title: Use of a real-size 3D-printed model as a preoperative and intraoperative tool for minimally invasive plating of comminuted midshaft clavicle fractures.
abstract: BACKGROUND
  Open reduction and plate fixation is the standard operative treatment for displaced midshaft clavicle fracture. However, sometimes it is difficult to achieve anatomic reduction by open reduction technique in cases with comminution.
  
  
  METHODS
  We describe a novel technique using a real-size three dimensionally (3D)-printed clavicle model as a preoperative and intraoperative tool for minimally invasive plating of displaced comminuted midshaft clavicle fractures. A computed tomography (CT) scan is taken of both clavicles in patients with a unilateral displaced comminuted midshaft clavicle fracture. Both clavicles are 3D printed into a real-size clavicle model. Using the mirror imaging technique, the uninjured side clavicle is 3D printed into the opposite side model to produce a suitable replica of the fractured side clavicle pre-injury.
  
  
  RESULTS
  The 3D-printed fractured clavicle model allows the surgeon to observe and manipulate accurate anatomical replicas of the fractured bone to assist in fracture reduction prior to surgery. The 3D-printed uninjured clavicle model can be utilized as a template to select the anatomically precontoured locking plate which best fits the model. The plate can be inserted through a small incision and fixed with locking screws without exposing the fracture site. Seven comminuted clavicle fractures treated with this technique achieved good bone union.
  
  
  CONCLUSIONS
  This technique can be used for a unilateral displaced comminuted midshaft clavicle fracture when it is difficult to achieve anatomic reduction by open reduction technique. Level of evidence V.
authors.affiliation: Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Dalim-1dong, Youngdeungpo-gu, Seoul, 150-950, South Korea. hyongnyun@naver.com.
authors.forename: Hyong Nyun
authors.initials: HN
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, The Second Hospital, Jilin University, Changchun, China. jluliuxiaoning@gmail.com.
authors.forename: Xiao Ning
authors.initials: XN
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 948-1, Dalim-1dong, Youngdeungpo-gu, Seoul, 150-950, South Korea. happyshoulder@hallym.or.kr.
authors.forename: Kyu Cheol
authors.initials: KC
authors.lastname: Noh
mesh_terms: D001860:Bone Plates; D002968:Clavicle / Q000293:injuries*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D019990:Perioperative Care; D066330:Printing, Three-Dimensional