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European Journal of Trauma and Emergency Surgery

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Open Access 31-08-2021 | Tibial Plateau Fracture | Review Article

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

Authors: Nick Assink, Inge H. F. Reininga, Kaj ten Duis, Job N. Doornberg, Harm Hoekstra, Joep Kraeima, Max J. H. Witjes, Jean-Paul P. M. de Vries, Frank F. A. IJpma

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2022

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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Parkkinen M, Madanat R, Mustonen A, Koskinen SK, Paavola M, Lindahl J. Factors predicting the development of early osteoarthritis following lateral tibial plateau fractures: mid-term clinical and radiographic outcomes of 73 operatively treated patients. Scand J Surg. 2014. https://doi.org/10.1177/1457496914520854.CrossRefPubMed

Meulenkamp B, Martin R, Desy NM, Duffy P, Korley R, Puloski S, et al. Incidence, risk factors, and location of articular malreductions of the Tibial Plateau. J Orthop Trauma. 2017. https://doi.org/10.1097/BOT.0000000000000735.CrossRefPubMed

Mthethwa J, Chikate A. A review of the management of Tibial Plateau fractures. Musculoskelet Surg. 2018. https://doi.org/10.1007/s12306-017-0514-8.CrossRefPubMed

Assink N, Kraeima J, Slump CH, ten Duis K, de Vries JPPM, Meesters AML, et al. Quantitative 3D measurements of Tibial Plateau fractures. Sci Rep. 2019. https://doi.org/10.1038/s41598-019-50887-6.CrossRefPubMedPubMedCentral

Xiong L, Li X, Li H, Chen Z, Xiao T. The efficacy of 3D printing-assisted surgery for traumatic fracture: a meta-analysis. Postgrad Med J. 2019. https://doi.org/10.1136/postgradmedj-2019-136482.CrossRefPubMed

Wixted CM, Peterson JR, Kadakia RJ, Adams SB. Three-dimensional printing in orthopaedic surgery: current applications and future developments. J Am Acad Orthop Surg Glob Res Rev. 2021. https://doi.org/10.5435/JAAOSGlobal-D-20-00230.CrossRefPubMedPubMedCentral

Lal H, Patralekh MK. 3D printing and its applications in orthopaedic trauma: a technological marvel. J Clin Orthop Trauma. 2018. https://doi.org/10.1016/j.jcot.2018.07.022.CrossRefPubMedPubMedCentral

Bizzotto N, Tami I, Santucci A, Adani R, Poggi P, Romani D, et al. 3D-printed replica of articular fractures for surgical planning and patient consent: a two years multi-centric experience. 3D Print Med. 2016. https://doi.org/10.1186/s41205-016-0006-8.CrossRefPubMedCentral

Weidert S, Andress S, Suero E, Becker C, Hartel M, Behle M, et al. 3D-Druck in der unfallchirurgischen Fort- und Weiterbildung. Unfallchirurg. 2019. https://doi.org/10.1007/s00113-019-0650-8.CrossRefPubMed

10.

Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009. https://doi.org/10.1371/journal.pmed.1000097.CrossRefPubMedPubMedCentral

11.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016. https://doi.org/10.1186/s13643-016-0384-4.CrossRefPubMedPubMedCentral

12.

Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Cochrane Book Ser. 2008. https://doi.org/10.1002/9780470712184.CrossRef

13.

Law M, Stewart D, Pollock N, Letts L, Bosch J, Westmoreland M. Guidelines for critical review form—quantitative studies. Quant Rev Form Guidel. 1998. https://doi.org/10.1088/1751-8113/44/8/085201.CrossRef

14.

Jinsihan N, Jin G. Recent developments of 3D-printing technique assisted surgery in the management of complex fractures. Int J Clin Exp Med. 2018. https://doi.org/10.1109/ICCONS.2018.8662981.CrossRef

15.

