Top

International Orthopaedics

Published in:

01-04-2016 | Original Paper

A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures

Authors: Feng Qiao, Dichen Li, Zhongmin Jin, Dingjun Hao, Yonghua Liao, Sihai Gong

Published in: International Orthopaedics | Issue 4/2016

Abstract

Purpose

Good reduction and appropriate fixation are critical for long bone fractures, however, neither has been addressed satisfactorily. Robotic and navigation techniques can help improve the reduction accuracy. However, their clinical applications are limited by high cost and complexity in operation. The aim of this study was to discuss the feasibility of a customized external fixator in treating long bone fractures.

Methods

We combined a computer-assisted reduction technique with 3D printing to develop a customized external fixator for treating three cases of tibial fractures. The reduction accuracy and fixation results were discussed in terms of operation time, X-ray examinations after operation, and limb function recovery.

Results

Good reduction results were obtained on all three tibial fractures with an average lateral displacement of 2.04 mm (±1.53) and an angulation of 2.54° (±1.33). The surgery was not experience-dependent, and no intra-operative X-ray examinations were conducted. The average operative time was 8.67 minutes (±0.58).

Conclusions

A novel customized external fixator for the treatment of tibial fractures has the advantages of easy manipulation, accurate reduction, appropriate fixation, minimal invasion and experience-independence, and therefore has huge potential in clinical applications.

Available only for authorised users

Friedlaender GE, Perry CR, Cole JD, Cook SD, Cierny G, Muschler GF, Zych GA, Calhoun JH, LaForte AJ, Yin S (2001) Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions - A prospective, randomized clinical trial comparing rhOP-1 with fresh bone autograft. J Bone Joint Surg-Am 83A:S151–S158

Phieffer LS, Goulet JA (2006) Delayed unions of the tibia. J Bone Joint Surg-Am 88A:206–216

Bhandari M, Guyatt G, Tornetta P III, Schemitsch EH, Swiontkowski M, Sanders D, Walter SD, Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators (2008) Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg-Am 90A:2567–2578. doi:10.2106/jbjs.g.01694

Lawyer RB, Lubbers LM (1980) Use of the Hoffmann apparatus in the treatment of unstable tibial fractures. J Bone Joint Surg-Am 62:1264–1273PubMed

Wu JJ, Shyr HS, Chao EYS, Kelly PJ (1984) Comparison of osteotomy healing under external fixation devices with different stiffness characteristics. J Bone Joint Surg-Am 66A:1258–1264

Wilharm A, Gras F, Rausch S, Linder R, Marintschev I, Hofmann GO, Mueckley T (2011) Navigation in femoral-shaft fractures-from lab tests to clinical routine. Injury-Int J Care Injured 42:1346–1352. doi:10.1016/j.injury.2011.06.023 CrossRef

Koo TKK, Mak AFT (2007) A knowledge-based computer-aided system for closed diaphyseal fracture reduction. Clin Biomech 22:884–893. doi:10.1016/j.clinbiomech.2007.05.005 CrossRef

Kahler DM (2009) Navigated long-bone fracture reduction. J Bone Joint Surg-Am 91A:102–107. doi:10.2106/jbjs.h.01286

Tang P, Hu L, Du H, Gong M, Zhang L (2012) Novel 3D hexapod computer-assisted orthopaedic surgery system for closed diaphyseal fracture reduction. Int J Med Robotics Com Assisted Surg 8:17–24. doi:10.1002/rcs.417 CrossRef

10.

Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta P, Hanson B, Weaver B, Sprague S, Schemitsch EH (2001) Surgeon’s preferences for the operative treatment of fractures of the tibial shaft - An international survey. J Bone Joint Surg-Am 83A:1746–1752

11.

Fleming B, Paley D, Kristiansen T, Pope M (1989) A biomechanical analysis of the Ilizarov external fixator. Clin Orthopaedics Related Res 241:95–105

12.

Narayan B, Marsh DR (2003) (iv) The Ilizarov method in the treatment of fresh fractures. Curr Orthop 17:447–457. doi:10.1016/j.cuor.2003.11.002 CrossRef

13.

