Chinese researchers Wei Yongwu (transliteration), Wei Guoxu (transliteration), Chunyouwan (transliteration) and Minfang (transliteration) outlined the important role of 3D printing in the process of surgical planning for complex tibial plateau fractures before internal fixation and external fixation. In this study, researchers used a three-dimensional printing model to assess the effectiveness of short-term internal and external fixation for complex tibial plateau fractures. They examined and treated 34 different patients with external fixators and 35 patients with internal fixators.
Medical scientists continue to research to find a faster way to cure patients, and bone regeneration and healing are facing challenges, so more advanced technology is constantly needed. Researchers pointed out that 1% to 2% of all fractures were found on the tibial plateau, while 8% were found in the elderly. These types of injuries are usually accompanied by extensive soft tissue injuries, making surgery more complex.
"The goal of this high-energy tibial plateau fracture treatment is to maintain joint stability, coordination and alignment without too much soft tissue dissection, thus contributing to early knee movement," the researchers said. "This requires that surgeons have a clear understanding of the fracture morphology and choose a reasonable fixation method according to the fracture morphology.
Male patient, 50 years old. A traffic accident resulted in type 6 tibial plateau fracture. During the operation, comminuted fracture of articular surface and proximal tibial fracture were found. The articular surface was reduced and fixed with locking plate. The knee joint function was good two years after operation.
Open reduction and internal fixation of the tibial plateau alone can help maintain the consistency of the anatomic joints and restore the mechanical alignment, and allow early motion of the knee joint. However, extensive exposure of the lateral and medial sides is usually required; combining primary injuries with extensive surgery can lead to high incidence of complications, including wound healing problems and infections."
Although external fixation (EF) is also a successful method, there are still problems of infection and collapse. Fixators may cause stiffness of joints. Collapse is a holistic problem, leading surgeons to seek better ways to treat tibial plateau fractures. Compared with X-ray and CT, 3D printing technology has been greatly improved, which enables doctors and surgeons to examine fracture sites more carefully and prepare for surgery. The wound can be reconstructed in 3D so that the doctor can see not only the injured part, but also any collapsed part. The information they can gather is essential to help them make better surgical plans and reduce the number of operations.
Male patient, 45 years old. Schatzker VI tibial plateau fracture caused by traffic accident. Joint surface rupture and collapse were found during operation. External fixation combined with limited internal fixation maintained articular surface stability. Three months later, the external fixator was removed. The knee joint function was good 2 years after operation.
In this study, scientists observed two different fixation methods, plus three-dimensional printing, to create improved surgical procedures, and to better analyze the advantages and disadvantages of internal fixation and external fixation. Ultimately, they found that both types of surgery were effective, and "there was no relationship between the quality of reduction and the method of fixation". They also found that using 3-D printing resulted in fewer infections and injuries during surgery.
The researchers concluded that "the use of 3D printing technology can compensate for the limitation of observing the surface of the joint during external fixation, thus achieving a similar reduction in quality as internal fixation."
Male patient, 47 years old. After traumatic local swelling, pain, deformity and movement limitation of the right knee, the patient was hospitalized for 4 hours. Under combined spinal-epidural anesthesia, right tibial plateau fractures were treated with prying reduction, hollow screw fixation and external fixator fixation. After two years of follow-up, the function was good.
"The application of 3D printing model before tibial plateau fracture surgery can effectively eliminate the limitation of limited joint visualization in external fixation treatment and improve the reduction quality. Combined with 3D printing technology, external fixation for complex tibial plateau fractures can effectively reduce intraoperative bleeding, intraoperative operation time and hospitalization days, and ensure satisfactory reduction quality and postoperative function.
3D printing models can be widely used in surgical planning. Medical professionals around the world have begun to use these models to educate patients, train medical students, and allow surgeons to spend weeks themselves learning and practicing a model, such as preparing for a rare operation, or possibly not doing it. Surgery.