Xie L, Chen C, Zhang Y, Zheng W, Chen H, Cai L. Three-dimensional printing assisted ORIF versus conventional ORIF for tibial plateau fractures: a systematic review and meta-analysis. Int J Surg. 2018. https://doi.org/10.1016/j.ijsu.2018.07.012.CrossRefPubMed

16.

Beisemann N, Keil H, Swartman B, Schnetzke M, Franke J, Grützner PA, et al. Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases. J Orthop Surg Res. 2019. https://doi.org/10.1186/s13018-019-1286-7.CrossRefPubMedPubMedCentral

17.

Citak M, Citak M, Suero EM, O’Loughlin PF, Hüfner T, Krettek C. Navigated reconstruction of a tibial plateau compression fracture post-virtual reconstruction. A case report. Knee. 2011. https://doi.org/10.1016/j.knee.2010.04.007.CrossRefPubMed

18.

Delcogliano M, Marin R, Deabate L, Previtali D, Filardo G, Surace MF, et al. Arthroscopically assisted and three-dimensionally modeled minimally invasive rim plate osteosynthesis via modified anterolateral approach for posterolateral tibial plateau fractures. Knee. 2020. https://doi.org/10.1016/j.knee.2020.02.011.CrossRefPubMed

19.

Franke J, Vetter SY, Beisemann N, Swartman B, Grϋtzner PA, Schnetzke M. 3-D-Sicherheit bei gelenknahen Osteosynthesen. Unfallchirurg. 2016. https://doi.org/10.1007/s00113-016-0228-7.CrossRefPubMed

20.

Giannetti S, Bizzotto N, Stancati A, Santucci A. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing. Injury. 2017. https://doi.org/10.1016/j.injury.2016.11.015.CrossRefPubMed

21.

Guo C, Zhang Y, Yang L, Zhu Q, Zou S. The application and operation-effect analysis for complex tibial plateau fractures with 3D printing technique. Int J Clin Med. 2019. https://doi.org/10.4236/ijcm.2019.103010.CrossRef

22.

Horas K, Hoffmann R, Faulenbach M, Heinz SM, Langheinrich A, Schweigkofler U. Advances in the preoperative planning of revision trauma surgery using 3D printing technology. J Orthop Trauma. 2020. https://doi.org/10.1097/BOT.0000000000001708.CrossRefPubMed

23.

Huang H, Hsieh MF, Zhang G, Ouyang H, Zeng C, Yan B, et al. Improved accuracy of 3D-printed navigational template during complicated tibial plateau fracture surgery. Australas Phys Eng Sci Med. 2015. https://doi.org/10.1007/s13246-015-0330-0.CrossRefPubMed

24.

Lou Y, Cai L, Wang C, Tang Q, Pan T, Guo X, et al. Comparison of traditional surgery and surgery assisted by three dimensional printing technology in the treatment of tibial plateau fractures. Int Orthop. 2017. https://doi.org/10.1007/s00264-017-3445-y.CrossRefPubMed

25.

Mishra A, Verma T, Vaish A, Vaish R, Vaishya R, Maini L. Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma. Chin J Traumatol Engl Ed. 2019. https://doi.org/10.1016/j.cjtee.2019.07.006.CrossRef

26.

Nie W, Gu F, Wang Z, Wu R, Yue Y, Shao A. Preliminary application of three-dimension printing technology in surgical management of bicondylar tibial plateau fractures. Injury. 2019. https://doi.org/10.1016/j.injury.2018.12.019.CrossRefPubMed

27.

Ozturk AM, Suer O, Derin O, Ozer MA, Govsa F, Aktuglu K. Surgical advantages of using 3D patient-specific models in high-energy tibial plateau fractures. Eur J Trauma Emerg Surg. 2020. https://doi.org/10.1007/s00068-020-01378-1.CrossRefPubMed

28.

