Efficacy and safety of 3D print-assisted surgery for the treatment of pilon fractures: a meta-analysis of randomized controlled trials

Utility of three-dimensional printing in the surgical management of intra-articular distal humerus fractures: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures.

METHODS

A systematic literature search was carried out in various electronic databases. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software.

RESULTS

Three randomized controlled trials with 144 cases were included in the final analysis. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74-19.76 minutes; P<0.001) and mean intraoperative blood loss (30.40 mL; 95% CI, 10.45-60.36 mL; P=0.005) compared with the conventional group. The 3D-printed group also tended to have fewer complications and a better likelihood of good or excellent outcomes as per the Mayo elbow performance score, but this did not reach statistical significance.

CONCLUSIONS

Three-dimensional-printing-assisted surgery in distal humerus fractures has several benefits in reduced operating time and lower blood loss, indirectly decreasing other complications such as infection and anemia-related issues. Future good-quality studies are required to conclusively demonstrate the benefits of 3D printing in improving clinical outcomes. Level of evidence: I.

Does using 3D printed models for pre-operative planning improve surgical outcomes of foot and ankle fracture fixation? A systematic review and meta-analysis

PURPOSE

The systematic review aims to establish the value of using 3D printing-assisted pre-operative planning, compared to conventional planning, for the operative management of foot and ankle fractures.

METHODS

The systematic review was performed according to PRISMA guidelines. Two authors performed searches on three electronic databases. Studies were included if they conformed to pre-established eligibility criteria. Primary outcome measures included intraoperative blood loss, operation duration, and fluoroscopy time. The American orthopaedic foot and ankle score (AOFAS) was used as a secondary outcome. Quality assessment was completed using the Cochrane RoB2 form and a meta-analysis was performed to assess heterogeneity.

RESULTS

Five studies met the inclusion and exclusion criteria and were eventually included in the review. A meta-analysis established that using 3D printed models for pre-operative planning resulted in a significant reduction in operation duration (mean difference [MD] = - 23.52 min, 95% CI [- 39.31, - 7.74], p = 0.003), intraoperative blood loss (MD = - 30.59 mL, 95% CI [- 46.31, - 14.87], p = 0.0001), and number of times fluoroscopy was used (MD = - 3.20 times, 95% CI [- 4.69, - 1.72], p < 0.0001). Using 3D printed models also significantly increased AOFAS score results (MD = 2.24, 95% CI [0.69, 3.78], p = 0.005), demonstrating improved ankle health.

CONCLUSION

The systematic review provides promising evidence that 3D printing-assisted surgery significantly improves treatment for foot and ankle fractures in terms of operation duration, intraoperative blood loss, number of times fluoroscopy was used intraoperatively, and improved overall ankle health as measured by the AOFAS score.

Anteromedial cannulated screw fixation for Hawkins II/III talus fractures in children: a retrospective study

OBJECTIVE

To investigate the clinical effect of the anteromedial cannulated screw approach in the treatment of Hawkins II/III talus fractures in children.

METHODS

A retrospective study was conducted on 20 children with talar fractures admitted to Renmin Hospital from September 2018 to February 2022. The fracture healing and functional recovery of the affected limb were strictly followed up after the operation. There were 14 males and 6 females. The average age was 9 years (range 6-12 years). According to the Hawkins classification, there were 12 cases of talar neck fracture type II and 8 cases of type III. All patients were fixed with cannulated compression screws via an anteromedial approach. According to the American Orthopedic Foot and Ankle Society ankle and hindfoot function scoring system, limb function was evaluated before and after the operation. A visual analog scale was used to evaluate the degree of postoperative pain.

