Clinical outcomes of the use of 3D printing models in fracture management: a meta-analysis of randomized studies

Efficacy of Three-Dimensional Printing in the Management of Frontal Bone Trauma

Objectives  Craniomaxillofacial (CMF) trauma surgery is difficult because of its unique architecture and vast range of injuries in the head and neck area. This study sought to determine the potential of employing preoperative three-dimensional (3D)-printed models to improve frontal fracture healing outcomes. Methods  This prospective cohort clinical trial involved 20 patients who were surgically fitted and had a frontal bone fracture, as evidenced by computed tomography. The patients were separated into two groups: Group A: patients with frontal bone trauma reduced using 3D printing; and Group B: patients with frontal bone trauma reduced without 3D printing. Results  Compared to Group B, Group A had a considerably shorter operational time ( p  < 0.001). The esthetic results, complications, and functional outcomes were not significantly different between the two groups. All patients in Groups A and B underwent accurate radiographic evaluations (correct placement of the titanium mesh). Conclusion  3D printing in preoperative planning improves frontal fracture repair with respect to operative length but does not reduce intraoperative blood loss or improve postoperative function compared with normal management.

Efficacy and safety of three-dimensional printing technology assisted open reduction and internal fixation versus conventional surgery in the treatment of acetabular fractures: a meta-analysis of randomized controlled trials

PURPOSE

The objective of this meta-analysis was to assess the influence of three-dimensional (3D) printing technology on open reduction and internal fixation (ORIF) of acetabular fractures from current randomized controlled trials (RCTs).

METHODS

A structured meta-analysis was conducted, and we searched online databases for published RCTs related to 3D printing and acetabular fracture, including PubMed, Cochrane Library, ScienceDirect, Wan fang, and CNKI up to November 2024. The outcome data of intraoperative blood loss, operation time, hip function (Harris score), quality of fracture reduction (Matta score) and incidence of complications were extracted. Stata16.0 and RevMan5.3 were used for our meta-analysis.

RESULTS

19 RCTs met our inclusion criteria and a total of 1046 patients were included in this meta-analysis. The meta-analysis showed significant difference in intraoperative blood loss (WMD = -274.65, 95% CI [-326.47, -222.83]), operation time (WMD = -53.26, 95% CI [-63.72, -42.80]), intraoperative fluoroscopy (WMD = -5.24, 95% CI [-6.57, -3.91]), instrumentation time (WMD = -35.31, 95% CI [-53.42, -17.21]), and post-surgery Matta score (RR = 1.17, 95% CI [1.09, 1.25]), incidence rate of complications (RR = 0.34, 95%CI [0.22, 0.52]). There is no significant difference in time from injury to operation (WMD=-0.06, 95%CI [-0.36, 0.24]) and Harris score (RR = 1.22, 95%CI [0.83, 1.79]) between two groups.

CONCLUSION

3D printing group showed reduced intraoperative blood loss, shorter operation time, faster instrumentation, less intraoperative fluoroscopy, better post-surgery reduction, and reduced incidence rate of complications. Therefore, based on existing research, ORIF guided by 3D printing technology should be a more effective method for treating acetabular fractures.

Investigating the Key Trends in Applying Artificial Intelligence to Health Technologies: A Scoping Review

BACKGROUND

The use of Artificial Intelligence (AI) is exponentially rising in the healthcare sector. This change influences various domains of early identification, diagnosis, and treatment of diseases.

PURPOSE

This study examines the integration of AI in healthcare, focusing on its transformative potential in diagnostics and treatment, and the challenges and methodologies. shaping its future development.

METHODS

The review included 68 academic studies retracted from different databases (WOS, Scopus and Pubmed) from January 2020 and April 2024. After careful review and data analysis, AI methodologies, benefits and challenges, were summarized.

