The Efficacy of 3D Printing Model in the Intraarticular Osteotomy in the Treatment of Malunion of Tibial Plateau Fracture

• Published in: Orthopaedic surgery Vol. 15; no. 1; pp. 85 - 92
• Main Authors: Jiang, Liangjun, Li, Hang, Huang, Lu
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.01.2023; John Wiley & Sons, Inc; Wiley
• Subjects: 3-D printers; 3D printing technology; Clinical; Fracture Fixation, Internal - methods; Fractures; Hospitals; Humans; Intraarticular osteotomy; Knee; Medical imaging; Osteotomy - methods; Patients; Preoperative planning; Printing, Three-Dimensional; Retrospective Studies; Statistical analysis; Surgeons; Surgery; Tibial Fractures - surgery; Tibial plateau fracture malunion; Tibial Plateau Fractures; Treatment Outcome; Weightlifting; X-rays; Intraarticular osteotomy; 3D printing technology; Tibial plateau fracture malunion; Preoperative planning
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13554

Objectives Three‐dimensional (3D) printing technology has shown potential advantages in accurate and efficient tibial plateau fracture (TPF) treatment. This technology can provide structural morphology to repair fracture fragments. Here, we summarize our experience with the use of 3D printing technology during intraarticular osteotomy in the treatment of the malunion of TPF. Methods The patients who were treated with malunion of TPF in our hospital between January 2015 and December 2018 were retrospectively analyzed. These patients were divided into two groups: the conventional group without 3D‐printed model application and the 3D printing group with 3D‐printed model application. All patients received the intraarticular osteotomy during operation, and we compared the operation time (min), fracture healing time (months), postoperative knee Rasmussen scores (0–30 points), knee mobility range (0–140°) (the independent t‐test), fracture reduction evaluation (Biggi's method) (the chi‐square test: Fisher's exact test), and postoperative complications of each group. Results Twenty‐six patients aged 18–65 years who underwent TPF revision operation were included in this study, including 18 patients in the conventional group, and eight patients in the 3D printing group. The follow‐up time was 24–48 months, and the operation time was 185 min in the conventional group and 180 min in the 3D printing group. All patients received a bone union at the last follow‐up. The healing time was 4.2 months in the conventional group and 3.75 months in the 3D printing group (p > 0.05). The respective postoperative Rasmussen scores were 24.6 and 26.2, and postoperative knee mobility was 103.5° and 118.5° in the conventional group and 3D printing group, respectively. Both the Rasmussen scores and degrees of mobility were significantly improved after surgery (p < 0.05), and the postoperative knee mobility was significantly better in the 3D printing group versus the conventional group (p < 0.05). Four patients still had a 2‐mm collapse on the articular surface, and two patients still had slight valgus (<5°) in the conventional group. Only one case in the 3D printing group suffered from an articular surface collapse. Superficial wound infections occurred in two patients in the conventional group. Conclusion The results show that 3D printing technology is an effective preoperative preparation in the treatment of TPF malunion. This technology can facilitate accurate preoperative planning to select the optimal surgical approach, plan the implant placement, visualize the screw trajectory, and anticipate possible intraoperative difficulties. To explore the use of 3D printing technology in the intraarticular osteotomy in the treatment of malunion of tibial plateau fracture, we summarize our experiences and clinical results of 3D printing model application. Our patients with malunion of tibial plateau fracture (TPF) were divided into conventional group or 3D printing group according to without/with 3D printing model application. A total of 26 patients were included, 18 patients in conventional group and eight patients in 3D printing group, the follow‐up time was 24–48 months. Operation time and the healing time was similar in the two groups (p > 0.05). The respective postoperative Rasmussen score and postoperative knee mobility in the two groups both were significantly improved before surgery (p < 0.05), and the postoperative knee mobility was significant better in 3D printing group compared with conventional group (p < 0.05). Four patients still had 2 mm collapse on the articular surface, and two patients still had slight valgus (<5°) in conventional group. Only one case in 3D printing group had articular surface collapse. Our conclusion is the 3D‐printing model is an effective preoperative preparation in the treatment of malunion of tibial plateau fracture.