RESULTS

All 20 children were followed up for 12 months to 30 months, with an average of 15 months. We found that there was no significant difference in the excellent and good rate (76.9%) and necrosis rate (30.8%) between male children and female children (71.4%) and necrosis rate (28.6%) (P > 0.05). The excellent and good rates (92.9%) of children younger than 9 years old at the time of injury were higher than those of children older than 9 years old (33.3%), and the incidence of avascular necrosis of the talus was lower. The differences between the two groups were statistically significant (P < 0.05). The average prognosis score of children who underwent surgery within 5 days after injury was 89.2 ± 6.4, which was significantly higher than that of children who underwent surgery after 5 days (72.9 ± 13.1), and the difference was statistically significant (P < 0.05). There was no significant difference between patients who underwent surgery within 5 days after injury (15.4%) and those who underwent surgery after 5 days (51.7%) (P > 0.05). The excellent and good rates of talar neck fracture type II and talar neck fracture type III were 90.1% and 55.6%, respectively.

CONCLUSION

The anteromedial approach combined with cannulated compression screws for the treatment of Hawkins II/III talus fractures in children not only has a clear surgical field, but the fracture can also be reduced and fixed under direct vision using this technique. It does not affect the stability of the ankle joint and is conducive to the recovery of ankle function. It can be used as a surgical scheme for the treatment of talar fractures in children.

3D printing combined with anteroposterior cannulated screws for the treatment of posterolateral tibial plateau fracture

PURPOSE

This study aimed to compare the effects of conventional surgery and three-dimension (3D) printing technology-assisted surgery in the treatment of posterolateral tibial plateau fractures (PTPF).

METHODS

A cohort of 61 patients afflicted with PTPF, spanning from June 2015 to October 2021, was enrolled. They were divided randomly into two groups: 31 cases of 3D printing group, 30 cases of conventional group. The personalized 3D-printed models were used to simulate the surgical procedures in 3D printing group. The demographic characteristics and clinical data were recorded, encompassing operation duration, intraoperative blood loss, intraoperative fluoroscopy shoots and fracture union time. The radiographic outcomes were gauged, encompassing tibiofemoral angle (FTA), tibial plateau angle (TPA), posterolateral slope angle (PSA) and Rasmussen's anatomical score. The functional outcomes were assessed at the 12-month postoperative juncture, encompassing range of motion, Hospital for Special Surgery (HSS) score and Rasmussen's functional score. Furthermore, fracture complications were evaluated,, encompassing infections, traumatic osteoarthritis, and delayed union.

RESULTS

The 3D printing group exhibited the operation time of 95.8 ± 30.2 min, intraoperative blood loss of 101.1 ± 55.3 ml, and intraoperative fluoroscopy shoots of 6.3 ± 2.3 times, while the conventional group recorded respective values of 115.5 ± 34.0 min, 137.0 ± 49.2 ml and 9.13 ± 2.5 times. Noteworthy disparities were evident between the conventional and 3D printing groups (p < 0.05). Furthermore, in comparison to the conventional group, the 3D printing group exhibited commendable radiological and functional outcomes both immediately and 12 months post-surgery, although statistical significance was not attained. Moreover, the 3D printing group experienced a paucity of complications compared to the conventional group, although without achieving statistical significance.

CONCLUSION

This study demonstrated the clinical feasibility of 3D printing combined with anteroposterior cannulated screws for the treatment of posterolateral tibial plateau fracture.

Analysis of the Ability of a Distal Tibial Anatomical Locking Plate to Capture the Distal Tibial Fragments in Patients with Pilon Fractures

OBJECTIVE

Although pilon fractures are rare in clinical practice, they are difficult to treat because of their complexity. Effective fixation of the fracture fragment is the key to the treatment of pilon fractures. Plate osteosynthesis is common clinically, but there are many types of plates and the evaluation of the effect of fixation plates is not comprehensive. This study attempted to compare the capture effect of different fixation plates on the fracture fragments based on 3D modeling and fine distinctions of fracture fragments.

