Preliminary results using patient-specific 3d printed models to improve preoperative planning for correction of post-traumatic tibial deformities with circular frames.

Preliminary results using patient-specific 3d printed models to improve preoperative planning for correction of post-traumatic tibial deformities with circular frames. Corona, P. S., Vicente, M., Tetsworth, K., & Glatt, V. Injury, 49 Suppl 2:S51–S59, September, 2018.
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BACKGROUND: Preoperative planning for circular external fixators is considered vital towards achieving the best results for complex post-traumatic tibial deformities, and patient-specific 3D printed (3DP) models were used here as a planning aid. The main goal was to investigate the fidelity of the preoperative planning process, by assessing the potential to reduce operative time and determining the need to adjust pre-constructed frames intra-operatively. PATIENTS AND METHODS: Nine patients (10 limbs) underwent treatment for post-traumatic tibial complications using circular external fixation. These were compared to 10 similar cases where a 3DPM was not used as a pre-operative planning aide (Control group). Patient-specific models of affected bones were printed, and preoperative planning was performed using conventional techniques and Hexapod-assisted software. Detailed planning in a virtual procedure determined osteotomy levels and identified sites for wires and half-pins. The prototype of the external fixator was locked in this optimized configuration, removed from the model, and sterilized prior to the actual procedure. RESULTS: Nine patients with 10 limbs were treated for complications following tibial fractures. Seven were infected non-unions, and three cases were malunions. For all cases a CT based 3DP model of the full tibia was used in the preoperative planning stage. Image analysis required a mean of 1.7 h, with an average of 14.9 h to 3D print each model. In the control group (without a 3D model), the mean surgical time was 329 min (180-680). The mean surgical time in the 3DPM group was only 172.4 min (72-240), (p = 0.024), reducing the surgery time by 48%. For the 3DPM group it was not necessary to modify the preassembled frame in any case, while in the Control group, the pre-constructed frame required intra-operative modifications in 8 of the 10 cases (p = 0.0007). CONCLUSION: Using patient-specific 3D models has allowed us to carry out meticulous preoperative planning sessions, eliminating the need to modify or alter the frame assembly in the operating room, saving substantial surgical time and enabling a more precise design of the apparatus. This was especially useful in multiplanar deformities and for the spatial configuration of the foot support, talus ring, and ankle ring.

@article{corona_preliminary_2018,
	title = {Preliminary results using patient-specific 3d printed models to improve preoperative planning for correction of post-traumatic tibial deformities with circular frames.},
	volume = {49 Suppl 2},
	copyright = {Copyright (c) 2018 Elsevier Ltd. All rights reserved.},
	issn = {1879-0267 0020-1383},
	doi = {10.1016/j.injury.2018.07.017},
	abstract = {BACKGROUND: Preoperative planning for circular external fixators is considered vital towards achieving the best results for complex post-traumatic tibial deformities, and patient-specific 3D printed (3DP) models were used here as a planning aid. The main goal was to investigate the fidelity of the preoperative planning process, by assessing the potential to reduce operative time and determining the need to adjust pre-constructed frames intra-operatively. PATIENTS AND METHODS: Nine patients (10 limbs) underwent treatment for post-traumatic tibial complications using circular external fixation. These were compared to 10  similar cases where a 3DPM was not used as a pre-operative planning aide (Control group). Patient-specific models of affected bones were printed, and preoperative  planning was performed using conventional techniques and Hexapod-assisted software. Detailed planning in a virtual procedure determined osteotomy levels and identified sites for wires and half-pins. The prototype of the external fixator was locked in this optimized configuration, removed from the model, and sterilized prior to the actual procedure. RESULTS: Nine patients with 10 limbs were treated for complications following tibial fractures. Seven were infected non-unions, and three cases were malunions. For all cases a CT based 3DP model of the full tibia was used in the preoperative planning stage. Image analysis required a mean of 1.7 h, with an average of 14.9 h to 3D print each model. In the control group (without a 3D model), the mean surgical time was 329 min (180-680). The mean surgical time in the 3DPM group was only 172.4 min (72-240),  (p = 0.024), reducing the surgery time by 48\%. For the 3DPM group it was not necessary to modify the preassembled frame in any case, while in the Control group, the pre-constructed frame required intra-operative modifications in 8 of the 10 cases (p = 0.0007). CONCLUSION: Using patient-specific 3D models has allowed us to carry out meticulous preoperative planning sessions, eliminating the need to modify or alter the frame assembly in the operating room, saving substantial surgical time and enabling a more precise design of the apparatus. This was especially useful in multiplanar deformities and for the spatial configuration of the foot support, talus ring, and ankle ring.},
	language = {eng},
	journal = {Injury},
	author = {Corona, Pablo S. and Vicente, Matias and Tetsworth, Kevin and Glatt, Vaida},
	month = sep,
	year = {2018},
	pmid = {30219148},
	keywords = {*Fracture Fixation/instrumentation, *Preoperative Care, *Printing, Three-Dimensional, *Tibia, 3D modelling, 3D printing, Adult, Aged, Bone Malalignment/diagnostic imaging/*surgery, Deformity correction, External Fixators, Female, Follow-Up Studies, Hexapod, Humans, Male, Malunion, Middle Aged, Orthopaedic trauma, Osteotomy, Postoperative Complications/diagnostic imaging/physiopathology/*surgery, Radiography, Retrospective Studies, Surgery, Computer-Assisted, Tibia fractures, Tibial Fractures/diagnostic imaging/physiopathology/*surgery, Treatment Outcome, Virtual surgery planning},
	pages = {S51--S59},
}

