Computer-Assisted Virtual Surgical Technology Versus Three-Dimensional Printing Technology in Preoperative Planning for Displaced Three and Four-Part Fractures of the Proximal End of the Humerus

Abstract

Background: This study aimed to determine the difference between computer-assisted virtual surgical technology and 3-dimensional (3D) printing technology in preoperative planning for proximal humeral fractures.

Methods: Between February 2009 and October 2015, 131 patients with 3 and 4-part proximal humeral fractures were divided into 3 groups on the basis of the preoperative planning method: conventional (n = 53), virtual surgical (n = 46), and 3D printing (n = 32). Fracture characteristics and intraoperative realization of preoperative planning (reduction shape and implant choices) were evaluated. Postoperative functional outcomes were assessed using the American Shoulder and Elbow Surgeons, Constant-Murley, and Short Form-36 (SF-36) scoring systems and shoulder range of motion; postoperative radiographic outcomes were assessed with respect to the loss of the neck-shaft angle (NSA) and loss of humeral head height (HHH).

Results: Excellent sensitivity, specificity, and accuracy for fracture characteristics were seen in all 3 groups. The correlations for NSA (p = 0.033) and HHH (p = 0.035) were higher in the virtual surgical group than in the 3D printing group. The lengths of the medial support screws in the actual choices were shorter than those in the preoperative plan for the 3D printing group, but a similar pattern was not seen in the virtual surgical group. Compared with the conventional method, the virtual surgical and 3D printing methods of preoperative planning resulted in shorter operative time, less blood loss, and fewer fluoroscopic images. The functional outcomes in both the 3D printing and virtual surgical groups were better than those in the conventional group. The virtual surgical method was faster than the 3D printing method, as suggested by a shorter time to surgery (2.5 compared with 4.6 days; p < 0.001), a shorter time for preoperative planning (30.4 compared with 262.4 minutes; p < 0.001), and a decreased duration of hospital stay (10.9 compared with 14.6 days; p < 0.001).

Conclusions: The clinical outcomes in both the virtual surgical and 3D printing groups were better than those in the conventional group. However, computer-assisted virtual surgical technology is more convenient and efficient, considering the shorter time for preoperative planning. In addition, it has improved correlation with preoperative planning.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.