RESULTS

The number of studies showed a steady rise from 2020 to 2023. Most of them were the results of a collaborative work with international universities (92.1%). The majority (66.7%) were published in top-tier (Q1) journals and 40% were cited 2-10 times. The results have shown that AI tools such as deep learning methods and machine learning continue to significantly improve accuracy and timely execution of medical processes. Benefits were discussed from both the organizational and the patient perspective in the categories of diagnosis, treatment, consultation and health monitoring of diseases. However, some challenges may exist, despite these benefits, and are related to data integration, errors related to data processing and decision making, and patient safety.

CONCLUSION

The article examines the present status of AI in medical applications and explores its potential future applications. The findings of this review are useful for healthcare professionals to acquire deeper knowledge on the use of medical AI from design to implementation stage. However, a thorough assessment is essential to gather more insights into whether AI benefits outweigh its risks. Additionally, ethical and privacy issues need careful consideration.

[Patient-specific 3D-printed implants and templates for elbow and forearm]

The process of 3D printing has found its way into orthopedics and trauma surgery, particularly for complex interventions on the elbow and forearm. By producing patient-specific implants and surgical templates misalignments, fractures and deformities can be precisely corrected. It could be shown that this technology increases the surgical accuracy, shortens recovery times and reduces postoperative complications. Compared to conventional implants 3D-printed implants provide the advantage of individual adaptation to the anatomical situation of the patient. This is particularly relevant in complex cases, such as malunions, congenital malformations (e.g., Madelung's deformity) and tumor-related deformities. The preoperative planning with 3D models enables a detailed simulation of the procedure and optimizes the placement of the implants. Despite these advantages challenges still remain: the production of patient-specific implants is time-consuming and cost-intensive. In addition, the technology requires expertise and special resources, which limit its application in less specialized centers. Future developments, such as 4D printing with shape-changing implants, promise further progress. By combining precision, individualization and dynamic adaptability, 3D-printed implants could sustainably improve patient care in orthopedics and trauma surgery.

Clinical added value of 3D printed patient-specific guides in orthopedic surgery (excluding knee arthroplasty): a systematic review

INTRODUCTION

Patient-specific guides (PSGs) provide customized solutions and enhanced precision. However, the question remains: does clinical evidence support the added value of PSGs? This study critically appraises, summarizes, and compares the literature to assess the clinical value of PSGs in orthopedic surgery.

MATERIALS AND METHODS

PubMed and Embase were used to search for studies reporting on randomized controlled trials (RCTs) that compared the use of PSGs with a control group for an orthopedic intervention, excluding knee arthroplasty. The risk of bias was assessed using the Cochrane risk-of-bias tool (RoB 2). The clinical value was expressed as patient reported outcome measures (PROMs), complications, accuracy, surgery duration, blood loss, and radiation exposure. Relative and absolute differences were determined, and whether these were negative or positive for using PSGs.

RESULTS

From 6310 studies, 27 RCTs were included, covering various interventions. The studies' heterogeneity prevented meta-analysis. Six (22.2%) of the included articles scored low risk of bias. Significant differences in the benefit of PSGs were reported across all included metrics: 32.2% in PROMs, 22.7% in complications, 69.8% in accuracy, 42.1% in surgery duration, 46.7% in blood loss, and 93.3% in radiation exposure. No significant negative differences were found in any of the studies.

CONCLUSION

PSGs generally show superior outcomes for accuracy and radiation exposure across multiple intervention types, while the reduction in complications was primarily significant in spinal fusion surgery. For PROMs, complications in other treatments, surgery duration, and blood loss, there may be clinical added value but future well-designed RCTs are needed to provide stronger evidence.

Comparing the efficacy of 3D-printing-assisted surgery with traditional surgical treatment of fracture: an umbrella review

BACKGROUND

The objective of this review is to evaluate the methodological quality of meta-analyses and observe the consistency of the evidence they generated to provide comprehensive and reliable evidence for the clinical use of three-dimensional (3D) printing in surgical treatment of fracture.

