019-0195-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 01/20/2023] Open
Abstract
Background Proximal humerus fractures are frequent, and several studies show low diagnostic agreement among the observers, as well as an inaccurate classification of these lesions. The divergences are generally correlated with the experience of the surgeons as well as the diagnostic methods used. This paper challenges these problems including alternative diagnostic methods such as 3D models and augmented reality (holography) and including the observers’ period of medical experience as a factor. Methods Twenty orthopedists (ten experts in shoulder surgery and ten experts in traumatology) and thirty resident physicians in orthopedics classified nine proximal humerus fractures randomly distributed as x-ray, tomographies, 3D models and holography, using AO/ASIF and Neer’s classification. In the end, we evaluated the intra- and inter-observer agreement between diagnostic methods and whether the experience of the observers interfered in the evaluations and the classifications used. Results We found overall kappa coefficients ranging from 0.241 (fair) to 0.624 (substantial) between the two classifications (AO / ASIF and Neer), concerning the diagnostic methods used. We identified image modality differences (p = 0.017), where 3D models presented an average kappa coefficient value superior to that of tomographies. There were no differences between kappa scores for x-ray and holography compared to the others. The kappa scores for AO / ASIF classification and Neer classification and subdivided by observer period of experience showed no differences concerning the diagnostic method used. Conclusions 3D models can substantially improve diagnostic agreement for proximal humerus fractures evaluation among experts or resident physicians. The holography showed good agreement between the experts and can be a similar option to x-ray and tomography in the evaluation and classification of these fractures. The observers’ period of experience did not improve the diagnostic agreement between the image modalities studied. Trial registration Registered in the Brazil Platform under no. CAAE 88912318.1.0000.5487.
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Affiliation(s)
- Luiz Fernando Cocco
- 1Department of Orthopedics and Traumatology, (DOT/UNIFESP)- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, 01 andar, São Paulo, SP CEP 04024-002 Brazil.,2Department of Orthopedics and Traumatology, UNIFESP, São Paulo, Brazil
| | - João Alberto Yazzigi
- 1Department of Orthopedics and Traumatology, (DOT/UNIFESP)- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, 01 andar, São Paulo, SP CEP 04024-002 Brazil.,2Department of Orthopedics and Traumatology, UNIFESP, São Paulo, Brazil
| | | | | | | | - Marcus Vinicius Malheiro Luzo
- 1Department of Orthopedics and Traumatology, (DOT/UNIFESP)- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715, 01 andar, São Paulo, SP CEP 04024-002 Brazil.,2Department of Orthopedics and Traumatology, UNIFESP, São Paulo, Brazil.,3Department of Diagnostic Imaging, UNIFESP, São Paulo, Brazil
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Nie W, Gu F, Wang Z, Wu R, Yue Y, Shao A. Preliminary application of three-dimension printing technology in surgical management of bicondylar tibial plateau fractures. Injury 2019; 50:476-483. [PMID: 30580928 DOI: 10.1016/j.injury.2018.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/10/2018] [Accepted: 12/16/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Surgical management of bicondylar tibial plateau fractures, which is frequently associate with high wound complication rates and functional impairment, remains a challenge for orthopedic surgeons. Recently, the emergence of three-dimension(3D) printing provided orthopedic surgeons with a new technology which has revolutionary impacts on surgical planning, operative guidance and custom-made implants manufacture. The aim of this study is to explore the clinical feasibility and application value of 3D printing in the surgical management of bicondylar tibial plateau fractures. METHOD Data of this retrospective study was collected from 11 patients suffering bicondylar tibial plateau fracture from October 2015 to August 2016. All of them underwent surgical treatment with the assistance of 3D printing technology. Real-size solid models and screw guide templates were printed for preoperative planning, surgical simulation and intraoperative guidance. Patients' Demographics, surgery duration, intraoperative blood loss, the accuracy of preoperative planning were recorded and evaluated. RESULT The 3D printed models successfully provided the omni-directional exhibition of the fracture morphology. Model-based surgical simulation procedures and pre-selection of implants were generally consistent with the results of actual surgeries. There were no significant differences between the length of the osteosynthesis screws and that of actual surgeries (59.43 ± 11.13 mm vs 60.14 ± 12.05 mm). Beyond that, other parameters, such as surgical duration, intraoperative blood loss and HSS scores was satisfactory according to the surgical records and follow-up. CONCLUSIONS According to our experience, the assistance of 3D printing technology in the surgical management of bicondylar tibial plateau fractures provides a comprehensive understanding of fracture features, an accurate patient-specific preoperative planning and an intraoperative guidance for real surgeries, thus leading to the optimization of clinical outcomes.
