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A cortical screw is inserted into the central hole of the plate toward the stable medial fragment to compress the plate against the blown out lateral wall to restore the width.
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... or 2 K-wires are temporarily inserted through the plate holes to keep the plate in position. A cortical screw is inserted into the central hole of the plate toward the stable medial frag- ment to compress the plate against the blown out lateral wall to restore the width (Figure 9). Typically, the anterior lock- ing screws and the posterior facet fixation screws can be inserted through the previous incision, and the posterior locking screws can be inserted percutaneously with a small stab incision (Figure 10). ...
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To analyze the clinical results of operative treatment of distal tibia fracture with locking compression plate fixation through a minimally invasive percutaneous plate osteosynthesis technique.
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Citations
... Time taken to create a 3D virtual model depends on the process used, which may involve reconstruction of the fracture using CAD software or mirroring the uninjured side. 3D reconstruction using CAD has been reported to take 90 minutes to 4.3 hours while mirroring the uninjured side can produce a virtual model in as little as 11-30 minutes 11,23,24 Time taken to build the 3D model is influenced by a number of factors, including size and complexity of the model and the type of additive manufacturing used. 24 Manufacturing time reported in the literature varies from 2 to 15 days. ...
Three-dimensional (3D) offers exciting opportunities in medicine, particularly in orthopaedics. The boundaries of 3D printing are continuously being re-established and have paved the way for further innovations, including 3D bioprinting, custom printing refined methods, 4D bioprinting, and 5D printing potential. The quality of these applications have been steadily improving, increasing their widespread use among clinicians. This article provides a review of the current literature with a brief introduction to the process of additive manufacturing, 3D printing, and its applications in fracture care. We illustrate this technology with a case series of 3D printing used for correction of complex fractures/nonunion. Factors limiting the use of this technology, including cost, and potential solutions are discussed. Finally, we discuss 4D bioprinting and 5D printing and their potential role in fracture surgery.
... The application of 3D printing technology in orthopedics is rapidly progressing and mainly focuses on five aspects [5][6][7][8][9][10][11] : (i) preparation of lesion model and 3D display of complex lesion structure, which would help surgeons improve the surgical plan and enable better preoperative communication with the patients; (ii) preparation of customized guide plates to assist the positioning during surgery, thereby reducing surgical trauma and saving the operation time; (iii) preparation of customized protective gears and rehabilitation supplies, which would improve the outcome compared with traditional treatment such as cast immobilization; (iv) preparation of grafts implanted intraoperatively in patients to overcome the deficiencies of using volume-produced products; and (v) direct printing of cell-material complexes, which would simplify the construction process of engineered tissues and organs. Among them, the application of 3D-printed orthopedic implants has been applied in the clinic, such as spinal fusion cages, acetabular cups, knee joints, etc. ...
In foot and ankle surgery, internal fixation was crucial to maintain the stability of bony structure, and bone grafting material is commonly used to treat bone defects. With rapid development of three-dimensional (3D) printing technology, new advances were made in these two aspects. In this study, digital image correlation method (DICM) data of the patient’s ankle via computed tomography (CT) examination were obtained and imported into a series of software. The engineer cooperated with the surgeon to design the customized implants. Ti-6Al-4V spherical metal powder was chosen as raw material and fused together by selective electron beam melting (SEBM), a type of 3D printing technology, to prepare the implant. The implants were sterilized with ethylene oxide. The customized 3D-printed implants were successfully utilized in tibiotalocalcaneal (TTC) arthrodesis to maintain the bony structures at the functional position. In another case, the 3D-printed fusion cage was applied in subtalar arthrodesis to treat bone defects. In these clinical cases, 3D-printed customized titanium implants helped improve the surgical operation flow, and no obvious tissue reaction was observed. The successful implementation suggested that the application of 3D printing technology to prepare customized titanium implants would play an important role in future foot and ankle surgery.
... Technical advances have considerably improved medical treatment practices, and 3D printing (3DP) techniques have been applied to the field of orthopedics [7][8][9][10][11][12]. Recently, several studies have shown that 3DP, the rapid prototyping technology, can be used for efficient preoperative plate contouring as per the exact surface of the individualized 3DP bone model [13][14][15][16]. ...
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.
... With recent developments in 3D printing, Computer Tomography (CT) scan images or Magnetic Resonance Imaging (MRI) can be used in fabrication of three dimensional anatomical models using softwares such as MIMICS (Materialise Interactive Medical Image Control System), 3D slicer, ABAQUS, ANSYS and many more. The printed model is intraoperatively used to assess the deformity which gives better insight and visualization of the defective tissue [5]. ...
