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. 2020 Jul 10;21(1):451.
doi: 10.1186/s12891-020-03370-7.

Three-dimensional printing of patient-specific plates for the treatment of acetabular fractures involving quadrilateral plate disruption

Canbin Wang  1   2 , Yuhui Chen  1 , Liping Wang  3   4 , Di Wang  5 , Cheng Gu  1 , Xuezhi Lin  1 , Han Liu  1 , Jiahui Chen  1 , Xiangyuan Wen  1 , Yuancheng Liu  1 , Fuming Huang  1 , Lufeng Yao  3 , Shicai Fan  6 , Wenhua Huang  7   8 , Jianghui Dong  9   10
Affiliations

Three-dimensional printing of patient-specific plates for the treatment of acetabular fractures involving quadrilateral plate disruption

Canbin Wang et al. BMC Musculoskelet Disord. .

Abstract

Background: Complicated acetabular fractures comprise the most challenging field for orthopedists. The purpose of this study was to develop three-dimensional printed patient-specific (3DPPS) Ti-6Al-4 V plates to treat complicated acetabular fractures involving quadrilateral plate (QLP) disruption and to evaluate their efficacy.

Methods: Fifty patients with acetabular fractures involving QLP disruption were selected between January 2016 and June 2017. Patients were divided into a control group (Group A, 35 patients) and an experimental group (Group B, 15 patients), and were treated by the conventional method of shaping reconstruction plates or with 3DPPS Ti-6AL-4 V plates, respectively. The efficacy of Ti-6AL-4 V plates was evaluated by blood loss, operative time, reduction quality, postoperative residual displacement, and complications.

Results: The operative time and blood loss in Group B were reduced compared to Group A, and the difference was statistically significant (P < 0.05). There was no significant difference in reduction quality between the two groups (P > 0.05). Reduction quality in Group B was anatomic in 10 (66.7%), satisfactory in four (26.7%), and poor in one (6.7%). In Group A, they were anatomic in 18 (51.4%), satisfactory in 13 (37.1%), and poor in four (11.4%). Residual displacement in Group B was less than that in Group A, and the difference was statistically significant (P < 0.05). In Group B, one case exhibited loosening of the pubic screw postoperatively. In Group A, there was one case of wound infection, one of deep vein thrombosis (DVT) in the ipsilateral lower limb, one case of traumatic arthritis and two obturator nerve injuries.

Conclusions: The 3DPPS Ti-6AL-4 V plate is a feasible, accurate and effective implant for acetabular fracture treatment.

Keywords: 3D printing patient-specific plates; Acetabular fractures; Patient-specific implants; Quadrilateral plate disruption; Virtual surgical planning.

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Figures

Fig. 1
Fig. 1
The design procedure of the 3DPPS plate. a 3D reconstruction of the CT scan results; b 3D reconstruction of the pelvis in Mimics; c Mirror model of the uninjured pelvis (cyan) and the model of the uninjured pelvis (purple) and d Model of the injured pelvis (green) and mirrored model of the uninjured pelvis (cyan). e The contour and position of the 3DPPS plate; f A virtual 3.5 mm-thick prototype plate model; g–l Virtual screw insertion in Mimics, which shows no screw penetrates into the pelvic cavity or hip joint and no overlap occurs
Fig. 2
Fig. 2
Fixation simulation on the 3D-printed acetabular model. a 3DPPS plate model; b 3D-printed acetabular model; c Match test of the 3DPPS plate and the 3D-printed acetabular model; d Simulation of all 3.5 mm screw insertions (blue arrow); e Simulation of 6.5 mm lag screw insertion (red arrow); f Fixation with the 3DPPS plate after insertion of all screws
Fig. 3
Fig. 3
A 45-year old female who fell from a height and sustained a both-column fracture with QLP involvement, was treated with the 3DPPS plate. a 3DPPS plate with anodic coating; b Intra-operative fixation with the 3DPPS plate, yellow arrow is the 3DPPS plate, red arrow is the 6.5 mm lag screw; c Intra-operative radiographic data shows good reduction and fixation with the 3DPPS plate. Blue arrow is the percutaneous iliosacral screw; d–e Postoperative AP and Judet oblique view; f Axial images from a postoperative CT scan, demonstrating a near-anatomical adaptation of the 3DPPS plate; h–i AP view and Judet view at 3-month follow-up
Fig. 4
Fig. 4
A 52-year old female, who was injured in a motor vehicle accident and sustained a both-column fracture with QLP involvement, was treated with the 3DPPS plate. a Preoperative AP view; b Preoperative 3D reconstruction of CT data; c Schematic design of the virtual fixation for the fractured acetabulum; d 3DPPS plate with anodic coating; e intra-operative fixation with the 3DPPS plate, red triangle indicates the 3DPPS plate; f Postoperative AP view; g Axial images from postoperative CT scan, demonstrating a near-anatomical adaptation of the 3DPPS plate h 3D reconstruction of postoperative CT data; i AP view at 6-month follow-up
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