title: A combination of three-dimensional printing and computer-assisted virtual surgical procedure for preoperative planning of acetabular fracture reduction.
abstract: OBJECTIVE
  Treatment of acetabular fractures remains one of the most challenging tasks that orthopaedic surgeons face. An accurate assessment of the injuries and preoperative planning are essential for an excellent reduction. The purpose of this study was to evaluate the feasibility, accuracy and effectiveness of performing 3D printing technology and computer-assisted virtual surgical procedures for preoperative planning in acetabular fractures. We hypothesised that more accurate preoperative planning using 3D printing models will reduce the operation time and significantly improve the outcome of acetabular fracture repair.
  
  
  METHODS
  Ten patients with acetabular fractures were recruited prospectively and examined by CT scanning. A 3-D model of each acetabular fracture was reconstructed with MIMICS14.0 software from the DICOM file of the CT data. Bone fragments were moved and rotated to simulate fracture reduction and restore the pelvic integrity with virtual fixation. The computer-assisted 3D image of the reduced acetabula was printed for surgery simulation and plate pre-bending. The postoperative CT scan was performed to compare the consistency of the preoperative planning with the surgical implants by 3D-superimposition in MIMICS14.0, and evaluated by Matta's method.
  
  
  RESULTS
  Computer-based pre-operations were precisely mimicked and consistent with the actual operations in all cases. The pre-bent fixation plates had an anatomical shape specifically fit to the individual pelvis without further bending or adjustment at the time of surgery and fracture reductions were significantly improved. Seven out of 10 patients had a displacement of fracture reduction of less than 1mm; 3 cases had a displacement of fracture reduction between 1 and 2mm.
  
  
  CONCLUSIONS
  The 3D printing technology combined with virtual surgery for acetabular fractures is feasible, accurate, and effective leading to improved patient-specific preoperative planning and outcome of real surgery. The results provide useful technical tips in planning pelvic surgeries.
authors.affiliation: Department of Orthopedics, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics Guangdong Province, Guangzhou, Guangdong 510630, China; Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong 510515, China.
authors.forename: Canjun
authors.initials: C
authors.lastname: Zeng
authors.affiliation: Musculoskeletal Disease Center, Jerry L. Pettis Memorial VA Medical Center, Research Service, 11201 Benton St, Loma Linda, CA 92357, USA.
authors.forename: Weirong
authors.initials: W
authors.lastname: Xing
authors.affiliation: The Fifth Affiliated Hospital Of Southern Medical University, Guangzhou 510900, China.
authors.forename: Zhanglin
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, Third Affiliated Hospital of Southern Medical University, Academy of Orthopedics Guangdong Province, Guangzhou, Guangdong 510630, China.
authors.forename: Huajun
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong 510515, China. Electronic address: huangwenhua2009@139.com.
authors.forename: Wenhua
authors.initials: W
authors.lastname: Huang
mesh_terms: D000077:Acetabulum / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000293:injuries; D000328:Adult; D001860:Bone Plates; D002681:China; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D066330:Printing, Three-Dimensional; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: 3D printing; Acetabular fracture; Internal fixation; Virtual surgical simulation