METHODS

We searched three databases (PubMed, Embase, and Web of Science) up until August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were adhered to in this review. The Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 was used to rate the quality and reliability of the meta-analyses (MAs), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to grade the outcomes. Furthermore, Graphical Representation of Overlap for Overviews (GROOVE) was employed to examine overlap, and the resulting evidence was categorized into four groups according to established criteria for evidence classification.

RESULTS

Results from 14 meta-analyses were combined. AMSTAR 2 gave six meta-analyses a high rating, six MAs a moderate rating, and two MAs a low rating. Three-dimensional printing shows promising results in fracture surgical treatment, significantly reducing operation time and loss of blood for tibial plateau fracture. For acetabular fracture, apart from the positive effects on operation time (ratio of mean (ROM) = 0.74, 95% confidence interval (CI), 0.66-0.83, I2 = 93%) and blood loss (ROM = 0.71, 95% CI 0.63-0.81, I2 = 71%), 3D printing helps reduce postoperative complications (odds ratio (OR) = 0.42, 95% CI, 0.22-0.78, I2 = 9%). For proximal humerus fracture, 3D printing helps shorten operation time (weighted mean difference (WMD) = -19.49; 95% CI -26.95 to -12.03; p < 0.05; I2 = 91%), reduce blood loss (WMD = -46.49; 95% CI -76.01 to -16.97; p < 0.05; I2 = 98%), and get higher Neer score that includes evaluation of pain, function, range of motion, and anatomical positioning (WMD = 9.57; 95% CI 8.11 to 11.04; p < 0.05; I2 = 64%). Additionally, positive results are also indicated for other fractures, especially for operation time, blood loss, and postoperative complications.

CONCLUSIONS

Compared with traditional fracture surgical treatment, 3D-printing-assisted surgery has significant advantages and great effectiveness in terms of operation time, loss of blood, and postoperative complications in the treatment of many different types of fractures, with less harm to patients.

Clinical Efficacy of Three-Dimensional-Printed Pure Titanium Fracture Plates with Locking Screw Systems in Distal Tibia Fractures

Background and Objectives: Distal tibia fractures are high-energy injuries characterized by a mismatch between standard plate designs and the patient's specific anatomical bone structure, which can lead to severe soft tissue damage. Recent advancements have focused on the development of customized metal plates using three-dimensional (3D) printing technology. However, 3D-printed metal plates using titanium alloys have not incorporated a locking system due to the brittleness of these alloys. Therefore, this study aimed to determine whether a locking mechanism can be effectively implemented using 3D-printed pure titanium and further evaluate the clinical outcomes of such implants in patients with distal tibia fractures. Materials and Methods: Between March 2021 and June 2022, nine patients who underwent open reduction and internal fixation for distal tibia fractures using 3D-printed pure titanium plates were enrolled. Pure titanium powder (Ti Gr.2, Type A, 3D Systems, USA) was spread to a thickness of 30 μm and partially sintered using a 500 W laser to produce the 3D-printed metal plates. The locking screws were fabricated using a milling process. Open reduction and internal fixation were performed on the nine patients using 10 customized plates. The clinical efficacy was analyzed using the union rate, and complications, such as infection and skin irritation, were evaluated to ensure a comprehensive outcome assessment. Results: Surgical treatment was successfully performed on nine patients, with nine of ten plates remaining stable and undamaged. However, one patient with neurofibromatosis experienced a fractured metal plate, which necessitated revision surgery using a metal rod. No screw loosening or surgical wound complications occurred. Conclusions: This study showed that 3D-printed pure titanium plates with integrated locking screw systems provide a viable and effective solution for managing distal tibia fractures. Three-dimensional printing and pure titanium show promise for orthopedic advancements.

