Abstract
BackgroundThe aim of this study was to investigate the feasibility of an individual navigation template for the deep pin position on the iliac crest, based on digital design and 3D printing technology.MethodsThe preoperative CT images of 8 patients with pelvic fractures were collected. The data were reconstructed using a 3D imaging reconstruction workstation. An individual navigation template for the deep pin position on the iliac crest was designed on a virtual 3D model. The individual drill template and the solid pelvic model were produced using the 3D printing technology. The individual drill template was used for intraoperative deep pin position on the iliac crest after the preoperative simulation was completed.ResultsThirty-two external fixator pins were inserted using the individual drill template. The average depth of pins was 84.82 mm. The trajectories were appropriate based on the postoperative X-ray and CT scan. No significant difference in the entry point, convergence angle, and caudal angle of the pins were noted before and after the operation (all P > 0.05). Finite element analysis indicated that the deep external fixator pin position could more reasonably distribute the stress in the cortical and spongy bones in the pelvis. All patients could perform partial weight-bearing activity 6 weeks postoperatively. No loosening and rupture of the pin, infection, and no damage of blood vessels and nervous tissue were found during the entire follow-up period.ConclusionsThe individual drill template technique is an improvement of the traditional technique, which could increase precision and the depth of pin position. In addition, good mechanical stability and low risk of pin-related complications occurred due to the individual drill template, which makes the external fixation technique a potential alternative.
Highlights
The aim of this study was to investigate the feasibility of an individual navigation template for the deep pin position on the iliac crest, based on digital design and 3D printing technology
It is difficult to control the direction of external fixator pins using the traditional surgical technique, which often results in the pin tip penetrating the cortex of the ilium during the surgery
In contrast with our experience using the percutaneous approach, correct pin placement using the anterosuperior approach is difficult for inexperienced surgeons, Wailakul et al reported that the incidence rate of incorrect pin placement up to 18% at the iliac crest for external fixation [4]
Summary
The aim of this study was to investigate the feasibility of an individual navigation template for the deep pin position on the iliac crest, based on digital design and 3D printing technology. Pelvic fractures are usually caused by high-energy trauma, such as traffic accident or falls from heights in young population, and with a consequent of associated injuries. The traditional external fixation on the iliac crest is the commonly used surgical technique because it is minimally invasive and easy to perform [3]. In contrast with our experience using the percutaneous approach, correct pin placement using the anterosuperior approach is difficult for inexperienced surgeons, Wailakul et al reported that the incidence rate of incorrect pin placement up to 18% at the iliac crest for external fixation [4]. We wanted to investigate a simple modification of the traditional method to place pin from the iliac crest toward the supraacetabular region, to improve the mechanical stability of external fixation. To the best of our knowledge, there are no reported studies improving the current surgical technique until now [7]
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