Anatomical reduction and precise internal fixation of intra-articular fractures of the distal radius with virtual X-ray and 3D printing

Jing Xu,Wenhua Huang,Shizhen Zhong,Haibin Lin,Yudong Zheng,Wei Li,Yongshao Chen,Chunrong Wei,Guodong Zhang,Zaopeng He

doi:10.1007/s13246-019-00795-w

Abstract

To evaluate and precisely internal fix intra-articular distal radial fracture (IDRF) using the virtual X-ray and three-dimensional (3D) printing technologies. Twenty-one patients with IDRF were recruited, and the data from digital design group (DDG) and real surgery group (RSG) were collected and analyzed. In DDG, the data from thin-slice computed tomography scan, virtual X-ray measurement parameters, including volar tilt, palmar tilt, radius length (D1), ulnar variation (D2), locking plate position parameter (D3) and distance between key nail and joint surface (D4) were collected. The bone was virtually fixed with the locking plate, and the final model of radius with the screw was obtained by 3D printing. In RSG, the locking plate was precisely pre-bended and used in surgery. During the surgery, the key K-wire was accurately placed and the locking plate was adjusted with the aid of the U-shaped navigation arm. The C-arm was used to observe the positions of key K-wires and the locking plate, and the same above-mentioned parameters were measured intra- and post-operatively. The data from RSG and DDG were compared statistically by t test. This approach proved to be successful in all 21 patients, and none of the screws pierced through the wrist joint surface. All the measured parameters, including the volar tilt, palmar tilt, D1–4, in RSG were not significantly different from preoperative DDG data. Virtual X-ray measurement of anatomical reduction parameters and 3D printing can help the anatomical reduction and precise internal fixation by providing quantitative references, preoperatively, intraoperatively and postoperatively.

Highlights

The anatomical structure adjacent to the distal radius is very complex, which is directly related to the hand function [1, 2]
It is still very challenging to completely recover from the Intra-articular Distal radial fracture (DRF) (IDRF), because it is necessary to achieve an anatomical reduction [4, 5], i.e., complete reconstruction of radius and the articular surface [6], and a strong and precise internal fixation to facilitate early rehabilitation [7]; otherwise complications such as traumatic arthritis will often occur, which will seriously affect the function of the hands and wrists [8, 9]
We explored a new approach by designing a digital surgical method based on virtual engineer, including thin-layer computed tomography (CT) scan data, virtual three-dimensional (3D) reconstruction and 3D printing, which could simultaneously realize the quantitative evaluation, accurate anatomical reduction and internal fixation of IDRF

Summary

Introduction

The anatomical structure adjacent to the distal radius is very complex, which is directly related to the hand function [1, 2]. Jing Xu is the first author, Guodong Zhang and Zaopeng He are co-first authors. It is still very challenging to completely recover from the IDRF, because it is necessary to achieve an anatomical reduction [4, 5], i.e., complete reconstruction of radius and the articular surface [6], and a strong and precise internal fixation to facilitate early rehabilitation [7]; otherwise complications such as traumatic arthritis will often occur, which will seriously affect the function of the hands and wrists [8, 9]

Methods

Results

Conclusion