A Hallux Valgus Surgical Planning Survey Using WBCT-based 3D Printing

Background

Recent literature highlights the importance of treating hallux valgus (HV) as a 3-dimensional (3D) deformity. Although 3D printing may enhance visualization of the multiplanar aspects of HV, its influence on surgical planning remains unclear. This study assessed changes in surgical plans when surgeons sequentially reviewed 2D radiographs, 3D weightbearing computed tomography (WBCT), and 3D-printed models, hypothesizing that 3D printing would have the greatest impact.

Methods

A single HV case (a 40-year-old woman, intermetatarsal angle [IMA] 21 degrees, HV angle [HVA] 47 degrees) was evaluated by 30 surgeons in a masked, stepwise manner. Surgical plans were recorded at each stage. Surgeons rated the influence of WBCT and 3D printing using a 5-point Likert scale. A follow-up survey examined the effect of these technologies on correction amplitudes.

Results

The participants were mostly early career surgeons (median age 35.5 years, 2 years in practice). WBCT was accessible to 43.3% and used in 30% of HV cases, whereas 3D printing was accessible to 23.3% and used in 6.6%. Changes in the treatment algorithm occurred in 30% of cases after WBCT and in 43.3% after 3D printing. Significant differences (P < .05) were observed for the Lapicotton procedure between radiography and WBCT, and between WBCT and 3D printing. Surgeons performing <50 HV cases annually or with >70% Foot and Ankle specialization were more influenced by WBCT. Follow-up data (n = 23) indicated that WBCT and 3D printing influenced correction amplitudes, particularly for pronation and distal metatarsal articular angle (DMAA), more than for the IMA.

Discussion

Both WBCT and 3D printing influenced surgical planning, mostly explained by changes in first ray tarsometatarsal procedures. The rotational components (pronation and DMAA) were perceived as the most significantly affected. Future studies should explore cost-effectiveness, patient outcomes, and the utility of combining WBCT and 3D printing in other deformities requiring multiplanar corrections.Level of Evidence: Level IV, cross-sectional survey.

Application of 3D printing technology in preoperative planning and treatment of proximal humerus fractures: a retrospective study

BACKGROUND

The application of 3D printing technology in preoperative planning and treatment of these fractures has shown promise in improving surgical efficiency, trauma, and patient outcomes. This study aims to demonstrate the advantages of applying 3D printing technology to the treatment of proximal humeral fractures by comparing cases selected for 3D printing with a control group (conventional surgery group), in order to further promote the application of 3D technology in a broader range of trauma treatments.

METHODS

This study conducted the clinical data of 51 patients with proximal humeral fractures. Inclusion criteria encompassed patients diagnosed with Neer II and III type proximal humerus fractures. Among them, 24 patients underwent traditional surgery, while 27 patients underwent surgery with 3D printing technology support. Intraoperative parameters, functional outcomes, radiographic results at 6 months, and pain scores were collected and analyzed.

RESULTS

The 3D printing group demonstrated significantly reduced total surgery time compared to the traditional surgery group (P < 0.05). Implant placement accuracy was significantly higher in the 3D printing group compared to the traditional surgery group (P < 0.05). Functional outcomes at 6 months favored the 3D printing group, with higher Constant-Murley Score and lower Disability of the Arm, Shoulder, and Hand (DASH) Score compared to the traditional surgery group (P < 0.05). Additionally, the 3D printing group showed a significantly lower prevalence of heterotopic ossification compared to the traditional surgery group (P < 0.05). Preoperative and early postoperative pain scores were significantly lower in the 3D printing group compared to the traditional surgery group (P < 0.05).

CONCLUSION

The integration of 3D printing technology into the preoperative planning and treatment of complex proximal humerus fractures demonstrated significant advantages in surgical efficiency, functional outcomes, radiographic prognosis, and pain management.