METHODS

The computed tomography (CT) images before treatment of 127 patients with pilon fractures from January 2019 to December 2021 were retrospectively collected. The fracture lines were mapped and digitally displayed as 3D images using MIMICS 21 software. APLUS distal tibia anatomical locking plate (Plate A) and ZIMMER distal tibia anatomical plate (Plate B) were placed on a pseudo-bone model and CT scans were used to determine the number of screws in the major and minor fragments of pilon fractures. The frequency of the two plates capturing the fracture fragments was recorded.

RESULTS

Under Assumption 1 or 2, Plate A performed significantly better than Plate B in capturing the major, Chaput, Volkmann, medial malleolus, and die-punch fracture fragments. Plate A captured markedly more minor fragments than Plate B under Assumption 2 but was not significantly different from Plate B under Assumption 1. Plate A or Plate B showed no obvious difference between major and minor capture rates under the same assumption, and A1 or B1 showed a markedly higher capture rate compared with A2 or B2. In addition, there was a significant positive correlation between the major capture rate and the major fragments in B1, and a significant negative correlation between the minor capture rate and the minor fragments in Plates A and B. However, there was no correlation between the major capture rate of Plate A and the major fragments.

CONCLUSION

The APLUS distal tibial anatomical locking plate is superior to the ZIMMER distal tibia anatomical plate in the ability to capture distal tibial fragments in pilon fracture cases.

Effectiveness of 3D-printed models prepared from radiological data for anatomy education: A meta-analysis and trial sequential analysis of 22 randomized, controlled, crossover trials

BACKGROUND

Many academicians suggested the supplementary use of 3D-printed models reconstructed from radiological images for optimal anatomy education. 3D-printed model is newer technology available to us. The purpose of this systematic review was to capture the usefulness or effectiveness of this newer technology in anatomy education.

MATERIALS AND METHODS

Twenty-two studies met the inclusion and exclusion criteria for quantitative synthesis. The included studies were sub-grouped according to the interventions and participants. No restrictions were applied based on geographical location, language and publication years. Randomized, controlled trial, cross-sectional and cross-over designs were included. The effect size of each intervention in both participants was computed as a standardized mean difference (SMD).

RESULTS

Twenty-two randomized, controlled trials were included for quantitative estimation of effect size of knowledge acquisition as standardized mean difference in 1435 participants. The pooled effect size for 3D-printed model was 0.77 (0.45-1.09, 95% CI, P < 0.0001) with 86% heterogeneity. The accuracy score was measured in only three studies and estimated effect size was 2.81 (1.08-4.54, 95% CI, P = 0.001) with 92% heterogeneity. The satisfaction score was examined by questionnaire in 6 studies. The estimated effect size was 2.00 (0.69-3.32, 95% CI, P = 0.003) with significant heterogeneity.

CONCLUSION

The participants exposed to the 3D-printed model performed better than participants who used traditional methodologies. Thus, the 3D-printed model is a potential tool for anatomy education.

Development and implementation of a three-dimensional (3D) printing elective course for health science students

Three-dimensional (3D) printing technology has become more affordable, accessible, and relevant in healthcare, however, the knowledge of transforming medical images to physical prints still requires some level of training. Anatomy educators can play a pivotal role in introducing learners to 3D printing due to the spatial context inherent to learning anatomy. To bridge this knowledge gap and decrease the intimidation associated with learning 3D printing technology, an elective was developed through a collaboration between the Department of Anatomy and the Makers Lab at the University of California, San Francisco. A self-directed digital resource was created for the elective to guide learners through the 3D printing workflow, which begins with a patient's computed tomography digital imaging and communication in medicine (DICOM) file to a physical 3D printed model. In addition to practicing the 3D printing workflow during the elective, a series of guest speakers presented on 3D printing applications they utilize in their clinical practice and/or research laboratories. Student evaluations indicated that their intimidation associated with 3D printing decreased, the clinical and research topics were directly applicable to their intended careers, and they enjoyed the autonomy associated with the elective format. The elective and the associated digital resource provided students with the foundational knowledge of 3D printing, including the ability to extract, edit, manipulate, and 3D print from DICOM files, making 3D printing more accessible. The aim of disseminating this work is to help other anatomy educators adopt this curriculum at their institution.