... The authors used softwares such as 3D Slicer, MeshLab and Free CAD for fabrication of a model that was beneficial in preoperative surgical planning. A study was carried by Chung et al. [5] and Ramlee et al. [19] in which they studied about fixing the calcaneus fractures using 3D printed models as a pre-operative tool for fixing the invasive plate in the ankle. CT scan images and fluoroscopic image were taken for the proper fixation from time to time. ...
The performance of surgery on human body is considered to be difficult task due to complex anatomical structure. With evolution of medical imaging techniques such as magnetic resonance imaging and multi detector computed tomography, the radiographic diagnosis has become more informative. Although, these techniques provide high resolution 2D images, however, it is difficult to understand 3D anatomical structures from 2D images. Surface or volume rendering results in 3D virtual images that are difficult to interpret due to large differences between virtual images and real anatomical structures. To overcome the limitation of virtual analysis, the technique of 3D Printing has been devised that plays an important role in customization of implants, tissue engineering and organ printing. The surgeons find pre planning of surgical treatments difficult using 2D CT scan images. Thus, the current study is focused on witnessing the impact of 3D Printing on pre planning of ankle foot and pelvis deformities encountered by doctors of nearby local hospital. It was witnessed that poly lactic acid based 3D printed structures of deformities significantly helped in pre planning of surgical treatments with reduced time consumption and blood loss.
... Chung Kj. в своей статье для решения вопроса предлагает использовать реальных размеров трёхмерную модель пяточной кости как пред-и интраоперационный инструмент MIPO при её переломах [62]. Для этого, по аналогии с вышеуказанными работами, выполняется создание зеркальной модели здоровой пяточной кости по данным КТ, по которой моделируется пластина до операции, а затем вводится через малоинвазивный доступ без дополнительного изгибания. ...
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.
... There is early evidence that this approach can provide accurate and reproducible alignments [41]. 3D-printed anatomical models can also be used to plan surgical approaches [42] and prepare surgical hardware [43]. The use of a 3D-printed model for preoperative planning of tibial fractures was found to reduce surgical times by 48% [44]. ...
Computed tomography (CT) is a medical imaging modality that has found a range of clinical and research applications related to foot and ankle biomechanics. Data from a CT scan can provide detailed information about the anatomy of the foot and ankle in health and disease, particularly in relation to bone. This makes CT an essential technology for tasks such as fracture assessment, study of bone morphology, and computation model development. In this chapter, we give an overview of the technology and its development, review its applications in the context of foot and ankle biomechanics, and propose future areas of research.
... Calcaneal fractures can be effectively reduced with minimum invasion by 3D printing the fractured calcanei and mirror image of its contralateral side . Be it fractures of the tibia, talar neck, tibial plateau, distal femur, pelvis, radius or any other bone of the upper and lower limbs, 3D printing can be used to understand the complex anatomies and fracture patterns, prepare templates for the selection of anatomical plates and aid the surgeon in planning screw trajectories for reduction and fixation (Chung et al., 2014). ...
... [2][3][4][5] Specifically in the orthopedic area, surgeons and patients have benefited from this technology in the creation of surgical guides and in the prior planning for the intraoperative use of printed parts, guiding the correct position during osteotomies, bone perforations, and placement of various types of implant materials (Kirschner wires, drills and screws, etc.), reducing surgical time and improving accuracy. [6][7][8][9][10] With the popularization and greater accessibility of home 3D printers, surgeons have planned and created their guides in a homemade mode, sterilizing them in their institutions for use during surgery, discarding them after their application. The most used materials in mold prototyping are plastic filaments in polylactic acid (PLA) or acrylonitrile butadiene styrene (ABS) polymer, due to their cost-effectiveness and handling, but both still have difficul-ties for sterilization, mainly because they are thermosensitive. ...
Resumo
Objetivo Devido à popularidade da tecnologia 3D, cirurgiões podem criar guias cirúrgicos específicos e esterilizá-los nas suas instituições. O objetivo do presente estudo é comparar a eficácia dos métodos de esterilização por autoclave e óxido de etileno (OE) de objetos produzidos pela impressão 3D com material ácido polilático (PLA, na sigla em inglês).
Métodos Quarenta objetos em formato cúbico foram impressos com material de PLA. Vinte eram sólidos e 20 eram ocos (impressos com pouco enchimento interno). Vinte objetos (10 sólidos e 10 ocos) foram esterilizados em autoclave, formando o Grupo 1. Os demais (10 sólidos e 10 ocos) foram esterilizados em OE, compondo o Grupo 2. Após a esterilização, os objetos foram armazenados e encaminhados para cultura. Objetos ocos de ambos os grupos foram quebrados durante a semeadura, comunicando o espaço morto com o meio de cultura. Os resultados obtidos foram analisados estatisticamente (teste exato de Fisher e análise de resíduo).
