Impact of 3D Printed Calcaneal Fracture Models on Injury Understanding in Orthopaedic Surgery Residents

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

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01773-2 ◽

2021 ◽

Author(s):

Nick Assink ◽

Inge H. F. Reininga ◽

Kaj ten Duis ◽

Job N. Doornberg ◽

Harm Hoekstra ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

3D Imaging ◽

Tibial Plateau ◽

Operation Time ◽

Tibial Plateau Fractures ◽

Conventional Surgery ◽

Surgical Guides ◽

Fracture Models ◽

3D Printed

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.

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Effect of Calcaneus Fracture Gap Without Step-Off on Stress Distribution Across the Subtalar Joint

Foot & Ankle International ◽

10.1177/1071100716678808 ◽

2016 ◽

Vol 38 (3) ◽

pp. 298-303 ◽

Cited By ~ 5

Author(s):

Brett Barrick ◽

Donald A. Joyce ◽

Frederick W. Werner ◽

Maria Iannolo

Keyword(s):

Subtalar Joint ◽

Peak Pressure ◽

Articular Surface ◽

Axial Loading ◽

Calcaneal Fracture ◽

Subtalar Arthritis ◽

Pressure Area ◽

Fracture Models ◽

Lateral Fragment ◽

Surface Changes

Background: Subtalar arthritis is a common consequence following calcaneal fracture, and its development is related to the severity of the fracture. Previous calcaneal fracture models have demonstrated altered contact characteristics when a step-off is created in the posterior facet articular surface. Changes in posterior facet contact characteristics have not been previously characterized for calcaneal fracture gap without step-off. Methods: The contact characteristics (peak pressure, area of contact, and centroid of pressure) of the posterior facet of the subtalar joint were determined in 6 cadaveric specimens. After creating a calcaneal fracture to simulate a Sanders type II fracture, the contact characteristics were determined with the posterior facet anatomically reduced followed by an incremental increase in fracture gap displacement of 2, 3, and 5 mm without a step-off of the articular surface. Results: Peak pressure on the medial fragment was significantly less with a 5-mm gap compared to a 2- or 3-mm gap, or reduced. On the lateral fragment, the peak pressure was significantly increased with a 5-mm gap compared to a 2- or 3-mm gap. Contact area significantly changed with increased gap. Conclusion: In this study, there were no significant differences in contact characteristics between a <3-mm gap and an anatomically reduced fracture, conceding the study limitations including limiting axial loading to 50% of donor body weight. Clinical Relevance: A small amount of articular incongruity without a step-off can be tolerated by the subtalar joint, in contrast to articular incongruity with a step-off present.

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Virtual Hip Replacement Simulator for 3D Printed Implants

2017 Design of Medical Devices Conference ◽

10.1115/dmd2017-3496 ◽

2017 ◽

Author(s):

Neil Vaughan ◽

Venketesh N. Dubey

Keyword(s):

Virtual Reality ◽

Hip Fractures ◽

Hip Replacement ◽

Orthopaedic Surgery ◽

Orthopaedic Surgeons ◽

Total Hip ◽

Hip Replacements ◽

3D Printed ◽

Orthopaedic Training ◽

The Uk

This research presents a virtual reality simulator for total hip replacement surgery. The simulator supports a library of 3D hip stem models for different sizes and manufacturers. The 3D hip stems can be adjusted in size and shape by parametric software and sent for 3D printing. Biocompatible materials such as titanium enable the 3D printed stems to be directly implanted on patients. Currently surgical simulation for orthopaedic procedures is not as advanced as other surgical disciplines. As a result there are only limited training simulators available for orthopaedic surgery such as total hip replacement, hip resurfacing or knee replacement. This is demanding since 66,000 hip replacements are performed annually in the UK. One area which is neglected in VR orthopaedic simulation is the digital library generation of implants. Currently orthopaedic surgeons have limited choice in terms of an exact identification of implant specific to patient requirements. We conducted a literature review of orthopaedic training simulators which found no simulators catering for this [9]. Orthopaedic surgeons generally have a positive opinion for the use of virtual reality (VR) training systems. A survey amongst all orthopaedic surgeons in New Zealand found that 77% of qualified surgeons believe simulation is effective for practicing and learning surgical procedures [1]. A separate review from the American Academy of Orthopaedic Surgeons (AAOS) showed that over 80% agreed that surgical skills simulations should become a required part of orthopaedic training, based on views from 185 program directors and 4549 residents. There was a strong agreement that simulation technology should be a required component of orthopaedic resident training [2]. The hip replacement procedure has been considered as the most successful and influential orthopaedic surgery of the twentieth century. Currently over 66,000 total hip replacements (THR) are performed each year in England and Wales by the National Health Service (NHS) and around 75,000 hip fractures are treated each year in the UK. Knee arthroscopy has increased 49% from 1996–2006 and now over 1 million are performed each year [3]. Each year there are an increasing number of orthopaedic procedures due to the aging population. Currently 247,000 hip fractures occur yearly in the United States, with the majority occurring in the population over 45 years old [4]. The incidence of hip fracture is also on the rise, partly due to the aging population, with over half a million hip fractures annually expected by 2040. The cost of these fractures is also expected to rise from $7 billion per year [4], to nearly $16 billion per year by 2040 [5]. Each hip fracture is estimated at costing between $39,555 and $40,600 in the first year after surgery [6]. Hip fractures have the highest cost of any orthopaedic procedure after surgery, and also incur $11,241 each year following surgery in extra health costs. Due to increased life expectancy, worldwide by 2050, it is projected that 6.26 million hip fractures will occur annually [7]. A paradigm shift is underway toward use of surgical training simulations [8]. The conventional master-apprentice learning model for surgical training of ‘see one, do one, teach one’ has recently been seen as inefficient. Due to orthopaedics being heavily dependent on technical skill, orthopaedic VR simulation holds potential to have great impact for improving surgical skill. The transition to VR simulation is relatively new compared to cadaver training which has been the gold standard for several centuries.

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Projector-Based Augmented Reality System for Computer Assisted Orthopaedic Surgery

10.29007/9sb7 ◽

2020 ◽

Author(s):

Yuan Gao ◽

Le Xie ◽

Guoyan Zheng

Keyword(s):

Augmented Reality ◽

Orthopaedic Surgery ◽

Clinical Information ◽

Computer Assisted ◽

Alignment Error ◽

Augmented Reality System ◽

Projection Distance ◽

Computer Assisted Orthopaedic Surgery ◽

3D Printed

This paper presents a projector-based augmented reality (AR) system for Computer- Assisted Orthopaedic Surgery (CAOS). After calibration, our AR system allows for projection of not only the virtual model directly on the surface of the target organ to create an augmented reality but also important clinical information such as distance and angular deviations from a surgical plan, which are important for various computer-assisted surgical procedures such as trajectory drilling and fracture reduction. The feasibility and accuracy of the system is experimentally validated on a 3D printed phantom model with pyramid shape, a dry goat bone and an in vitro pig leg. An average projection distance error of 1.03±0.58mm and an average drill alignment error of 1.17±0.43°were found. The results demonstrate the efficacy of the proposed AR system.

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