Insights into geometric deviations of medical 3d-printing: a phantom study utilizing error propagation analysis

BACKGROUND

The use of 3D-printing in medicine requires a context-specific quality assurance program to ensure patient safety. The process of medical 3D-printing involves several steps, each of which might be prone to its own set of errors. The segmentation error (SegE), the digital editing error (DEE) and the printing error (PrE) are the most important partial errors. Approaches to evaluate these have not yet been implemented in a joint concept. Consequently, information on the stability of the overall process is often lacking and possible process optimizations are difficult to implement. In this study, SegE, DEE, and PrE are evaluated individually, and error propagation is used to examine the cumulative effect of the partial errors.

METHODS

The partial errors were analyzed employing surface deviation analyses. The effects of slice thickness, kernel, threshold, software and printers were investigated. The total error was calculated as the sum of SegE, DEE and PrE.

RESULTS

The higher the threshold value was chosen, the smaller were the segmentation results. The deviation values varied more when the CT slices were thicker and when the threshold was more distant from a value of around -400 HU. Bone kernel-based segmentations were prone to artifact formation. The relative reduction in STL file size [as a proy for model complexity] was greater for higher levels of smoothing and thinner slice thickness of the DICOM datasets. The slice thickness had a minor effect on the surface deviation caused by smoothing, but it was affected by the level of smoothing. The PrE was mainly influenced by the adhesion of the printed part to the build plate. Based on the experiments, the total error was calculated for an optimal and a worst-case parameter configuration. Deviations of 0.0093 mm ± 0.2265 mm and 0.3494 mm ± 0.8001 mm were calculated for the total error.

CONCLUSIONS

Various parameters affecting geometric deviations in medical 3D-printing were analyzed. Especially, soft reconstruction kernels seem to be advantageous for segmentation. The concept of error propagation can contribute to a better understanding of the process specific errors and enable future analytical approaches to calculate the total error based on process parameters.

Accuracy of pelvic bone segmentation for 3d printing: a study of segmentation accuracy based on anatomic landmarks to evaluate the influence of the observer

BACKGROUND

3D printing has a wide range of applications and has brought significant change to many medical fields. However, ensuring quality assurance (QA) is essential for patient safety and requires a QA program that encompasses the entire production process. This process begins with imaging and continues on with segmentation, which is the conversion of Digital Imaging and Communications in Medicine (DICOM) data into virtual 3D-models. Since segmentation is highly influenced by manual intervention the influence of the users background on segmentation accuracy should be thoroughly investigated.

METHODS

Seventeen computed tomography (CT) scans of the pelvis with physiological bony structures were identified, anonymized, exported as DICOM data sets, and pelvic bones were segmented by four observers with different backgrounds. Landmarks were measured on DICOM images and in the segmentations. Intraclass correlation coefficients (ICCs) were calculated to assess inter-observer agreement, and the trueness of the segmentation results was analyzed by comparing the DICOM landmark measurements with the measurements of the segmentation results. The correlation between segmentation trueness and segmentation time was analyzed.

RESULTS

The lower limits of the 95% confidence intervals of the ICCs for the seven landmarks analyzed ranged from 0.511 to 0.986. The distance between the iliac crests showed the highest agreement between observers, while the distance between the ischial tuberosities showed the lowest. The distance between the upper edge of the symphysis and the promontory showed the lowest deviation between DICOM measurements and segmentation measurements (mean deviations < 1 mm), while the intertuberous distance showed the highest deviation (mean deviations 14.5-18.2 mm).

CONCLUSIONS

Investigators with diverse backgrounds in segmentation and varying experience with slice images achieved pelvic bone segmentations with landmark measurements of mostly high agreement in a setup with high realism. In contrast, high variability was observed in the segmentation of the coccyx. In general, interobserver agreement was high, but due to measurement inaccuracies, landmark-based approaches cannot conclusively show that segmentation accuracy is within a clinically tolerable range of 2 mm for the pelvis. If the segmentation is performed by a very inexperienced user, the result should be reviewed critically by the clinician in charge.

