3D surgical planning including patient-specific drilling guides for tibial plateau fractures: a prospective feasibility study
Aims: Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods: A pros...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2024-01-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.51.BJO-2023-0130.R1 |
| _version_ | 1827370744481316864 |
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| author | Nick Assink Kaj ten Duis Jean-Paul P. M. de Vries Max J. H. Witjes Joep Kraeima Job N. Doornberg Frank F. A. IJpma |
| author_facet | Nick Assink Kaj ten Duis Jean-Paul P. M. de Vries Max J. H. Witjes Joep Kraeima Job N. Doornberg Frank F. A. IJpma |
| author_sort | Nick Assink |
| collection | DOAJ |
| description | Aims: Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods: A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results: A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026). Conclusion: The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort. Cite this article: Bone Jt Open 2024;5(1):46–52. |
| first_indexed | 2024-03-08T10:23:00Z |
| format | Article |
| id | doaj.art-c3b8d8c9663b4a0f9a1d3d34b4bf2301 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-03-08T10:23:00Z |
| publishDate | 2024-01-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-c3b8d8c9663b4a0f9a1d3d34b4bf23012024-01-27T12:16:40ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622024-01-0151465210.1302/2633-1462.51.BJO-2023-0130.R13D surgical planning including patient-specific drilling guides for tibial plateau fractures: a prospective feasibility studyNick Assink0https://orcid.org/0000-0002-0034-6816Kaj ten Duis1Jean-Paul P. M. de Vries2Max J. H. Witjes3Joep Kraeima4Job N. Doornberg5Frank F. A. IJpma6Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, NetherlandsDepartment of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, NetherlandsDepartment of Surgery, University Medical Center Groningen, Groningen, Netherlands3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands3D Lab, University of Groningen, University Medical Center Groningen, Groningen, NetherlandsDepartment of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, NetherlandsDepartment of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, NetherlandsAims: Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods: A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results: A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026). Conclusion: The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort. Cite this article: Bone Jt Open 2024;5(1):46–52.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.51.BJO-2023-0130.R1tibial plateau fracture3dvirtual planning3d planningsurgical guidestibial plateau fracturesfracture reductionct scanskirschner (k)-wiresanesthesiologistslocking compression platessurgical treatmentrandomized controlled trialfracture fixationclinical studies |
| spellingShingle | Nick Assink Kaj ten Duis Jean-Paul P. M. de Vries Max J. H. Witjes Joep Kraeima Job N. Doornberg Frank F. A. IJpma 3D surgical planning including patient-specific drilling guides for tibial plateau fractures: a prospective feasibility study Bone & Joint Open tibial plateau fracture 3d virtual planning 3d planning surgical guides tibial plateau fractures fracture reduction ct scans kirschner (k)-wires anesthesiologists locking compression plates surgical treatment randomized controlled trial fracture fixation clinical studies |
| title | 3D surgical planning including patient-specific drilling guides for tibial plateau fractures: a prospective feasibility study |
| title_full | 3D surgical planning including patient-specific drilling guides for tibial plateau fractures: a prospective feasibility study |
| title_fullStr | 3D surgical planning including patient-specific drilling guides for tibial plateau fractures: a prospective feasibility study |
| title_full_unstemmed | 3D surgical planning including patient-specific drilling guides for tibial plateau fractures: a prospective feasibility study |
| title_short | 3D surgical planning including patient-specific drilling guides for tibial plateau fractures: a prospective feasibility study |
| title_sort | 3d surgical planning including patient specific drilling guides for tibial plateau fractures a prospective feasibility study |
| topic | tibial plateau fracture 3d virtual planning 3d planning surgical guides tibial plateau fractures fracture reduction ct scans kirschner (k)-wires anesthesiologists locking compression plates surgical treatment randomized controlled trial fracture fixation clinical studies |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.51.BJO-2023-0130.R1 |
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