3D Printing Medical Models for Preoperative Planning in Healing Tibial Plateau Fractures

3D printing plays a large role in the surgical planning process, outlined in ‘Preoperative Plan with 3D Printing in Internal and External Fixation for Complex Tibial Plateau Fractures,’ by Chinese researchers Wei-yong Wu MM, Wei-guo Xu MD, Chun-you Wan MD, and Min Fang MM. In this study, the researchers use 3D printed models to evaluate the effects of short-term treatment of complicated tibial plateau fractures, with both internal and external fixation. They were able to examine and treat 34 different patients with an external fixator, and 35 with internal fixation.

Medical scientists continue ongoing studies to find ways to heal patients faster—while both bone regeneration and bone healing present challenges, thus presenting a constant need for more progressive technology. The researchers point out that one to two percent of all fractures in patients are found in the tibial plateau, while eight percent of them are found in the elderly. These types of injuries are often accompanied by extensive soft tissue injury, making surgeries even more complex.

“The goals of treatment in such high-energy tibial plateau fractures are to maintain joint stability, congruity, and alignment without much soft tissue dissection, thereby helping in early mobilization of the knee joint,” state the researchers. “This requires a surgeon to have a clear understanding of the fracture morphology and to choose a reasonable fixation method according to the fracture morphology.

“Open reduction and internal fixation of individual tibial plateau helps maintain anatomic articular congruity and restoration of mechanical alignment and allows early mobilization of the knee joint. However, extensive exposure of the lateral and medial side is often required; the combination of original injury damage with the extensive surgical approach led to a high rate of complications, including wound healing problems and infection.”

Male patient, 50 years old. A traffic accident resulted in type VI fracture of the tibial plateau. During surgery, comminuted fracture of articular surface and proximal tibia fracture were found. The articular surface was reduced and fixed with a locking plate. The knee joint function was good two years after surgery.

While external fixation (EF) is also known to be a successful method, there are still issues with infection and collapse—and fixators may lead to joint stiffness. Collapse is an overall issue, causing surgeons to seek better ways to treat tibial plateau fractures. 3D printing arrives as an improvement over X-rays and CTs, allowing doctors and surgeons to examine fractures more closely, along with preparing for surgeries. The break can be re-created in 3D form, allowing doctors to see not only the injury, but any point of collapse also. The information they may be able to glean is critical in allowing them to create better surgical plans and reduction methods.

In this study, the scientists observed two different fixation methods with the addition of 3D printing, created improved surgical plans, and were better able to analyze the pros and cons of internal and external fixation. Ultimately, they discovered that both types of surgical treatment were effective, with ‘no association between the quality of the reduction and the methods of fixation.’ They also discovered that with 3D printing there were less infections and less trauma in surgery.

“Using 3D printing technology can remedy the limitations of viewing the surface of the joint in external fixation, to achieve reduction quality similar to internal fixation,” concluded the researchers.

“Using 3D printed models in tibial plateau fractures preoperatively can effectively eliminate the disadvantages of limited joint visualization in external fixation treatment and improve the quality of reduction. Combined with 3D printing, external fixation for complex tibial plateau fractures can effectively reduce intraoperative bleeding, intraoperative operation time and hospitalization days, and ensure satisfactory reduction quality and postoperative function.”

Male patient, 45 years old. Fracture of Schatzker type VI tibial plateau caused by a traffic accident. Splitting and collapse of the articular surface were found during the operation. External fixation combined with limited internal fixation maintained the stability of the articular surface. After 3 months, the external fixator was removed. The knee joint function was good 2 years after surgery.

3D printed models can be used extensively in surgical planning, and medical professionals around the world have begun taking advantage of them to educate patients, as well as training medical students—and allowing surgeons themselves to spend weeks sometimes studying and practicing on a model as they prepare for a rare surgery, or one that may never have been performed before. What do you think of this news? Let us know your thoughts! Join the discussion of this and other 3D printing topics at 3DPrintBoard.com.

Male patient, 47 years old. Following traumatic right knee local swelling, pain, deformity, and movement limitation, the patient was admitted to the hospital for 4 hours. Under combined spinal–epidural anesthesia, right tibial plateau fracture was treated with prying reduction, hollow screw fixation, and external fixator fixation. After two years’ follow-up, the function was good.