Development of patient-specific osteosynthesis including 3D-printed drilling guides for medial tibial plateau fracture surgery

Nick Assink; Miriam G E Oldhoff; Kaj Ten Duis; Joep Kraeima; Job N Doornberg; Max J H Witjes; Jean-Paul P M de Vries; Anne M L Meesters; Frank F A IJpma

doi:10.1007/s00068-023-02313-w

Development of patient-specific osteosynthesis including 3D-printed drilling guides for medial tibial plateau fracture surgery

Eur J Trauma Emerg Surg. 2024 Feb;50(1):11-19. doi: 10.1007/s00068-023-02313-w. Epub 2023 Jun 30.

Authors

Nick Assink^{1

2}, Miriam G E Oldhoff^{3

4}, Kaj Ten Duis³, Joep Kraeima⁴, Job N Doornberg³, Max J H Witjes⁴, Jean-Paul P M de Vries⁵, Anne M L Meesters^{3

4}, Frank F A IJpma³

Affiliations

¹ Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. n.assink@umcg.nl.
² 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, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
⁴ 3D lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁵ Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.

Abstract

Purpose: A substantial proportion of conventional tibial plateau plates have a poor fit, which may result in suboptimal fracture reduction due to applied -uncontrolled- compression on the bone. This study aimed to assess whether patient-specific osteosyntheses could facilitate proper fracture reduction in medial tibial plateau fractures.

Methods: In three Thiel embalmed human cadavers, a total of six tibial plateau fractures (three Schatzker 4, and three Schatzker 6) were created and CT scans were made. A 3D surgical plan was created and a patient-specific implant was designed and fabricated for each fracture. Drilling guides that fitted on top of the customized plates were designed and 3D printed in order to assist the surgeon in positioning the plate and steering the screws in the preplanned direction. After surgery, a postoperative CT scan was obtained and outcome was compared with the preoperative planning in terms of articular reduction, plate positioning, and screw direction.

Results: A total of six patient-specific implants including 41 screws were used to operate six tibial plateau fractures. Three fractures were treated with single plating, and three fractures with dual plating. The median intra-articular gap was reduced from 6.0 (IQR 4.5-9.5) to 0.9 mm (IQR 0.2-1.4), whereas the median step-off was reduced from 4.8 (IQR 4.1-5.3) to 1.3 mm (IQR 0.9-1.5). The median Euclidean distance between the centre of gravity of the planned and actual implant was 3.0 mm (IQR: 2.8-3.7). The lengths of the screws were according to the predetermined plan. None of the screws led to screw penetration. The median difference between the planned and actual screw direction was 3.3° (IQR: 2.5-5.1).

Conclusion: This feasibility study described the development and implementation of a patient-specific workflow for medial tibial plateau fracture surgery that facilitates proper fracture reduction, tibial alignment and accurately placed screws by using custom-made osteosynthesis plates with drilling guides.

Keywords: 3D printing; Guided surgery; Medial tibial plateau; PSI; Patient-specific implant; Three-dimensional; Tibial plateau fracture; Virtual surgical planning.

MeSH terms

Bone Plates
Bone Screws
Fracture Fixation, Internal
Humans
Printing, Three-Dimensional
Tibial Fractures* / diagnostic imaging
Tibial Fractures* / surgery
Tibial Plateau Fractures*