Development of a 3D printed patient-specific neonatal brain simulation model using multimodality imaging for perioperative management

BACKGROUND

Medical-imaging-based three-dimensional (3D) printed models enable improvement in skills training, surgical planning, and decision-making. This pilot study aimed to use multimodality imaging and to add and compare 3D ultrasound as a future standard to develop realistic neonatal brain models including the ventricular system.

METHODS

Retrospective computed tomography (CT), magnetic resonance imaging (MRI), and 3D ultrasound-based brain imaging protocols of five neonatal patients were analyzed and subsequently segmented with the aim of developing a multimodality imaging-based 3D printed model. The ventricular anatomy was analyzed to compare the MRI and 3D ultrasound modalities.

RESULTS

A realistic anatomical model of the neonatal brain, including the ventricular system, was created using MRI and 3D ultrasound data from one patient. T2-weighted isovoxel 3D MRI sequences were found to have better resolution and accuracy than 2D sequences. The surface area, anatomy, and volume of the lateral ventricles derived from both MRI and 3D ultrasound were comparable.

CONCLUSIONS

We created an ultrasound- and MRI-based 3D printed patient-specific neonatal brain simulation model that can be used for perioperative management. To introduce 3D ultrasound as a standard for 3D models, additional dimensional correlations between MRI and ultrasound need to be examined.

IMPACT

We studied the feasibility of implementing 3D ultrasound as a standard for 3D printed models of the neonatal brain. Different imaging modalities were compared and both 3D isotropic MRI and 3D ultrasound imaging are feasible for printing neonatal brain models with good dimensional accuracy and anatomical replication. Further dimensional correlations need to be defined to implement it as a standard to produce 3D printed models.

Suture button versus syndesmotic screw in ankle fractures - evaluation with 3D imaging-based measurements

BACKGROUND

Inadequate reduction of syndesmotic injuries can result in disabling clinical outcomes. The aim of the study was to compare syndesmosis congruity after fixation by syndesmotic screws (SYS) or a suture button system (SBS) using three-dimensional (3D) computed imaging techniques.

METHODS

In a retrospective single-center study, patients with unilateral stabilization of an ankle fracture with a syndesmotic injury and post-operative bilateral CT scans were analyzed using a recently established 3D method. The side-to-side differences were compared for tibio-fibular clear space (∆CS), translation angle (∆α), and vertical offset (∆z) among patients stabilized with syndesmotic screws or suture button system. Syndesmotic malreduction was defined for ∆CS > 2 mm and for |∆α| > 5°. ∆CS and ∆α were correlated with two-dimensional (2D) measurements.

RESULTS

Eighteen patients stabilized with a syndesmosis screw and 29 stabilized with a suture button system were analyzed. After stabilization, both groups revealed mild diastasis (SYS: mean ∆CS 0.3 mm, SD 1.1 mm vs SBS: mean ∆CS 0.2 mm, SD 1.2 mm, p = 0.710). In addition, both stabilization methods showed slight dorsalization of the fibula (SYS: mean ∆α 0.5°, SD 4.6° vs SBS: mean ∆α 2.1°, SD 3.7°, p = 0.192). Also, restoration of the fibula-to-tibia length ratio also did not differ between the two groups (SYS: mean Δz of 0.5 mm, SD 2.4 mm vs SBS: mean Δz of 0 mm, SD 1.2 mm; p = 0.477). Malreduction according to high ∆α was most common (26% of cases), with equal distribution between the groups (p = 0.234). ∆CS and ∆α showed good correlation with 2D measurements (ρ = 0.567; ρ = 0.671).

