Abstract
BackgroundDistal femoral fractures are increasing with an aging population. The computer-assisted preoperative planning has great potential, but there are no preoperative plans to determine appropriate fixation methods for distal femoral fractures on an individual basis. The aims of this study are: (1) to describe the technique of finite element analysis combined with computer-assisted preoperative planning to determine a fixation method for distal femoral fractures and (2) to evaluate the intra-operative realization of this technology and the clinical outcomes based on it for distal femoral fractures.Materials and MethodsBetween January 2017 and January 2020, 31 patients with distal femoral fractures treated by open reduction and internal fixation were included and randomly divided into two groups based on preoperative planning methods: conventional group (n = 15) and computer-assisted group (n = 16). Firstly, how to determine the most appropriate plate and screw length and placement in the preoperative planning of distal femoral fractures was described. The time taken for preoperative planning for different fracture types in the computer-assisted group was then analyzed. Finally, intraoperative and postoperative parameters were compared between the conventional and computer-assisted groups, assessing operative time, intraoperative blood loss, number of intraoperative fluoroscopies, days of hospital stay, Visual Analog Scale for Pain Score (VAS), and Knee Society Score (KSS).ResultsMean total planning time for 33-A, 33-B, and 33-C fractures in computer-assisted group were 194.8 ± 6.49, 163.71 ± 9.22, and 237 ± 5.33 min, respectively. Compared with the conventional group, the patients in the computer-assisted group had less blood loss, fewer fluoroscopic images, and shorter operation time (p < 0.05). However, there was no significant difference in the hospitalization days, KSS score and VAS score between the two groups (p > 0.05).ConclusionsThe results of this study show that finite element combined with computer-assisted preoperative planning can effectively help surgeons to make accurate and clinically relevant preoperative planning for distal femoral fractures, especially in the selection of appropriate plate length and screw positioning.
Highlights
Distal femoral fractures account for 4–6% of all femoral fractures and approximately 1% of all fractures, and its incidence is gradually increasing as the population ages and periprosthetic fractures intensify [1]
We present a method for preoperative planning of distal femoral fractures by combining finite element analysis methods with computer simulation
The time spent in each computer planning phase was the segmentation of the fracture fragment which completed in the software in an average time of 38.12 min, the repositioning of the fracture block in 18.89 min, the reverse modeling in 16.47 min, the virtual placement of the internal fixation in 56.76 min and the finite element analysis in 64.06 min
Summary
Distal femoral fractures account for 4–6% of all femoral fractures and approximately 1% of all fractures, and its incidence is gradually increasing as the population ages and periprosthetic fractures intensify [1]. Surgical treatment of distal femoral fractures includes open reduction and internal fixation, joint replacement, etc. Appropriate preoperative planning is necessary for the treatment of distal femoral fractures. Distal femoral fractures are increasing with an aging population. The computer-assisted preoperative planning has great potential, but there are no preoperative plans to determine appropriate fixation methods for distal femoral fractures on an individual basis. The aims of this study are: [1] to describe the technique of finite element analysis combined with computer-assisted preoperative planning to determine a fixation method for distal femoral fractures and [2] to evaluate the intra-operative realization of this technology and the clinical outcomes based on it for distal femoral fractures
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