Surgical advantages of using 3D patient-specific models in high-energy tibial plateau fractures
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ORIGINAL ARTICLE
Surgical advantages of using 3D patient‑specific models in high‑energy tibial plateau fractures Anil Murat Ozturk1 · Onur Suer1 · Okan Derin2 · Mehmet Asim Ozer2 · Figen Govsa2 · Kemal Aktuglu1 Received: 12 January 2019 / Accepted: 20 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Treatment of tibial plateau fractures are difficult due to the intra-articular nature of the proximal tibia and extensive involvement of the soft tissue envelope. In this study, we investigated the surgical experience acquired using digitally designed life-size fracture models to guide as a template to place plates and screws in the treatment of tibial plateau fractures and anatomic reduction of joint. Methods 20 tibial plateau frature patients were divided into two equal surgery groups as conventional versus 3D model assisted. The fracture line angles, depression depth, and preoperative/postoperative Rasmussen knee score were measured for each patient. Results The duration of the operation, blood loss volume, turniquet time and number of intraoperative fluoroscopy was 89.5 ± 5.9 min, 160.5 ± 15.3 ml, 74.5 ± 6 min and 10.7 ± 1.76 times, for 3D printing group and 127 ± 14.5 min, 276 ± 44.8 ml, 104.5 ± 5.5 min and 18.5 ± 2.17 times for the conventional group, respectively. 3D model-assisted group indicated significantly shorter operation time, less blood loss volume, shorter turniquet and fluoroscopy times, and better outcome than the conventional one. Conclusions The customized 3D model was user friendly, and it provided a radiation-free tibial screw insertion. The use of these models assisted surgical planning, maximized the possibility of ideal anatomical reduction and provided individualized information concerning tibial plateau fractures. Keywords Tibial plateau fracture · 3D model · Schatzker type · Personalized surgery · Preoperative planning · Patientspecific model
Introduction One of the most critical load-bearing areas in human body is the tibial plateau. Fractures in this area are hard to treat due to the intra-articular nature of the proximal tibia and extensive involvement of the soft tissue envelope [1, 2]. Open reduction and internal fixation are often required to restore the joint surface and the alignment of the lower limb [3, 4], particularly, for displaced bicondylar tibial plateau fractures since they affect knee alignment, stability and motion [5–8]. * Figen Govsa [email protected] 1
Department of Orthopedic Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, Turkey
2
Although plain radiographs, Schatzker, Three Column and AO classifications describe the location and general pattern of fracture and the fact that all the classified systems locate the fractures based on CT, they still do not define nor particularize morphological characteristics of depression and the fracture line orientation [1, 2, 9–11] (Figs. 1, 2). which wou
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