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

Abstract

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 AND 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.

Figure 1

Schematic diagrams of log-splitter injury. (A) The industrial wedge for splitting firewood is similar to log-splitter injury in morphology, which is vividly described as the “log-splitter injury”. (B) The talus is simulated as a sharp wedge embedded into (along with the direction of arrow) the distal tibiofibular syndesmosis, leading to distal syndesmotic disruption and displacement.

Figure 2

Preoperative radiographs of log-splitter injury. (A) Anteroposterior X-ray of injured ankle joint. (B) Lateral X-ray of injured ankle joint. (C) Axial CT image of bilateral ankle joints. (D) CT three-dimensional reconstruction of bilateral ankle joints

Figure 3

The reconstruction, simulated reduction, and fixation of log-splitter injury in Mimics 19.0 software. (A) Anterior view of reconstructed model. (B) Posterior view of reconstructed model. (C) Lateral view of reconstructed model. (D) Reconstructed model after the operations of noise reduction and smoothing. (E) Reconstructed model after virtual reset. (F) Reconstructed model after virtual fixation

Figure 4

Simulated extracorporeal operation prior to the actual surgery. (A) 3D printed models before and after reset. (B) Preparation of simulated operation. (C–E) Simulating the operation on the model (C: Anterior view, D: Left lateral view, E: Right lateral view). (F, G) X-rays after simulated operation (F: Anteroposterior view, G: Lateral view).

Figure 5

Postoperative radiographs after the surgery. (A) Anteroposterior and lateral X-ray after surgery. (B) Anteroposterior and lateral X-ray at 1-month follow-up. (C) The distal tibiofibular syndesmotic screw was removed 12 weeks postoperatively. (D) Anteroposterior and lateral X-ray at 20-month follow-up (after internal fixation removal).