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The main goal was to investigate the fidelity of the preoperative planning process, by assessing the potential to reduce operative time and determining the need to adjust pre-constructed frames intra-operatively. PATIENTS AND METHODS: Nine patients (10 limbs) underwent treatment for post-traumatic tibial complications using circular external fixation. These were compared to 10 similar cases where a 3DPM was not used as a pre-operative planning aide (Control group). Patient-specific models of affected bones were printed, and preoperative planning was performed using conventional techniques and Hexapod-assisted software. Detailed planning in a virtual procedure determined osteotomy levels and identified sites for wires and half-pins. The prototype of the external fixator was locked in this optimized configuration, removed from the model, and sterilized prior to the actual procedure. RESULTS: Nine patients with 10 limbs were treated for complications following tibial fractures. Seven were infected non-unions, and three cases were malunions. For all cases a CT based 3DP model of the full tibia was used in the preoperative planning stage. Image analysis required a mean of 1.7 h, with an average of 14.9 h to 3D print each model. In the control group (without a 3D model), the mean surgical time was 329 min (180-680). The mean surgical time in the 3DPM group was only 172.4 min (72-240), (p = 0.024), reducing the surgery time by 48%. For the 3DPM group it was not necessary to modify the preassembled frame in any case, while in the Control group, the pre-constructed frame required intra-operative modifications in 8 of the 10 cases (p = 0.0007). CONCLUSION: Using patient-specific 3D models has allowed us to carry out meticulous preoperative planning sessions, eliminating the need to modify or alter the frame assembly in the operating room, saving substantial surgical time and enabling a more precise design of the apparatus. 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Detailed planning in a virtual procedure determined osteotomy levels and identified sites for wires and half-pins. The prototype of the external fixator was locked in this optimized configuration, removed from the model, and sterilized prior to the actual procedure. RESULTS: Nine patients with 10 limbs were treated for complications following tibial fractures. Seven were infected non-unions, and three cases were malunions. For all cases a CT based 3DP model of the full tibia was used in the preoperative planning stage. Image analysis required a mean of 1.7 h, with an average of 14.9 h to 3D print each model. In the control group (without a 3D model), the mean surgical time was 329 min (180-680). The mean surgical time in the 3DPM group was only 172.4 min (72-240), (p = 0.024), reducing the surgery time by 48\\%. For the 3DPM group it was not necessary to modify the preassembled frame in any case, while in the Control group, the pre-constructed frame required intra-operative modifications in 8 of the 10 cases (p = 0.0007). CONCLUSION: Using patient-specific 3D models has allowed us to carry out meticulous preoperative planning sessions, eliminating the need to modify or alter the frame assembly in the operating room, saving substantial surgical time and enabling a more precise design of the apparatus. This was especially useful in multiplanar deformities and for the spatial configuration of the foot support, talus ring, and ankle ring.},\n\tlanguage = {eng},\n\tjournal = {Injury},\n\tauthor = {Corona, Pablo S. and Vicente, Matias and Tetsworth, Kevin and Glatt, Vaida},\n\tmonth = sep,\n\tyear = {2018},\n\tpmid = {30219148},\n\tkeywords = {*Fracture Fixation/instrumentation, *Preoperative Care, *Printing, Three-Dimensional, *Tibia, 3D modelling, 3D printing, Adult, Aged, Bone Malalignment/diagnostic imaging/*surgery, Deformity correction, External Fixators, Female, Follow-Up Studies, Hexapod, Humans, Male, Malunion, Middle Aged, Orthopaedic trauma, Osteotomy, Postoperative Complications/diagnostic imaging/physiopathology/*surgery, Radiography, Retrospective Studies, Surgery, Computer-Assisted, Tibia fractures, Tibial Fractures/diagnostic imaging/physiopathology/*surgery, Treatment Outcome, Virtual surgery planning},\n\tpages = {S51--S59},\n}\n\n","author_short":["Corona, P. 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