CONCLUSION

This in vivo analysis of post-operative 3D models showed no differences in immediate post-operative alignment after syndesmotic screws or suture button system. Special attention should be paid to syndesmotic malreduction in the sagittal orientation of the fibula in relation to the tibia in radiological control of the syndesmotic congruity as well as intra-operatively.

Impact of the COVID-19 pandemic on orthopedic fracture characteristics in three hospitals in Turkey: A multi-center epidemiological study

Objectives

In this study, we present the use of case specific three- dimensional (3D) printed plastic models and custom-made acetabular implants in orthopedic surgery.

Materials and methods

Between March 2018 and September 2020, surgeries were simulated using plastic models manufactured by 3D printers on the two patients with pilon fractures. Also, custom-made acetabular implants were used on two patients with an acetabular bone defect for the revision of total hip arthroplasty (THA).

Results

More comfortable surgeries were experienced in pilon fractures using preoperative plastic models. Similarly, during the follow-up period, the patients that applied custom-made acetabular implants showed a fixed and well-positioning in radiographic examination. These patients did not experience any surgical complications and achieved an excellent recovery.

Conclusion

Preoperative surgical simulation with 3D printed models can increase the comfort of fracture surgeries. Also, custom-made 3D printed acetabular implants can perform an important task in patients treated with revision THA surgery due to severe acetabular defects.

Application of Enhanced Recovery after Surgical Treatment of the Occipitocervical Region

Objective

The concept of enhanced recovery after surgery (ERAS) has been proposed to provide guidance for the improved postoperative rehabilitation of patients with occipitocervical region disease (ORD).

Methods

This study retrospectively investigated 208 consecutive patients (116 men and 92 women) ranging in age from 22 to 76 years with ORD between July 2014 and June 2017 in our medical center, who were divided into three groups that received different preoperative, intraoperative, and postoperative management plans: traditional group (n = 73), ameliorated group (n = 70), and ERAS group (n = 65). We compiled a range of data relating to demographics and postoperative changes in hemoglobin and albumin, surgery duration, intraoperative blood loss, number of postoperative hospitalization days and expenses, readmission rates, and visual analog scale pain symptoms. Data were statistically evaluated using one‐way analysis of variance with Student–Newman–Keuls‐q post hoc tests or chi‐square tests.

Results

There were no significant differences in terms of age (P = 0.235), gender (P = 0.691), body mass index (P = 0.723), American Society of Anesthesiologists grade (0.747), lesion character (P = 0.337) and lesion site (P = 0.957) between the three groups. Within a 6 months follow‐up period, there was no significant difference between the three groups in terms of surgery duration (P = 0.225), blood loss (P = 0.172), changes in hemoglobin (P = 0.255) and albumin (P = 0.178). However, postoperative hospitalization days (P = 0.000), postoperative costs (P = 0.019) and improvement of pain symptoms (P = 0.000) in ERAS group were significantly lower or higher than those in traditional group or ameliorated group, respectively. There were 29 (39.73%), 22 (31.43%), and 13 (20.00%), recorded cases of postoperative complications in traditional group, ameliorated group and ERAS group, respectively; complications in ERAS group were significantly lower than those in other two groups (P = 0.043). Moreover, all of the complications were mitigated effectively by the infusion of fluid, analgesia, treatment of infections, or antiemetic medications. There were 2 (2.74%), 3 (4.29%) and 2 (3.08%), recorded cases of re‐admission in traditional group, ameliorated group and ERAS group, respectively, but there were no statistically significant differences when compared across the three groups (P = 0.866).

Conclusions

ERAS can provide benefits when it applied to patients undergoing ORD surgery mainly in terms of reducing postoperative complications, however, ERAS does not increase the economic burden of patients or decrease the risk of readmission.

