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Original Article · Open access

Efficacy of 3D printing-assisted treatment for acetabular fractures

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Chunming Si

Department of Orthopaedic Center, Xinjiang Production and Construction Corps Hospital, Urumqi, China

ORCID: 0009-0003-2673-4168

Baolin Bai

Department of Orthopaedic Center, Xinjiang Production and Construction Corps Hospital, Urumqi, China

ORCID: 0009-0003-9877-9656

Wei Cong

Department of Orthopaedic Center, Xinjiang Production and Construction Corps Hospital, Urumqi, China

ORCID: 0009-0004-7092-5233

Lipeng Zhang

Department of Orthopaedic Center, Xinjiang Production and Construction Corps Hospital, Urumqi, China

ORCID: 0009-0001-0537-1922

Ruisheng Guan

Department of Orthopaedic Center, Xinjiang Production and Construction Corps Hospital, Urumqi, China

ORCID: 0009-0009-4552-9059

Abstract

Objectives: The aim of this study was to investigate the efficacy of three-dimensional (3D) printing-assisted treatment for acetabular fractures (AFs) and to compare with conventional surgical methods.

Patients and methods: Between May 2019 and May 2022, a total of 44 patients (33 males, 11 females; mean age: 40.6±11.8 years; range, 20 to 68 years) who were diagnosed with AFs based on clinical symptoms, X-ray and computed tomography (CT) and underwent open reduction and internal fixation in Hospital of Xinjiang Production and Construction Corps were retrospectively analyzed. The patients were divided into two groups based on whether 3D printing was applied as the experimental group (n=24) and control group (n=20). In the experimental group, pelvic and acetabular data were imported into a 3D printer, and an equal-scale highly simulated model was printed using photosensitive resin as the 3D printing material. The model was used to develop more specific personalized surgical plans, to determine the optimal sequence of surgical procedures for fracture reduction, and simulate surgery in vitro.

Results: In the experimental group, the mean surgical duration was shorter (123.57±22.05 vs. 163.57±26.20 min, p<0.001), the mean intraoperative bleeding loss was lower (557.14±174.15 vs. 885.71±203.27 mL, p<0.001), and the frequency of intraoperative fluoroscopy was lower (8.64±1.65 vs. 12.07±2.76, p<0.001) than in the control group. No statistically significant differences were found between the two groups in the Visual Analog Scale scores after surgery or the hip function score after treatment (p>0.05). No major postoperative complications were observed in any of the patients.

Conclusion: Compared to conventional surgical treatment, preoperative 3D printing-assisted treatment for adult patients with AFs can significantly reduce surgical duration, intraoperative bleeding loss and frequency of intraoperative C-arm fluoroscopy, reducing surgical difficulty and improving surgical safety.

Declarations

Ethics Committee Approval

The study protocol was approved by the Hospital of Xinjiang Production and Construction Corps Ethics Committee (date: 09.09.2022, no: 202206201). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed Consent

A written informed consent was obtained from each patient.

Author Contributions

Conceived of the study: S.C.M., G.R.S.; Participated in its design and data analysis and statistics: B.B.L., C.W., Z.L.P. All authors helped to draft the manuscript, read and approved the final manuscript

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

Xinjiang Production and Construction Corps’ Science and Technology Research Plan in Key Areas (2022AB029).