Ruan Z, Luo C, Feng D, Zhang C, Zeng B. Intraoperative three-dimensional imaging in tibial plateau fractures with complex depressions. Technol Heal Care. 2011. https://doi.org/10.3233/THC-2011-0613.CrossRef

29.

Shen S, Wang PZ, Li XY, Han X, Tan HL. Pre-operative simulation using a three-dimensional printing model for surgical treatment of old and complex tibial plateau fractures. Sci Rep. 2020. https://doi.org/10.1038/s41598-020-63219-w.CrossRefPubMedPubMedCentral

30.

Suero EM, Hüfner T, Stübig T, Krettek C, Citak M. Use of a virtual 3D software for planning of tibial plateau fracture reconstruction. Injury. 2010. https://doi.org/10.1016/j.injury.2009.10.053.CrossRefPubMed

31.

Wang H, Newman S, Wang J, Wang Q, Wang Q. Corrective osteotomies for complex intra-articular tibial plateau malunions using three-dimensional virtual planning and novel patient-specific guides. J Knee Surg. 2018. https://doi.org/10.1055/s-0037-1605563.CrossRefPubMedPubMedCentral

32.

Wu W, yong, Xu W guo, Wan C you, Fang M, . Preoperative plan with 3D printing in internal and external fixation for complex tibial plateau fractures. Orthop Surg. 2019. https://doi.org/10.1111/os.12466.CrossRefPubMedPubMedCentral

33.

Yang P, Du D, Zhou Z, Lu N, Fu Q, Ma J, et al. 3D printing-assisted osteotomy treatment for the malunion of lateral tibial plateau fracture. Injury. 2016. https://doi.org/10.1016/j.injury.2016.09.025.CrossRefPubMed

34.

Zhang H, Li Z, Xu Q, Zhang Y, Xu K, Ma X. Analysis for clinical effect of virtual windowing and poking reduction treatment for Schatzker III tibial plateau fracture based on 3D CT data. Biomed Res Int. 2015. https://doi.org/10.1155/2015/231820.CrossRefPubMedPubMedCentral

35.

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of The Knee Society clinical rating system. Clin Orthop Relat Res. 1989. https://doi.org/10.1097/00003086-198911000-00004.CrossRefPubMed

36.

Spek RWA, Schoolmeesters BJA, Oosterhoff JHF, Doornberg JN, van den Bekerom MPJ, Jaarsma RL, Eygendaal D, IJpma F; Traumaplatform 3D Consortium. 3D-printed handheld models do not improve recognition of specific characteristics and patterns of three-part and four-part proximal humerus fractures. Clin Orthop Relat Res. 2021. https://doi.org/10.1097/CORR.0000000000001921. Online ahead of print. PMID: 34427569

37.

Huang JH, Liao H, Tan XY, Xing WR, Zhou Q, Zheng YS, et al. Surgical treatment for both-column acetabular fractures using pre-operative virtual simulation and three-dimensional printing techniques. Chin Med J (Engl). 2020. https://doi.org/10.1097/CM9.0000000000000649.CrossRefPubMedCentral

38.

Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online. 2016. https://doi.org/10.1186/s12938-016-0236-4.CrossRefPubMedPubMedCentral

39.

Pijpker PAJ, Kraeima J, Witjes MJH, Oterdoom DLM, Vergeer RA, Coppes MH, et al. Accuracy of patient-specific 3D-printed drill guides for pedicle and lateral mass screw insertion. Spine (Phila Pa 1976). 2021. https://doi.org/10.1097/brs.0000000000003747.CrossRef

Title: Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients
Authors: Nick Assink
Inge H. F. Reininga
Kaj ten Duis
Job N. Doornberg
Harm Hoekstra
Joep Kraeima
Max J. H. Witjes
Jean-Paul P. M. de Vries
Frank F. A. IJpma
Publication date: 31-08-2021
Publisher: Springer Berlin Heidelberg
Keyword: Tibial Plateau Fracture
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01773-2

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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