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Affiliation(s)
- Wei Nie
- Department of Orthopaedic Surgery, Lianyungang Second People's Hospital, China
| | - Fei Gu
- Department of Orthopaedic Surgery, Lianyungang Second People's Hospital, China
| | - Zhaojun Wang
- Department of Orthopaedic Surgery, Lianyungang Second People's Hospital, China
| | - Rui Wu
- Department of Orthopaedic Surgery, Lianyungang Second People's Hospital, China
| | - Yang Yue
- Department of Orthopaedic Surgery, Lianyungang Second People's Hospital, China
| | - Anze Shao
- Department of Orthopaedic Surgery, Lianyungang Second People's Hospital, China.
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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Chen Y, Jia X, Qiang M, Zhang K, Chen S. Computer-Assisted Virtual Surgical Technology Versus Three-Dimensional Printing Technology in Preoperative Planning for Displaced Three and Four-Part Fractures of the Proximal End of the Humerus. J Bone Joint Surg Am 2018; 100:1960-1968. [PMID: 30480600 DOI: 10.2106/jbjs.18.00477] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to determine the difference between computer-assisted virtual surgical technology and 3-dimensional (3D) printing technology in preoperative planning for proximal humeral fractures. METHODS Between February 2009 and October 2015, 131 patients with 3 and 4-part proximal humeral fractures were divided into 3 groups on the basis of the preoperative planning method: conventional (n = 53), virtual surgical (n = 46), and 3D printing (n = 32). Fracture characteristics and intraoperative realization of preoperative planning (reduction shape and implant choices) were evaluated. Postoperative functional outcomes were assessed using the American Shoulder and Elbow Surgeons, Constant-Murley, and Short Form-36 (SF-36) scoring systems and shoulder range of motion; postoperative radiographic outcomes were assessed with respect to the loss of the neck-shaft angle (NSA) and loss of humeral head height (HHH). RESULTS Excellent sensitivity, specificity, and accuracy for fracture characteristics were seen in all 3 groups. The correlations for NSA (p = 0.033) and HHH (p = 0.035) were higher in the virtual surgical group than in the 3D printing group. The lengths of the medial support screws in the actual choices were shorter than those in the preoperative plan for the 3D printing group, but a similar pattern was not seen in the virtual surgical group. Compared with the conventional method, the virtual surgical and 3D printing methods of preoperative planning resulted in shorter operative time, less blood loss, and fewer fluoroscopic images. The functional outcomes in both the 3D printing and virtual surgical groups were better than those in the conventional group. The virtual surgical method was faster than the 3D printing method, as suggested by a shorter time to surgery (2.5 compared with 4.6 days; p < 0.001), a shorter time for preoperative planning (30.4 compared with 262.4 minutes; p < 0.001), and a decreased duration of hospital stay (10.9 compared with 14.6 days; p < 0.001). CONCLUSIONS The clinical outcomes in both the virtual surgical and 3D printing groups were better than those in the conventional group. However, computer-assisted virtual surgical technology is more convenient and efficient, considering the shorter time for preoperative planning. In addition, it has improved correlation with preoperative planning. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yanxi Chen
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyang Jia
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Minfei Qiang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kun Zhang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Song Chen
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
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Wang Q, Hu J, Guan J, Chen Y, Wang L. Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: benefit of pre-contouring plates on a 3D-printed model-a retrospective study. J Orthop Surg Res 2018; 13:203. [PMID: 30119637 PMCID: PMC6098615 DOI: 10.1186/s13018-018-0908-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore the clinical efficacy of 3D printing fracture models to assist in creating pre-contoured plates to treat proximal third humeral shaft fractures. METHODS We retrospectively identified proximal third humeral shaft fractures treated between February 2012 and February 2015. The patients were divided into two groups according to the treatment procedure: a Synbone group and a 3D-printed group. In the Synbone group, long proximal humeral internal locking system plates were pre-contoured into helical shape on Synbones before surgery, while in the 3D-printed group, they were contoured on 3D-printed bone models. The pre-contoured plates were sterilized before surgery and were then used for fracture fixation during surgery. Duration of surgeries, blood