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Dailey SK, Phillips CT, Radley JM, Archdeacon MT. Achieving anatomic acetabular fracture reduction-when is the best time to operate? J Orthop Trauma 2016;30:426-31. DOI: 10.1097/BOT.0000000000000576.
  2. Abo-Elsoud M, El-Gebeily M, El-Desouky I. Combined acetabular and femoral neck fractures with intrapelvic femoral head dislocation: Successful staged management of a rare injury in two cases. Jt Dis Relat Surg 2022;33:230-7. DOI: 10.52312/jdrs.2022.548.
  3. Kenmegne GR, Zou C, He X, Lubamba GP, Fang Y. Bilateral acetabular fracture secondary to high-velocity trauma: A rare case report. Jt Dis Relat Surg 2022;33:455-61. DOI: 10.52312/jdrs.2022.641.
  4. In: Buckley R, Moran CG, Apivatthakakul T, editors. AO Principles of Fracture management. Shanghai: Shanghai Science and Technology Press; 2019.
  5. Manganaro MS, Morag Y, Weadock WJ, Yablon CM, Gaetke-Udager K, Stein EB. Creating three-dimensional printed models of acetabular fractures for use as educational tools. Radiographics 2017;37:871-80. DOI: 10.1148/rg.2017160129.
  6. Zhongyan Z, Tongning Q, Huaizhao M, Yu W, Yu J. Efficacy of 3D printing technology-assisted virtual surgical planning in acetabular fracture fixation. CJTER 2020;24:2405-9.
  7. Burnard JL, Parr WCH, Choy WJ, Walsh WR, Mobbs RJ. 3D-printed spine surgery implants: A systematic review of the efficacy and clinical safety profile of patient-specific and off-the-shelf devices. Eur Spine J 2020;29:1248-60. DOI: 10.1007/s00586-019-06236-2.
  8. Xie L, Chen C, Zhang Y, Zheng W, Chen H, Cai L. Threedimensional printing assisted ORIF versus conventional ORIF for tibial plateau fractures: A systematic review and meta-analysis. Int J Surg 2018;57:35-44. DOI: 10.1016/j.ijsu.2018.07.012.
  9. 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;39:2083-92. DOI: 10.1002/jor.24939.
  10. Chen X, Wu H, Cheng K, Liu X, Cai X. Inclined angles of acetabular quadrilateral plate: Digital measurement and clinical application of the new anatomical concept. J Orthop Surg Res 2023;18:723. DOI: 10.1186/s13018-023-04143-3.
  11. Shafshak TS, Elnemr R. The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain. J Clin Rheumatol 2021;27:282-5. DOI: 10.1097/RHU.0000000000001320.
  12. Fakru NH, Faisham WI, Hadizie D, Yahaya S. Functional outcome of surgical stabilisation of acetabular fractures. Malays Orthop J 2021;15:129-35. DOI: 10.5704/MOJ.2107.019.
  13. Lim PK, Stephenson GS, Keown TW, Byrne C, Lin CC, Marecek GS, et al. Use of 3D printed models in resident education for the classification of acetabulum fractures. J Surg Educ 2018;75:1679-84. DOI: 10.1016/j.jsurg.2018.04.019.
  14. Goyal S, Chua C, Chen YS, Murphy D, O 'Neill GK. Utility of 3D printed models as adjunct in acetabular fracture teaching for Orthopaedic trainees. BMC Med Educ 2022;22:595. DOI: 10.1186/s12909-022-03621-2.
  15. 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;95:414-9. DOI: 10.1136/postgradmedj-2019-136482.
  16. Wu L, Yang XC, Wu J, Zhao X, Lu ZD, Li P. Short-term outcome of artificial intelligence-assisted preoperative three-dimensional planning of total hip arthroplasty for developmental dysplasia of the hip compared to traditional surgery. Jt Dis Relat Surg 2023;34:571-82. DOI: 10.52312/jdrs.2023.1076.
  17. Mauffrey C, Stacey S, York PJ, Ziran BH, Archdeacon MT. Radiographic evaluation of acetabular fractures: Review and update on methodology. J Am Acad Orthop Surg 2018;26:83-93. DOI: 10.5435/JAAOS-D-15-00666.
  18. Scheinfeld MH, Dym AA, Spektor M, Avery LL, Dym RJ, Amanatullah DF. Acetabular fractures: What radiologists should know and how 3D CT can aid classification. Radiographics 2015;35:555-77. DOI: 10.1148/rg.352140098.
  19. Öztürk AM, Süer O, Şirintürk S, Aktuğlu K, Govsa F, Özer MA. A retrospective comparison of the conventional versus three-dimensional printed model-assisted surgery in the treatment of acetabular fractures. Acta Orthop Traumatol Turc 2020;54:385-93. DOI: 10.5152/j.aott.2020.19054.
  20. Wang C, Chen Y, Wang L, Wang D, Gu C, Lin X, et al. Threedimensional printing of patient-specific plates for the treatment of acetabular fractures involving quadrilateral plate disruption. BMC Musculoskelet Disord 2020;21:451. DOI: 10.1186/s12891-020-03370-7.
  21. Wan L, Zhang X, Zhang S, Li K, Cao P, Li J, et al. Clinical feasibility and application value of computer virtual reduction combined with 3D printing technique in complex acetabular fractures. Exp Ther Med 2019;17:3630-6. DOI: 10.3892/etm.2019.7344.
  22. Downey C, McCarrick C, Fenelon C, Murphy EP, O’Daly BJ, Leonard M. A novel approach using 3-D printing in the Irish National Centre for pelvic and acetabular surgery. Ir J Med Sci 2020;189:219-28. DOI: 10.1007/s11845-019-02055-y.
  23. Hung CC, Li YT, Chou YC, Chen JE, Wu CC, Shen HC, et al. Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture. Int Orthop 2019;43:425-31. DOI: 10.1007/s00264-018-3963-2.
  24. Cao J, Zhu H, Gao C. A systematic review and metaanalysis of 3D printing technology for the treatment of acetabular fractures. Biomed Res Int 2021;2021:5018791. DOI: 10.1155/2021/5018791.
  25. Ansari S, Barik S, Singh SK, Sarkar B, Goyal T, Kalia RB. Role of 3D printing in the management of complex acetabular fractures: A comparative study. Eur J Trauma Emerg Surg 2021;47:1291-6. DOI: 10.1007/s00068-020-01485-z.