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. 2022 Jun;48(3):1737-1749.
doi: 10.1007/s00068-021-01773-2. Epub 2021 Aug 31.

Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients

Nick Assink  1   2 , Inge H F Reininga  3 , Kaj Ten Duis  3 , Job N Doornberg  3 , Harm Hoekstra  4 , Joep Kraeima  5 , Max J H Witjes  5 , Jean-Paul P M de Vries  6 , Frank F A IJpma  3
Affiliations

Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients

Nick Assink et al. Eur J Trauma Emerg Surg. 2022 Jun.

Abstract

Purpose: The aim of this systematic review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess whether 3D-assisted surgery results in improved clinical outcome as compared to surgery based on conventional imaging modalities.

Methods: A literature search was performed in Pubmed and Embase for articles reporting on the use of 3D techniques in operative management of tibial plateau fractures. This systematic review was performed in concordance with the PRISMA-guidelines. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Differences in terms of operation time, blood loss, fluoroscopy frequency, intra-operative revision rates and patient-reported outcomes between 3D-assisted and conventional surgery were assessed. Data were pooled using the inverse variance weighting method in RevMan.

Results: Twenty articles evaluating 948 patients treated with 3D-assisted surgery and 126 patients with conventional surgery were included. Five different concepts of 3D-assisted surgery were identified: '3D virtual visualization', '3D printed hand-held fracture models', 'Pre-contouring of osteosynthesis plates', '3D printed surgical guides', and 'Intra-operative 3D imaging'. 3D-assisted surgery resulted in reduced operation time (104.7 vs. 126.4 min; P < 0.01), less blood loss (241 ml vs. 306 ml; P < 0.01), decreased frequency of fluoroscopy (5.8 vs. 9.1 times; P < 0.01). No differences in functional outcome was found (Hospital for Special Surgery Knee-Rating Scale: 88.6 vs. 82.8; P = 0.23).

Conclusions: Five concepts of 3D-assisted surgical management of tibial plateau fractures emerged over the last decade. These include 3D virtual fracture visualization, 3D-printed hand-held fracture models for surgical planning, 3D-printed models for pre-contouring of osteosynthesis plates, 3D-printed surgical guides, and intra-operative 3D imaging. 3D-assisted surgery may have a positive effect on operation time, blood loss, and fluoroscopy frequency.

Keywords: 3D preoperative planning; 3D printing; 3D virtual surgical planning; Guided surgery; Three dimensional; Tibial plateau fracture.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram according to PRISMA strategy
Fig. 2
Fig. 2
Schematic overview of the different concepts of 3D-assisted surgery in tibial plateau fractures
Fig. 3
Fig. 3
a Fluoroscopy of an intra-articular fracture of the tibial plateau. b 3D-printed han-held model of the tibial plateau fracture. c Intra-operative fracture assessment using the 3D-printed hand-held model
Fig. 4
Fig. 4
Forest plot for the operation time (min)
Fig. 5
Fig. 5
Forest plot for the blood loss (ml)
Fig. 6
Fig. 6
Forest plot for the fluoroscopy frequency (number of shots)
See this image and copyright information in PMC

References

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