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

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

doi:10.1007/s00068-021-01773-2

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

Eur J Trauma Emerg Surg. 2022 Jun;48(3):1737-1749. doi: 10.1007/s00068-021-01773-2. Epub 2021 Aug 31.

Authors

Nick Assink^{1

2}, Inge H F Reininga³, Kaj Ten Duis³, Job N Doornberg³, Harm Hoekstra⁴, Joep Kraeima⁵, Max J H Witjes⁵, Jean-Paul P M de Vries⁶, Frank F A IJpma³

Affiliations

¹ Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. n.assink@umcg.nl.
² Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. n.assink@umcg.nl.
³ Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
⁴ Department of Traumatology, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium.
⁵ Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁶ Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.

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.

Keywords: 3D preoperative planning; 3D printing; 3D virtual surgical planning; Guided surgery; Three dimensional; Tibial plateau fracture.

Publication types

Review
Systematic Review

MeSH terms

Bone Plates
Fracture Fixation, Internal / methods
Humans
Operative Time
Printing, Three-Dimensional*
Tibial Fractures* / diagnostic imaging
Tibial Fractures* / surgery
Treatment Outcome