High-Temperature Polylactic Acid Proves Reliable and Safe for Manufacturing 3D-Printed Patient-Specific Instruments in Pediatric Orthopedics-Results from over 80 Personalized Devices Employed in 47 Surgeries

(1) Background: Orthopedic surgery has been transformed by 3D-printed personalized instruments (3DP-PSIs), which enhance precision and reduce complications. Hospitals are adopting in-house 3D printing facilities, using cost-effective methods like Fused Deposition Modeling (FDM) with materials like Polylactic acid (PLA) to create 3DP-PSI. PLA's temperature limitations can be overcome by annealing High-Temperature PLA (ann-HTPLA), enabling steam sterilization without compromising properties. Our study examines the in vivo efficacy of ann-HTPLA 3DP-PSI in pediatric orthopedic surgery. (2) Methods: we investigated safety and efficacy using ann-HTPLA 3DP-PSI produced at an "in-office" 3D-printing Point-of-Care (3DP-PoC) aimed at correcting limb deformities in pediatric patients. Data on 3DP-PSI dimensions and printing parameters were collected, along with usability and complications. (3) Results: Eighty-three ann-HTPLA 3DP-PSIs were utilized in 33 patients (47 bone segments). The smallest guide used measured 3.8 cm3, and the largest measured 58.8 cm3. Seventy-nine PSIs (95.2%; 95% C.I.: 88.1-98.7%) demonstrated effective use without issues. Out of 47 procedures, 11 had complications, including 2 infections (4.3%; 95% CI: 0.5-14.5%). Intraoperative use of 3DP-PSIs did not significantly increase infection rates or other complications. (4) Conclusions: ann-HTPLA has proven satisfactory usability and safety as a suitable material for producing 3DP-PSI in an "in-office" 3DP-PoC.

Quality assurance of 3D-printed patient specific anatomical models: a systematic review

BACKGROUND

The responsible use of 3D-printing in medicine includes a context-based quality assurance. Considerable literature has been published in this field, yet the quality of assessment varies widely. The limited discriminatory power of some assessment methods challenges the comparison of results. The total error for patient specific anatomical models comprises relevant partial errors of the production process: segmentation error (SegE), digital editing error (DEE), printing error (PrE). The present review provides an overview to improve the general understanding of the process specific errors, quantitative analysis, and standardized terminology.

METHODS

This review focuses on literature on quality assurance of patient-specific anatomical models in terms of geometric accuracy published before December 4th, 2022 (n = 139). In an attempt to organize the literature, the publications are assigned to comparable categories and the absolute values of the maximum mean deviation (AMMD) per publication are determined therein.

RESULTS

The three major examined types of original structures are teeth or jaw (n = 52), skull bones without jaw (n = 17) and heart with coronary arteries (n = 16). VPP (vat photopolymerization) is the most frequently employed basic 3D-printing technology (n = 112 experiments). The median values of AMMD (AMMD: The metric AMMD is defined as the largest linear deviation, based on an average value from at least two individual measurements.) are 0.8 mm for the SegE, 0.26 mm for the PrE and 0.825 mm for the total error. No average values are found for the DEE.

CONCLUSION

The total error is not significantly higher than the partial errors which may compensate each other. Consequently SegE, DEE and PrE should be analyzed individually to describe the result quality as their sum according to rules of error propagation. Current methods for quality assurance of the segmentation are often either realistic and accurate or resource efficient. Future research should focus on implementing models for cost effective evaluations with high accuracy and realism. Our system of categorization may be enhancing the understanding of the overall process and a valuable contribution to the structural design and reporting of future experiments. It can be used to educate specialists for risk assessment and process validation within the additive manufacturing industry.

3D surgical planning including patient-specific drilling guides for tibial plateau fractures

Aims

Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery.

Methods

A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group.

Results

A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026).

Conclusion

The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort.

