Comparative use of the computer-aided angiography and rapid prototyping technology versus conventional imaging in the management of the Tile C pelvic fractures

Three-Dimensional Printing and Fracture Mapping in Pelvic and Acetabular Fractures: A Systematic Review and Meta-Analysis

Three-dimensional printing and fracture mapping technology is gaining popularity for preoperative planning of fractures. The aim of this meta-analysis is to further understand for the effects of 3D printing and fracture mapping on intraoperative parameters, postoperative complications, and functional recovery on pelvic and acetabular fractures. The PubMed, Embase, Cochrane and Web of Science databases were systematically searched for articles according to established criteria. A total of 17 studies were included in this study, of which 3 were RCTs, with a total of 889 patients, including 458 patients treated by traditional open reduction and internal fixation methods and 431 patients treated using 3D printing strategies. It was revealed that three-dimensional printing and fracture mapping reduced intraoperative surgical duration (RoM 0.74; 95% CI; 0.66–0.83; I² = 93%), and blood loss (RoM 0.71; 95% CI; 0.63–0.81; I² = 71%). as compared to traditional surgical approaches. In addition, there was significantly lower exposure to intraoperative imaging (RoM 0.36; 95% CI; 0.17–0.76; I² = 99%), significantly lower postoperative complications (OR 0.42; 95% CI; 0.22–0.78; I² = 9%) and significantly higher excellent/good reduction (OR 1.53; 95% CI; 1.08–2.17; I² = 0%) in the three-dimensional printing and fracture mapping group. Further stratification results with only prospective studies showed similar trends. Three-dimensional printing and fracture mapping technology has potential in enhancing treatment of complex fractures by improving surgical related factors and functional outcomes and therefore could be considered as a viable tool for future clinical applications.

Does 3D-Assisted Operative Treatment of Pelvic Ring Injuries Improve Patient Outcome?-A Systematic Review of the Literature

Background: There has been an exponential growth in the use of advanced technologies for three-dimensional (3D) virtual pre- and intra-operative planning of pelvic ring injury surgery but potential benefits remain unclear. The purpose of this study was to evaluate differences in intra- and post-operative results between 3D and conventional (2D) surgery. Methods: A systematic review was performed including published studies between 1 January 2010 and 22 May 2020 on all available 3D techniques in pelvic ring injury surgery. Studies were assessed for their methodological quality according to the Modified McMaster Critical Review form. Differences in operation time, blood loss, fluoroscopy time, screw malposition rate, fracture reduction and functional outcome between 3D-assisted and conventional (2D) pelvic injury treatment were evaluated and a best-evidence synthesis was performed. Results: Eighteen studies fulfilled the inclusion criteria, evaluating a total of 988 patients. Overall quality was moderate. Regarding intra-operative results of 3D-assisted versus conventional surgery: The weighted mean operation time per screw was 43 min versus 52 min; for overall operation time 126 min versus 141 min; blood loss 275 ± 197 mL versus 549 ± 404 mL; fluoroscopy time 74 s versus 125 s and fluoroscopy frequency 29 ± 4 versus 63 ± 3. In terms of post-operative outcomes of 3D-assisted versus conventional surgery: weighted mean screw malposition rate was 8% versus 18%; quality of fracture reduction measured by the total excellent/good rate by Matta was 86% versus 82% and Majeed excellent/good rate 88% versus 83%. Conclusion: The 3D-assisted surgery technologies seem to have a positive effect on operation time, blood loss, fluoroscopy dose, time and frequency as well as accuracy of screw placement. No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established so far. Due to a wide range of methodological quality and heterogeneity between the included studies, results should be interpreted with caution.

Use of three-dimensional printing in preoperative planning in orthopaedic trauma surgery: A systematic review and meta-analysis

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.

Creating patient-specific anatomical models for 3D printing and AR/VR: a supplement for the 2018 Radiological Society of North America (RSNA) hands-on course

Advanced visualization of medical image data in the form of three-dimensional (3D) printing continues to expand in clinical settings and many hospitals have started to adapt 3D technologies to aid in patient care. It is imperative that radiologists and other medical professionals understand the multi-step process of converting medical imaging data to digital files. To educate health care professionals about the steps required to prepare DICOM data for 3D printing anatomical models, hands-on courses have been delivered at the Radiological Society of North America (RSNA) annual meeting since 2014. In this paper, a supplement to the RSNA 2018 hands-on 3D printing course, we review methods to create cranio-maxillofacial (CMF), orthopedic, and renal cancer models which can be 3D printed or visualized in augmented reality (AR) or virtual reality (VR).

[Hybrid operating room : Application in trauma surgery and orthopaedics]

BACKGROUND

For some years now, more and more hospitals in Germany have acquired so-called hybrid operating rooms. In these operating rooms it is possible to produce three-dimensional imaging during the operation. Originally developed for cardiovascular surgery, these rooms are increasingly being used for interdisciplinary purposes. Previous experiences in the use for trauma surgery and orthopedics has shown that three-dimensional imaging can have a positive effect on the success of surgery.

OBJECTIVE

Can minimally invasive operations on the spine benefit intraoperatively from three-dimensional imaging with respect to operating times and results?

METHODS

Minimally invasive operations on the spine performed at the UKSH Campus Kiel between 2015 and 2018 in the hybrid operating room were considered. These were compared to minimally invasive spinal surgery performed in conventional operating rooms.

RESULTS

As is usual with the establishment of a new procedure, there are initially longer operating times. With regular use and appropriate training and experience of the personnel, the processes can be optimized.

CONCLUSION

Due to the accuracy of the three-dimensional imaging, errors can be detected and eliminated at an early stage during the operation. Revisions are less frequent. In contrast, there is increased radiation exposure and sometimes longer operation and anesthesia times.

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios

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.