3D-printed template-assisted reduction of long bone fractures

Abstract

In multiply injured patients, the time period between the initial treatment with external fixators (damage control) and the definitive treatment can last from days to weeks. Apoor reduction result with the fixator (e.g. malposition in axis, length and rotation) and along delay from trauma to definitive osteosynthesis are associated with longer operation times, higher intraoperative radiation doses, higher infection rates and an increased likelihood for the necessity to perform an open reduction. In the described technique computed tomography (CT) is performed after temporary stabilization of the long bone fracture by an external fixator. On the basis of athree-dimensional dataset the fracture can be virtually reduced and apatient-specific reduction fixator can be designed and printed. The 3Dprinted reduction fixator fits only in the reduced position of the fracture, thus maintaining anatomical bone alignment. The procedure was used for the first time in the Trauma Surgery Clinic of the Medical University Hanover in May 2018 in a polytraumatized female patient with severe brain injury and an open floating knee injury. The procedure could be performed for femoral and tibial shaft fractures. The postoperative CT showed asatisfactory reconstruction of length, torsion and frontal and sagittal plane alignment. Fracture healing was uneventful within 3 months. Severely injured patients who initially receive stabilization according to the damage control principle and subsequently remain in the intensive care unit, could particularly benefit from the described postoperative reduction technique. In addition, the reduction fixator can be helpful for the definitive treatment of patients with bilateral fractures of long bones, where a reference to a healthy side is not possible.