Advanced Preoperative Planning Techniques in the Management of Complex Proximal Humerus Fractures.

Abstract

This review evaluates the current literature on the recent advances of preoperative planning in the management of complex proximal humerus fractures (PHF). PHFs canpose a considerable challenge for orthopaedic surgeons due to their diversity inpresentation and complexity. Poor preoperative planning can lead to prolongedoperations, increased blood loss, higher risk of complications, and increased stress on the surgical team. Recent advances have seen the evolution of preoperative planning from conventionalmethods to computer-assisted virtual surgical technology (CAVST) and three-dimensional (3D) printing, which have been highlighted as transformative tools for improvingpreoperative planning and postoperative outcomes. CAVST allows the creation of 3D renderings of patient-specific anatomy, clearlydemonstrating fracture patterns and facilitating detailed planning for arthroplasty orsurgical fixation. The early studies show promising outcomes however the literaturecalls for more high-quality randomised controlled trials. Using 3D printing for high-fidelity simulation involving patient-specific physicalmodels offers an immersive experience for surgical planning. Preoperative planningwith 3D printing reduces operative time, blood loss and use of fluoroscopy. Thetechnology's potential to produce customisable surgical implants further improves itsversatility. There is a need for a cost analysis for the use of these technologies within theorthopaedic field, particularly considering the high expense of 3D printing materials andextended hospital stays until the printed models are available. CAVST and 3D printing also show promising applications within high-fidelity simulationsurgical training, with CAVST offering possibilities in virtual reality and haptic-enhancedsimulations and 3D printing providing physical models for trainee surgeons to honetheir skills. Moving forward, a reduction in the cost of 3D printing and the advancement of CAVSTusing artificial intelligence would lead to future improvement. In conclusion,preoperative planning supported by these innovative technologies will play a pivotalrole in improving surgical outcomes and training for complex PHF cases.