Accurate fixation of plates and screws for the treatment of acetabular fractures using 3D-printed guiding templates: An experimental study.
OBJECTIVE
To investigate the feasibility of the use of 3D-printed guiding templates for accurate placement of plates and screws for internal fixation of acetabular fractures.


METHODS
3D models of the pelvises of 14 adult cadavers were reconstructed using computed tomography (CT). Twenty-eight acetabular fractures were simulated and placement positions for plates and screw trajectories were designed. Bending module was obtained by 3D cutting; guiding template was manufactured using 3D printing, and the plate was pre-bent according to the bending module. Plates and screws were placed in cadaveric pelvises using the guiding template, and 3D model was reconstructed using CT. The designed and real trajectories were matched using 3D registration including the coordinates (entry and exit points) of designed trajectory. The number of qualified points with different accuracy levels was compared using Chi-squared test.


RESULTS
Sixty-four plates and 339 screws were placed with no cortical breach. The absolute difference of the X, Y, and Z coordinates between the designed and real entry points were 0.52±0.45, 0.43±0.36, and 0.53±0.44mm, respectively. The corresponding values for the exit points were 0.83±0.67, 1.22±0.87, and 1.26±0.83mm, respectively. With an accuracy degree ≥1.9mm for the entry points and ≥3.8mm for the exit points, there was no significant difference between the designed and the real trajectories.


CONCLUSIONS
The 3D-printed guiding template helped achieve accurate placement of plates and screws in the pelvis of adult cadavers.
Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China.
Xu
X
Chen
Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China.
Xuanhuang
X
Chen
Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China; Department of Human Anatomy, Southern Medical University, School of Basic Medical Sciences, Guangzhou 510515, China.
Guodong
G
Zhang
Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China. Electronic address: Lin@Medmail.com.cn.
Haibin
H
Lin
Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China.
Zhengxi
Z
Yu
Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China.
Changfu
C
Wu
Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China.
Xing
X
Li
Department of Orthopedics, Putian College Affiliated Hospital, Putian 351100, China.
Yijun
Y
Lin
Department of Human Anatomy, Southern Medical University, School of Basic Medical Sciences, Guangzhou 510515, China. Electronic address: 279352313@qq.com.
Wenhua
W
Huang
D000077:Acetabulum / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D017076:Computer-Aided Design; D005240:Feasibility Studies; D005593:Fracture Fixation, Internal / Q000193:education / Q000295:instrumentation*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008954:Models, Biological; D057285:Precision Medicine / Q000639:trends; D066330:Printing, Three-Dimensional / Q000295:instrumentation; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed
3D printing; Acetabular fracture; Guiding template; Internal fixation