Resultados No grupo 1 (autoclave) houve crescimento bacteriano em 50% dos objetos sólidos e em 30% dos objetos ocos. No grupo 2 (OE) o crescimento ocorreu em 20% dos objetos ocos, com ausência de crescimento bacteriano nos objetos sólidos (100% de amostras negativas). A bactéria isolada nos casos positivos foi Staphylococcus Gram positivo não produtor de coagulase.
Conclusões A esterilização tanto em autoclave quanto pelo OE não foi eficaz para objetos impressos no formato oco. Objetos sólidos esterilizados em autoclave não demonstraram 100% de amostras negativas, não sendo seguro no presente ensaio. Ausência completa de contaminação ocorreu apenas com objetos sólidos esterilizados pelo OE, sendo a combinação recomendada pelos autores.
... Since the design aspect is computer-aided, the surgeon gets a tactile and in-depth understanding of the complex fracture pattern that occurred to the bone. Unlike traditional implantation procedures, the surgeon can have a readymade patient-specific implant model in hand for pre-operative review to plan for intraoperative complications, which is crucial in surgery planning [141,142]. Some of the projected benefits of this approach are improved patient communication, shorter operative time, higher precision in the alignment of components, and a 3D model that acts as a patient-specific reference that improves the safety of the procedure [143]. ...
Biomimetics is an emerging field of science that adapts the working principles from nature to fine-tune the engineering design aspects to mimic biological structure and functions. The application mainly focuses on the development of medical implants for hard and soft tissue replacements. Additive manufacturing or 3D printing is an established processing norm with a superior resolution and control over process parameters than conventional methods and has allowed the incessant amalgamation of biomimetics into material manufacturing, thereby improving the adaptation of biomaterials and implants into the human body. The conventional manufacturing practices had design restrictions that prevented mimicking the natural architecture of human tissues into material manufacturing. However, with additive manufacturing, the material construction happens layer-by-layer over multiple axes simultaneously, thus enabling finer control over material placement , thereby overcoming the design challenge that prevented developing complex human archi-tectures. This review substantiates the dexterity of additive manufacturing in utilizing biomimetics to 3D print ceramic, polymer, and metal implants with excellent resemblance to natural tissue. It also cites some clinical references of experimental and commercial approaches employing biomi-metic 3D printing of implants.
... The use of 3D printing is proving to be more effective than traditional 2D imaging models in surgical procedures [26]. Chung et al. [27] showed that the application of 3D printing technology to assist in the internal fixation of steel plates can be more beneficial. Misselyn et al. [28] concluded that the 3D printing improves interobserver agreement in assessing calcaneal fractures. ...
Background
Three-dimensional (3D) printing technology has developed rapidly in orthopaedic surgery and effectively achieves precise and personalized surgery. The purpose of this meta-analysis was to assess the efficacy of 3D printing technology in the management of displaced intra-articular calcaneal fractures (DICFs) by extended lateral approach (ELA).
Methods
We searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and VANFUN databases were searched up to October 2020. All clinical studies comparing traditional surgery and 3D printing-assisted surgery in the management of DICFs were obtained, evaluating the quality of the included studies and extracting data. For each study, we assessed odds ratios (ORs), standard mean difference (SMD), and 95% confidence interval (95% CI) to assess and synthesize the outcomes.
Results
Three RCTs and nine retrospective studies involving 732 patients were included met our inclusion criteria with 366 patients in the 3D group and 366 patients in the conventional group. The meta-analysis showed that there were significant differences of the operative time in the 3D group [SMD = − 1.86, 95% CI (− 2.23, − 1.40), P < 0.001], intraoperative blood loss [SMD = − 1.26, 95% CI (− 1.82, − 0.69), P < 0.001], the number of intraoperative X-ray exposures [SMD = − 0.66, 95% CI (− 1.20, − 0.12), P < 0.001], postoperative complications [OR = 0.49, 95% CI (0.31, 0.79), P < 0.001], excellent and good rate of calcaneal fracture outcome [OR = 4.09, 95% CI (2.03, 8.22), P < 0.001].
Conclusion
The current study indicates that 3D printing-assisted ELA surgery showed a better rate of excellent and good outcome, shorter operation time, less intraoperative blood loss, fewer intraoperative fluoroscopies, fewer complications. Besides, there is still a need for large-sample, high-quality, long-term randomized controlled trials to confirm the conclusion.
