3D printed anatomical models for preoperative planning of complex orthopaedic surgical operations of the lower limb

Abstract

Complex multifragmentary fractures of the pelvis and lower limb are a major challenge for operative orthopaedic surgery. The successful metallic osteosynthesis of the fractures requires an extensive planning process, which can be dramatically improved with the 3D printed anatomical models – replicas of the bones with high fidelity generated from CT and MRI imaging studies. The models represent the spatial properties of the skeleton with a dimensional error of approximately 8 μm/mm. They can be manufactured easily and with high reproducibility with commercial or open-access software and FDM 3D printing. Orthopaedic surgeons use the preoperative models as a highly accurate physical model of complex fractures and allow them to choose and prepare the optimal operation window, surgical tools, metallic implants, and as a template for recontouring (pre-bending) of fixation plates, which will be used during the surgery. The approach provides a new level of personalisation in operative orthopaedic surgery and significantly reduces the duration of the operation, the amount of blood loss and the intraoperative X-rays. The proper anatomical repositioning of the fracture is achieved at a higher rate in the surgeries, which are planned with 3D-printed anatomical models. The planning of surgical operations with 3D-printed models increases the overall effectiveness of the surgery, reduces the rate of post-surgical complications, and allows for a patient-specific approach.The paper will describe the methods for manufacturing accurate 3D-printed anatomical models representing complex fractures and their application for preoperative planning of orthopaedic operation.The anatomical 3D models were generated from CT datasets with open-access medical informatics software (3D Slicer) and 3D printed on an FDM 3D printer with minimal thermal deformation (Polylactate, PLA). The finished models were used for preoperative planning of complex orthopaedic operations, including high-energy multifragmentary hip, knee and ankle fractures. The preoperative planning included selecting surgical access, preparing tools and implants, and contouring (pre-bending) metal plates for metallic osteosynthesis. Several parameters, such as operation time, blood loss, intraoperative X-rays, and the achievement of anatomical reduction of the fractures, were observed in order to measure the quality of the operations.Accurate anthropomorphic 3D models representing the spatial properties of the bones can be generated from tomographic imaging studies easily and accurately, even with open-source software. They can be utilised as a tool for preoperatively planning complex orthopaedical operations of the lower limb. Using 3D-printed models allows a patient-specific approach, which leads to good anatomical reduction and favourable functional results in complex surgeries regarding the pelvis, acetabulum, tibial plateau, and calcaneus.The methods described in the paper are routinely used for the preoperative planning of complex orthopaedical operations regarding the lower limb. In the future, they will be combined with the implementation of 3D-printed personalised titanium implants to achieve good anatomical reduction even for the most challenging multigragmental fractures.In the paper, we described the technical aspects and clinical considerations for the preoperative planning of complex orthopaedical operations, which can assist engineers and clinicians alike in implementing the useful method in clinical practice.