Feldman DS, Shin SS, Madan S, Koval KJ (2003) Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor spatial frame. J Orthopaedic Trauma 17:549–554. doi:10.1097/00005131-200309000-00002 CrossRef

14.

Bose S, Vahabzadeh S, Bandyopadhyay A (2013) Bone tissue engineering using 3D printing. Materials Today 16:496–504. doi:10.1016/j.mattod.2013.11.017 CrossRef

15.

Giovinco NA, Dunn SP, Dowling L, Smith C, Trowell L, Ruch JA, Armstrong DG (2012) A novel combination of printed 3-dimensional anatomic templates and computer-assisted surgical simulation for virtual preoperative planning in Charcot foot reconstruction. J Foot Ankle Surg 51:387–393. doi:10.1053/j.jfas.2012.01.014 CrossRefPubMed

16.

Qiao F, Li D, Jin Z, Gao Y, Zhou T, He J, Cheng L (2015) Application of 3D printed customized external fixator in fracture reduction. Injury 46:1150–1155. doi:10.1016/j.injury.2015.01.020 CrossRefPubMed

17.

Leung KS, Cheung WH, Yeung HY, Lee KM, Fung KP (2004) Effect of weightbearing on bone formation during distraction osteogenesis. Clin Orthop Rel Res 419:251–257. DOI 10.1097/01.blo.0000111889.64238.6a

18.

Paley D, Fleming B, Catagni M, Kristiansen T, Pope M (1990) Mechanical evaluation of external fixators used in limb lengthening. Clin Orthop Rel Res 250:50–57

19.

Keast-Butler O, Lutz MJ, Angelini M, Lash N, Pearce D, Crookshank M, Zdero R, Schemitsch EH (2012) Computer navigation in the reduction and fixation of femoral shaft fractures: a randomized control study. Injury-Int J Care Injured 43:749–756. doi:10.1016/j.injury.2011.08.020 CrossRef

20.

Rubin C, Turner AS, Bain S, Mallinckrodt C, McLeod K (2001) Anabolism - Low mechanical signals strengthen long bones. Nature 412:603–604. doi:10.1038/35088122 CrossRefPubMed

21.

Hente R, Fuchtmeier B, Schlegel U, Ernstberger A, Perren SM (2004) The influence of cyclic compression and distraction on the healing of experimental tibial fractures. J Orthopaedic Res 22:709–715. doi:10.1016/j.orthres.2003.11.007 CrossRef

22.

Larsson S, Kim W, Caja VL, Egger EL, Inoue N, Chao EYS (2001) Effect of early axial dynamization on tibial bone healing - A study in dogs. Clin Orthop Rel Res 338:240–251

23.

Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A (2014) Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop 38:1261–1267. doi:10.1007/s00264-014-2294-1 CrossRefPubMedPubMedCentral

24.

Fadel M, Ahmed MA, Al-Dars AM, Maabed MA, Shawki H (2015) Ilizarov external fixation versus plate osteosynthesis in the management of extra-articular fractures of the distal tibia. Int Orthop 39:513–519. doi:10.1007/s00264-014-2607-4 CrossRefPubMed

25.

Zhao H, Li Z (2015) Is there any difference in the management of extra-articular fractures of the distal tibia using Ilizarov external fixation versus plate osteosynthesis? Int Orthop 39:603–604. doi:10.1007/s00264-015-2681-2 CrossRefPubMed

Title: A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures
Authors: Feng Qiao
Dichen Li
Zhongmin Jin
Dingjun Hao
Yonghua Liao
Sihai Gong
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2943-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2016

A novel navigation template for fixation of acetabular posterior column fractures with antegrade lag screws: design and application

Modified head-neck offset for diagnosing anterior femoro-acetabular impingement

Is the use of thin, highly cross-linked polyethylene liners safe in total hip arthroplasty?

Comparative clinical study of the prophylaxis of heterotopic ossifications after total hip arthroplasty using etoricoxib or diclofenac

Triple attack technique for non-union of femoral neck fractures

Authorities and foundation of the orthopaedic school in Germany in the 19th century: part II: Richard von Volkmann, Julius Wolff, Albert Hoffa, Friedrich Trendelenburg and other German authors