Side-to-Side Flipping Wedge Osteotomy: Virtual Surgical Planning Suggested an Innovative One-Stage Procedure for Aligning Both Knees in "Windswept Deformity"

(1) Background: The adoption of Virtual Surgical Planning (VSP) and 3D technologies is rapidly growing within the field of orthopedic surgery, opening the door to highly innovative and individually tailored surgical techniques. We present an innovative correction approach successfully used in a child affected by "windswept deformity" of the knees. (2) Methods: We report a case involving a child diagnosed with "windswept deformity" of the knees. This condition was successfully addressed through a one-stage bilateral osteotomy of the distal femur. Notably, the wedge removed from the valgus side was flipped and employed on the varus side to achieve the correction of both knees simultaneously. The surgical technique was entirely conceptualized, simulated, and planned in a virtual environment. Customized cutting guides and bony models were produced at an in-hospital 3D printing point of care and used during the operation. (3) Results: The surgery was carried out according to the VSP, resulting in favorable outcomes. We achieved good corrections of the angular deformity with an absolute difference from the planned correction of 2° on the right side and 1° on the left side. Moreover, this precision not only improved surgical outcomes but also reduced the procedure's duration and overall cost, highlighting the efficiency of our approach. (4) Conclusions: The integration of VSP and 3D printing into the surgical treatment of rare limb anomalies not only deepens our understanding of these deformities but also opens the door to the development of innovative, personalized, and adaptable approaches for addressing these unique conditions.

The Clinical Efficacy of Contouring Periarticular Plates on a 3D Printed Bone Model

We report our experience of preoperative plate contouring for periarticular fractures using three-dimensional printing (3DP) technology and describe its benefits. We enrolled 34 patients, including 11 with humerus midshaft fractures, 12 with tibia plateau fractures, 2 with pilon fractures, and 9 with acetabulum fractures. The entire process of plate contouring over the 3DP model was videotaped and retrospectively analyzed. The total time and number of trials for the intraoperative positioning of precontoured plates and any further intraoperative contouring events were prospectively recorded. The mismatch between the planned and postoperative plate positions was evaluated. The average plate contouring time was 9.2 min for humerus shaft, 13.8 min for tibia plateau fractures, 8.8 min for pilon fractures, and 11.6 min for acetabular fractures. Most precontoured plates (88%, 30/34) could sit on the planned position without mismatch. In addition, only one patient with humerus shaft fracture required additional intraoperative contouring. Preoperative patient specific periarticular plate contouring using a 3DP model is a simple and efficient method that may alleviate the surgical challenges involved in plate contouring and positioning.

Structural analysis of customized 3D printed plate for pelvic bone by comparison with conventional plate based on bending process

Pelvic bone fracture is highly complex, and its anatomical reduction is difficult. Therefore, patient-specific customized plates have been developed using three-dimensional (3D) printing technology and are being increasingly used. In this study, the reduction status in five representative pelvic fracture models was compared between two groups: the 3D printing plate (3DP) group using a patient-specific 3D printed plate after virtual reduction and the conventional plate (CP) group using a conventional plate by manual bending. The 3DP and CP groups included 10 and 5 cases, respectively. The fractured models were reduced virtually and their non-locking metal plates were customized using 3D printing. The process of contouring the conventional plates to fit the contact surface of the bone with the bending tool was conducted by an experienced pelvic bone trauma surgeon. The reduction and fixation achieved using the two different plate groups was compared, and the significance of differences in the results was analyzed using paired t-tests, after verifying the normality of data distribution. The vertex distances between the surface of the bone and the contact surface of the plate were significantly lower in the 3DP group than in the CP group (0.407 ± 0.342 and 2.195 ± 1.643, respectively, P = 0.008). Length and angular variations, which are measurements of the reduction state, were also lower in the 3DP group than in the CP group (length variation: 3.211 ± 2.497 and 5.493 ± 3.609, respectively, P = 0.051; angular variation: 2.958 ± 1.977 and 4.352 ± 1.947, respectively, P = 0.037). The customized 3D printed plate in the virtual reduction model provided a highly accurate reduction of pelvic bone fractures, suggesting that the customized 3D printed plate may help ensure easy and accurate reduction.