Three-dimensional imaging and three-dimensional printing for plastic preparation of medical interventions

Three-dimensional (3D) imaging has been available for nearly four decades and is regarded as state of the art for visualization of anatomy and pathology and for procedure planning in many clinical fields. Together with 3D image reconstructions in the form of rendered virtual 3D models, it has helped to better perceive complex anatomic and pathologic relations, improved preprocedural measuring and sizing of implants, and nowadays enables even photorealistic quality. However, presentation on 2D displays limits the 3D experience. Novel 3D printing technologies can transfer virtual anatomic models into true 3D space and produce both patient-specific models and medical devices constructed by computer-aided design. Individualized anatomic models hold great potential for medical and patient education, research, device development and testing, procedure training, preoperative planning, and fabrication of individualized instruments and implants. Hand in hand with 3D imaging, medical 3D printing has started to revolutionize medicine in certain fields and new applications are developed and introduced regularly. The demand for medical 3D printing will likely continue to rise, as it is a promising tool for plastic preparation of medical interventions. However, there is ongoing debate on the appropriateness of medical 3D printing and further research on its efficiency is needed. As experts in 3D imaging, radiologists are not only capable of advising on adequate imaging parameters, but should also become adept in 3D printing to participate in on-site 3D printing facilities and randomized controlled trials on the topic, thus contributing to improving patient outcomes via personalized medicine through patient-specific preparation of medical interventions.

The role of 3D printed models in the teaching of human anatomy: a systematic review and meta-analysis

BACKGROUND

Three-dimensional (3D) printing is an emerging technology widely used in medical education. However, its role in the teaching of human anatomy needs further evaluation.

METHODS

PubMed, Embase, EBSCO, SpringerLink, and Nature databases were searched systematically for studies published from January 2011 to April 2020 in the English language. GRADEprofiler software was used to evaluate the quality of literature. In this study, a meta-analysis of continuous and binary data was conducted. Both descriptive and statistical analyses were used.

RESULTS

Comparing the post-training tests in neuroanatomy, cardiac anatomy, and abdominal anatomy, the standardized mean difference (SMD) of the 3D group and the conventional group were 1.27, 0.37, and 2.01, respectively (p < 0.05). For 3D vs. cadaver and 3D vs. 2D, the SMD were 0.69 and 1.05, respectively (p < 0.05). For answering time, the SMD of the 3D group vs. conventional group was - 0.61 (P < 0.05). For 3D print usefulness, RR = 2.29(P < 0.05). Five of the six studies showed that satisfaction of the 3D group was higher than that of the conventional group. Two studies showed that accuracy of answering questions in the 3D group was higher than that in the conventional group.

CONCLUSIONS

Compared with students in the conventional group, those in the 3D printing group had advantages in accuracy and answering time. In the test of anatomical knowledge, the test results of students in the 3D group were not inferior (higher or equal) to those in the conventional group. The post-training test results of the 3D group were higher than those in the cadaver or 2D group. More students in the 3D printing group were satisfied with their learning compared with the conventional group. The results could be influenced by the quality of the randomized controlled trials. In a framework of ethical rigor, the application of the 3D printing model in human anatomy teaching is expected to grow further.

A review of the manufacturing process and infection rate of 3D-printed models and guides sterilized by hydrogen peroxide plasma and utilized intra-operatively

3D printing in the context of medical application can allow for visualization of patient-specific anatomy to facilitate surgical planning and execution. Intra-operative usage of models and guides allows for real time feedback but ensuring sterility is essential to prevent infection. The additive manufacturing process restricts options for sterilisation owing to temperature sensitivity of thermoplastics utilised for fabrication. Here, we review one of the largest single cohorts of 3D models and guides constructed from Acrylonitrile butadiene styrene (ABS) and utilized intra-operatively, following terminal sterilization with hydrogen peroxide plasma. We describe our work flow from initial software rendering to printing, sterilization, and on-table application with the objective of demonstrating that our process is safe and can be implemented elsewhere. Overall, 7% (8/114 patients) of patients developed a surgical site infection, which was not elevated in comparison to related studies utilizing traditional surgical methods. Prolonged operation time with an associated increase in surgical complexity was identified to be a risk factor for infection. Low temperature plasma-based sterilization depends upon sufficient permeation and contact with surfaces which are a particular challenge when our 3D-printouts contain diffusion-restricted luminal spaces as well as hollows. Application of printouts as guides for power tools may further expose these regions to sterile bodily tissues and result in generation of debris. With each printout being a bespoke medical device, it is important that the multidisciplinary team involved in production and application understand potential pitfalls to ensuring sterility as to minimize infection risk.