loss volumes, the incidence of complications, and the time to fracture union were recorded, and functional outcomes were assessed by the Constant-Murley shoulder score and the Mayo Elbow Performance Score (MEPS) at 1-year follow-up. RESULTS The subjects comprised 46 patients; 25 patients were allocated to the Synbone group and the remaining 21 to the 3D-printed group. There was no significant difference between the baseline characteristics of the two groups. At the 1-year follow-up visit, all fractures were healed and showed a satisfactory outcome. There were no instances of iatrogenic radial nerve injury, and there was no significant difference between the two groups with regard to fracture union time, Constant-Murley score, or MEPS score. Surgery duration was significantly shorter in the 3D-printed group compared to the Synbone group (42.62 vs. 60.36 min, P = 0.001), and the 3D-printed group lost less blood during surgery (105.19 vs. 120.80 ml, P = 0.001). In addition, in the 3D-printed group, 9 surgeries were finished by senior attending doctors and 12 were finished by junior attending doctors; however, there was no significant difference between the 1-year outcomes of the two grades of surgeons. CONCLUSIONS Our results show that the 3D printing technique is helpful in shortening the duration of surgery, reducing blood loss volume, and in making this surgical procedure easier for less-experienced surgeons. TRIAL REGISTRATION This clinical study was registered in CHICTR on September 30, 2017 (number 17012852 ).
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Affiliation(s)
- Qiuke Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Jian Hu
- Department of Pathology, Shanghai Eighth People's Hospital, 8 Caobao Road, Shanghai, 200233, People's Republic of China
| | - Junjie Guan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Yunfeng Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
| | - Lei Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
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Lal H, Patralekh MK. 3D printing and its applications in orthopaedic trauma: A technological marvel. J Clin Orthop Trauma 2018; 9:260-268. [PMID: 30202159 PMCID: PMC6128305 DOI: 10.1016/j.jcot.2018.07.022] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND With rapid emergence of 3D printing technology, surgeons have recently started to apply this for nearly all areas of orthopaedic trauma surgery. Computed tomography or magnetic resonance images of trauma patients can be utilized for making graspable objects from 3D reconstructed images. Patient specific anatomical models can thereby be created. They enhance surgeon's knowledge of their patients' precise patho-anatomy, regarding both traumatized bones and soft tissue as well as normal areas, and therefore help in accurate preoperative planning. 3D printed patient specific instrumentation can help to achieve precise implant placement, and better surgical results. Most importantly, customized implants, casts, orthoses and prosthetics can be manufactured to match an individual's anatomy. Three dimensional (3D) printing, also called as 'additive manufacturing' and 'rapid prototyping' is considered as the "second industrial revolution", and this appears to be especially true for orthopaedic trauma surgery. METHODS A literature search was performed for extracting all papers related to 3D Printing applications in orthopaedics and allied sciences on the Pubmed, and SCOPUS; using suitable key terms and Boolean operators ("3D Printing" OR "3 dimensional printing" OR "3D printed" OR "additive manufacturing" OR "rapid prototyping") AND (''Orthopaedics" OR "Orthopaedics'') AND ("Trauma" OR "Injury")in June 2018. Search was also performed in Web of Science, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. No limits were set on the time period or evidence level, as 3D printing in orthopaedics is relatively recent and mainly low level evidence is available. Titles and abstracts were screened and all duplicate and unrelated papers were excluded. Papers related to orthopaedic trauma were manually selected for this review. RESULTS The search on Pubmed retrieved 144 Papers and similar search on SCOPUS retrieved 94 papers. Additional searches did not reveal more relevant papers. After excluding duplicates and unrelated papers, and on screening of titles and abstracts, 59 papers were considered for review. Papers related to spine fractures only were not included, as they have been covered in another paper in this journal issue. CONCLUSION All over the world, orthopaedic Surgeon's and allied professionals and scientists are enthusiastically using 3D printing technology for designing patient specific models, instrumentation, implants, orthosis and prosthesis, besides 3D bioprinting of bone and cartilage scaffolding, and the same has been applied for nearly all areas of orthopaedic trauma surgery, from head to foot.