Application of 3D modeling in a personalized approach to bone osteosynthesis (A literature review)

Three-dimensional printing opens up many opportunities for use in traumatology and orthopedics, because it takes into account personal characteristics of the patients. Modern methods of high-resolution medical imaging can process data to create threedimensional images for printing physical objects. Today, three-dimensional printers are able to create a model of any complexity of shape and geometry. The article provides a review of the literature about three-dimensional digital modeling in shaping implants for osteosynthesis. Data search was carried out on the Scopus, Web of Scince, Pubmed, RSCI databases for the period 2012–2022. The effectiveness of three-dimensional printing for preoperative modeling of bone plates has been confirmed: implants perfectly corresponds with the unique anatomy of the patient, since the template for it is based on the materials of computed tomography. Individual templates can be useful when the geometry of patients' bones goes beyond the standard, and when improved results of surgery are expected due to better matching of implants to the anatomical needs of patients. 

Does a Customized 3D Printing Plate Based on Virtual Reduction Facilitate the Restoration of Original Anatomy in Fractures?

The purpose of this study was to evaluate the restoration of original anatomy after fixation of sawbone fractures using case-specific 3D printing plates based on virtual reduction (VR). Three-dimensional models of 28 tibia sawbones with cortical marking holes were obtained. The sawbones were fractured at various locations of the shaft and 3D models were obtained. The fractured models were reduced virtually and customized non-locking metal plates that fit the reduced model were produced via 3D printing. The fractured sawbones were actually fixed to the customized plate with nonlocking screws and 3D models were generated. With the proximal fragments of the 3D models overlapped, the changes in length, 3D angulation, and rotation of the distal fragment were evaluated. Compared to the intact model (IN), the virtual reduction model (VR) and the actual fixation model (AF) showed no significant differences in length. Compared to the IN, the VR and the AF had mean 3D angulations of 0.39° and 0.64°, respectively. Compared to the IN model, the VR and the AF showed mean rotations of 0.89° and 1.51°, respectively. A customized plate based on VR facilitates the restoration of near-original anatomy in fractures of tibial sawbone shaft.

Advantages of three-dimensional printing in the management of acetabular fracture fixed by the Kocher-Langenbeck approach: randomised controlled trial

PURPOSE

To compare the outcomes of the Kocher-Langenbeck reduction and fixation of the posterior structures of the acetabulum between 3D printing technique and conventional technique.

METHODS

Forty-three patients who sustained fractures of the posterior part of the acetabulum were randomly assigned to two groups: 3D printing (G1; n = 20) and conventional technique (G2; n = 23). The surgical time, intra-operative blood loss, differences between pre-and post-operative haemoglobin, universal functional and radiographic scores, and complications were compared between the groups. The minimum follow-up was 18 months.

RESULTS

The average operating time (120.75 min) and intra-operative blood loss (244 ml) were lower in G1 than in G2 (125.87 min and 268.7 ml, respectively; p = 0.42, p = 0.1, respectively). The difference between the pre- and post-operative haemoglobin was 1.71 g/dl in G1 and 1.93 g/dl in G2 (p = 0.113). Post-operative complications occurred more frequently in patients in G2 (34.7%) than in patients in G1 (15%), though these differences were also not significant (p = 0.6). The radiographic result was satisfactory in 16 patients (80%) in G1 and 18 patients (78.26%) in G2 (p = 0.5). The clinical result was satisfactory in 15 patients (75%) in G1 and in 17 patients (73.9%) in G2 (p = 0.6).

CONCLUSIONS

No significant differences were found in terms of surgical time, overall complications, and radiographic or functional outcomes between 3D printing and the conventional technique.