Epidemiological and time series analysis of haemorrhagic fever with renal syndrome from 2004 to 2017 in Shandong Province, China

Shandong Province is an area of China with a high incidence of haemorrhagic fever with renal syndrome (HFRS); however, the general epidemic trend of HFRS in Shandong remains unclear. Therefore, we established a mathematical model to predict the incidence trend of HFRS and used Joinpoint regression analysis, a generalised additive model (GAM), and other methods to evaluate the data. Incidence data from the first half of 2018 were included in a range predicted by a modified sum autoregressive integrated moving average-support vector machine (ARIMA-SVM) combination model. The highest incidence of HFRS occurred in October and November, and the annual mortality rate decreased by 7.3% (p < 0.05) from 2004 to 2017. In cold months, the incidence of HFRS increased by 4%, −1%, and 0.8% for every unit increase in temperature, relative humidity, and rainfall, respectively; in warm months, this incidence changed by 2%, −3%, and 0% respectively. Overall, HFRS incidence and mortality in Shandong showed a downward trend over the past 10 years. In both cold and warm months, the effects of temperature, relative humidity, and rainfall on HFRS incidence varied. A modified ARIMA-SVM combination model could effectively predict the occurrence of HFRS.

Minimizing Posttraumatic Osteoarthritis After High-Energy Intra-Articular Fracture

This article serves to provide an overview of molecular and surgical interventions to minimize the progression of posttraumatic arthritis following high-energy intra-articular fractures. The roles of cartilage and the microcellular environment are discussed, as well as the response of the joint and cartilage to injury. Molecular therapies, such as glucocorticoids, mesenchymal stem cells, and bisphosphonates, are presented as potential treatments to prevent progression to posttraumatic arthritis. High-energy intra-articular fractures of the elbow, hip, knee, and ankle are discussed, with emphasis on restoring anatomic alignment, articular reduction, and stability of the joint.

Efficacy and Prognosis of 3D Printing Technology in Treatment of High-Energy Trans-Syndesmotic Ankle Fracture Dislocation - "Log-Splitter" Injury

Background

This study aimed to retrospectively assess the feasibility and efficacy of three-dimensional (3D) printing technology in the treatment of high-energy trans-syndesmotic ankle fracture dislocation – “log-splitter” injury – and to evaluate the efficacy and prognosis.

Material/Methods

We included 29 patients (17 males and 12 females; mean age, 44.0±13.2 years) with log-splitter injury from June 2011 to December 2016, divided into a routine group (n=13) and a 3D printing group (n=16) according to the surgical method used. Operation time, intraoperative blood loss, fluoroscopy times, fracture union time, functional outcomes based on AOFAS (American Orthopedic Foot and Ankle Society) score, and postoperative complications were observed and recorded.

Results

Compared with the routine treatment group, 3D printing technology had better safety and efficacy for the treatment of log-splitter injury and the advantages of shorter operation time, less intraoperative blood loss, fewer fluoroscopies needed, and higher rate of good functional outcome (P<0.001, P<0.001, P<0.001, and P=0.017, respectively). However, no significant difference was noted in the rate of anatomical reduction, mean AOFAS score at the last follow-up (mean time, 19.9±2.8 months), or postoperative complications between the 2 groups (P=0.370, P=0.156, and P=0.485, respectively).

Conclusions

Surgery assisted by 3D printing technology to treat log-splitter injury is feasible and effective, and may be a good optional approach to formulate a reasonable personalized surgical plan and to optimize the outcomes.