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Affiliation(s)
| | - Mohit Kumar Patralekh
- Central Institute of Orthopaedics, Safdarjung Hospital and VMMC, New Delhi, 110029, India
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Song Y, Lin K, He S, Wang C, Zhang S, Li D, Wang J, Cao T, Bi L, Pei G. Nano-biphasic calcium phosphate/polyvinyl alcohol composites with enhanced bioactivity for bone repair via low-temperature three-dimensional printing and loading with platelet-rich fibrin. Int J Nanomedicine 2018; 13:505-523. [PMID: 29416332 PMCID: PMC5790108 DOI: 10.2147/ijn.s152105] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background and aim As a newly emerging three-dimensional (3D) printing technology, low-temperature robocasting can be used to fabricate geometrically complex ceramic scaffolds at low temperatures. Here, we aimed to fabricate 3D printed ceramic scaffolds composed of nano-biphasic calcium phosphate (BCP), polyvinyl alcohol (PVA), and platelet-rich fibrin (PRF) at a low temperature without the addition of toxic chemicals. Methods Corresponding nonprinted scaffolds were prepared using a freeze-drying method. Compared with the nonprinted scaffolds, the printed scaffolds had specific shapes and well-connected internal structures. Results The incorporation of PRF enabled both the sustained release of bioactive factors from the scaffolds and improved biocompatibility and biological activity toward bone marrow-derived mesenchymal stem cells (BMSCs) in vitro. Additionally, the printed BCP/PVA/PRF scaffolds promoted significantly better BMSC adhesion, proliferation, and osteogenic differentiation in vitro than the printed BCP/PVA scaffolds. In vivo, the printed BCP/PVA/PRF scaffolds induced a greater extent of appropriate bone formation than the printed BCP/PVA scaffolds and nonprinted scaffolds in a critical-size segmental bone defect model in rabbits. Conclusion These experiments indicate that low-temperature robocasting could potentially be used to fabricate 3D printed BCP/PVA/PRF scaffolds with desired shapes and internal structures and incorporated bioactive factors to enhance the repair of segmental bone defects.
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Affiliation(s)
- Yue Song
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Kaifeng Lin
- Second Department of Orthopedics and Traumatology, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Fuzhou, China
| | - Shu He
- Department of Orthopedics, Xi'an Hong Hui Hospital, Xi'an, China
| | - Chunmei Wang
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Shuaishuai Zhang
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Donglin Li
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jimeng Wang
- Department of Orthopedics, The 251st Hospital of Chinese PLA, Zhangjiakou, China
| | - Tianqing Cao
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Long Bi
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Guoxian Pei
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Papagelopoulos PJ, Savvidou OD, Koutsouradis P, Chloros GD, Bolia IK, Sakellariou VI, Kontogeorgakos VA, Mavrodontis II, Mavrogenis AF, Diamantopoulos P. Three-dimensional Technologies in Orthopedics. Orthopedics 2018; 41:12-20. [PMID: 29401368 DOI: 10.3928/01477447-20180109-04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
New 3-dimensional digital technologies are revolutionizing orthopedic clinical practice, allowing structures of any complexity to be manufactured in just hours. Such technologies can make surgery for complex cases more precise, more cost-effective, and possibly easier to perform. Applications include pre-operative planning, surgical simulation, patient-specific instrumentation and implants, bioprinting, prosthetics, and orthotics. The basic principles of 3- dimensional technologies, including imaging, design, numerical simulation, and printing, and their current applications in orthopedics are reviewed. [Orthopedics. 2018; 41(1):12-20.].
