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. 2021 Nov;141(11):1899-1907.
doi: 10.1007/s00402-020-03654-6. Epub 2020 Oct 31.

Can 3D-printing avoid discomfort-related implant removal in midshaft clavicle fractures? A four-year follow-up

Rob F M van Doremalen  1   2   3 , Rens A van der Linde  4   5 , Jan J Kootstra  4   6 , Sven H van Helden  4 , Edsko E G Hekman  7
Affiliations

Can 3D-printing avoid discomfort-related implant removal in midshaft clavicle fractures? A four-year follow-up

Rob F M van Doremalen et al. Arch Orthop Trauma Surg. 2021 Nov.

Abstract

Introduction: Due to the variation in shape and curvature of the clavicle, plates often have to be adjusted during surgery to acquire a good fit. Poorly fitted plates can cause discomfort, eventually requiring implant removal. 3D-printed replicas of the fractured clavicle can assist in planning of the surgical approach, plate selection and, if necessary, adjustment of the plate prior to surgery. We hypothesized this method of preoperative preparation would reduce implant-related discomfort resulting in a reduced reoperation rate MATERIALS AND METHODS: In a prospective cohort study, perioperative plate handling and clavicle fixation were timed and follow-up data were collected from participants undergoing operative treatment for a midshaft clavicle fracture. The control group (n = 7) received conventional surgery with standard precontoured plates. For the intervention group (n = 7), 3D-printed replicas of the fractured clavicle and a mirrored version of the healthy contralateral clavicle were available prior to surgery for planning of the surgical approach, and for plate selection and contouring. Primary outcome was reoperation rate due to implant-related discomfort. Secondary outcomes were complications and time differences in the different surgical phases (reduction, fixation and overall operation time) RESULTS: More participants in the control group had the plate removed due to discomfort compared to the intervention group (5/7 vs. 0/6; P = 0.012). One participant was excluded from the intervention group due to a postoperative complication; an infection occurred at the implant site. No relevant time difference in surgical plate handling was found between both groups.

Conclusions: Preoperative preparation using 3D-printed replicas of the clavicle fracture may reduce implant removal caused by plated-related discomfort. No relevant effect on surgery time was found.

Trial registration: Registered with 'toetsingonline.nl', trial number NL51269.075/14, 17-02-2015.

Keywords: 3D-printing; Midshaft clavicle fracture; Plate fixation; Preoperative preparation; Reoperation rate.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Screenshot of three-dimensional surface mesh models of the fractured clavicle (right) and the contralateral clavicle (left)
Fig. 2
Fig. 2
a 3D-Printed models of the mirrored contralateral clavicle (top) and the fractured clavicle (bottom) and b two models from another case are stabilized in clay for support of the fragments. The precontoured plate is outlined on both clavicles and fitted on the fractured model (bottom) and the fracture lines are marked on the mirrored contralateral clavicle (top). By impressing the mirrored contralateral clavicle in the clay, a mold is formed to together the fractured clavicle
Fig. 3
Fig. 3
The left picture shows a pair of bending pliers and a precontoured plate in a basket, ready for sterilization. The right picture shows regular bending irons, used for both preoperative planning and perioperative plate adjustments
Fig. 4
Fig. 4
Flowchart of the patient selection procedure
See this image and copyright information in PMC

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