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Improved accuracy of 3D-printed navigational template during complicated tibial plateau fracture surgery

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Abstract

This study was aimed to improve the surgical accuracy of plating and screwing for complicated tibial plateau fracture assisted by 3D implants library and 3D-printed navigational template. Clinical cases were performed whereby complicated tibial plateau fractures were imaged using computed tomography and reconstructed into 3D fracture prototypes. The preoperative planning of anatomic matching plate with appropriate screw trajectories was performed with the help of the library of 3D models of implants. According to the optimal planning, patient-specific navigational templates produced by 3D printer were used to accurately guide the real surgical implantation. The fixation outcomes in term of the deviations of screw placement between preoperative and postoperative screw trajectories were measured and compared, including the screw lengths, entry point locations and screw directions. With virtual preoperative planning, we have achieved optimal and accurate fixation outcomes in the real clinical surgeries. The deviations of screw length was 1.57 ± 5.77 mm, P > 0.05. The displacements of the entry points in the x-, y-, and z-axis were 0.23 ± 0.62, 0.83 ± 1.91, and 0.46 ± 0.67 mm, respectively, P > 0.05. The deviations of projection angle in the coronal (x–y) and transverse (x–z) planes were 6.34 ± 3.42° and 4.68 ± 3.94°, respectively, P > 0.05. There was no significant difference in the deviations of screw length, entry point and projection angle between the ideal and real screw trajectories. The ideal and accurate preoperative planning of plating and screwing can be achieved in the real surgery assisted by the 3D models library of implants and the patient-specific navigational template. This technology improves the accuracy and efficiency of personalized internal fixation surgery and we have proved this in our clinical applications.

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Acknowledgments

This work is supported in part by the 863 Program of China under Grant 2012AA02A603, and in part by the Guangzhou science and technology planning Project under Grant 2014J4100153.

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Authors and Affiliations

  1. Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, North-1838, Guangzhou, 510515, China

    Huajun Huang, Guodong Zhang, Hanbin Ouyang, Bin Yan, Jing Xu, Yang Yang, Zhanglin Wu & Wenhua Huang

  2. Department of Biomedical Engineering, Chung Yuan Christian University, 200 Chung Pei Road, Chung Li District, Taoyuan City, 32023, Taiwan

    Ming-Fa Hsieh

  3. The Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics of Guangdong Province, Guangzhou, 510630, China

    Canjun Zeng

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  1. Huajun Huang
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  2. Ming-Fa Hsieh
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  9. Zhanglin Wu
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  10. Wenhua Huang
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Correspondence to Wenhua Huang.

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Huang, H., Hsieh, MF., Zhang, G. et al. Improved accuracy of 3D-printed navigational template during complicated tibial plateau fracture surgery. Australas Phys Eng Sci Med 38, 109–117 (2015). https://doi.org/10.1007/s13246-015-0330-0

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  • DOI: https://doi.org/10.1007/s13246-015-0330-0

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