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Abstract
OBJECTIVE To evaluate the clinical efficacy and effectiveness of using 3D printing to develop medical devices across all medical fields. DESIGN Systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES PubMed, Web of Science, OVID, IEEE Xplore and Google Scholar. METHODS A double-blinded review method was used to select all abstracts up to January 2017 that reported on clinical trials of a three-dimensional (3D)-printed medical device. The studies were ranked according to their level of evidence, divided into medical fields based on the International Classification of Diseases chapter divisions and categorised into whether they were used for preoperative planning, aiding surgery or therapy. The Downs and Black Quality Index critical appraisal tool was used to assess the quality of reporting, external validity, risk of bias, risk of confounding and power of each study. RESULTS Of the 3084 abstracts screened, 350 studies met the inclusion criteria. Oral and maxillofacial surgery contained 58.3% of studies, and 23.7% covered the musculoskeletal system. Only 21 studies were randomised controlled trials (RCTs), and all fitted within these two fields. The majority of RCTs were 3D-printed anatomical models for preoperative planning and guides for aiding surgery. The main benefits of these devices were decreased surgical operation times and increased surgical accuracy. CONCLUSIONS All medical fields that assessed 3D-printed devices concluded that they were clinically effective. The fields that most rigorously assessed 3D-printed devices were oral and maxillofacial surgery and the musculoskeletal system, both of which concluded that the 3D-printed devices outperformed their conventional comparators. However, the efficacy and effectiveness of 3D-printed devices remain undetermined for the majority of medical fields. 3D-printed devices can play an important role in healthcare, but more rigorous and long-term assessments are needed to determine if 3D-printed devices are clinically relevant before they become part of standard clinical practice.
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Affiliation(s)
- Laura E Diment
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Mark S Thompson
- Department of Engineering Science, University of Oxford, Oxford, UK
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Biomechanical Properties of 3-Dimensional Printed Volar Locking Distal Radius Plate: Comparison With Conventional Volar Locking Plate. J Hand Surg Am 2017. [PMID: 28648329 DOI: 10.1016/j.jhsa.2017.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE This study evaluated the biomechanical properties of a new volar locking plate made by 3-dimensional printing using titanium alloy powder and 2 conventional volar locking plates under static and dynamic loading conditions that were designed to replicate those seen during fracture healing and early postoperative rehabilitation. METHODS For all plate designs, 12 fourth-generation synthetic composite radii were fitted with volar locking plates according to the manufacturers' technique after segmental osteotomy. Each specimen was first preloaded 10 N and then was loaded to 100 N, 200 N, and 300 N in phases at a rate of 2 N/s. Each construct was then dynamically loaded for 2,000 cycles of fatigue loading in each phase for a total 10,000 cycles. Finally, the constructs were loaded to a failure at a rate of 5 mm/min. RESULTS All 3 plates showed increasing stiffness at higher loads. The 3-dimensional printed volar locking plate showed significantly higher stiffness at all dynamic loading tests compared with the 2 conventional volar locking plates. The 3-dimensional printed volar locking plate had the highest yield strength, which was significantly higher than those of 2 conventional volar locking plates. CONCLUSIONS A 3-dimensional printed volar locking plate has similar stiffness to conventional plates in an experimental model of a severely comminuted distal radius fracture in which the anterior and posterior metaphyseal cortex are involved. CLINICAL RELEVANCE These results support the potential clinical utility of 3-dimensional printed volar locking plates in which design can be modified according the fracture configuration and the anatomy of the radius.
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