Application of three-dimensional printing in the operation of distal tibia fracture involving epiphyseal plate injury for teenagers

Abstract

To investigate the application value of three-dimensional (3-D) printing technology in the operation of distal tibia fracture involving epiphyseal plate injury for teenagers. The retrospective analysis was conducted on the clinical data of 16 cases of children patients with distal tibia fracture involving epiphyseal plate injury undergoing the operation by using of 3-D printing technology between January 2014 and December 2015. There were 12 males and 4 females with an age of 9-14 years (mean, 12.8 years). The causes of injury included traffic accident injury in 9 cases, heavy pound injury in 3 cases, and sport injury in 4 cases. The time from injury to operation was 3-92 hours (mean, 25.8 hours). According to Salter-Harris typing standard, the typing for epiphyseal injury was classified as type Ⅱ in 11 cases, type Ⅲ in 4 cases, and type Ⅳ in 1 case. The thin slice CT scan on the affected limb was performed before operation, and the Mimics14.0 medical software was applied for the design and the 1∶1 fracture model was printed by the 3-D printer; the stimulation of operative reduction was made in the fracture model, and bone plate, Kirschner wire, and hollow screw with the appropriate size were chosen, then the complete operative approach and method were designed and the internal fixator regimen was chosen, then the practical operation was performed based on the preoperative design regimen. The operation time was 40-68 minutes (mean, 59.1 minutes); the intraoperative blood loss was 5-102 mL (mean, 35 mL); the intraoperative fluoroscopy times was 2-6 times (mean, 2.8 times). All the patiens were followed up 12-24 months (mean, 15 months). The fracture of 15 cases reached anatomic reduction, and 1 cases had no anatomic reduction with the displaced end less than 1 mm. All the fractures reached bony union with the healing time of 2-4 months (mean, 2.6 months). There was no deep vein thrombosis, premature epiphyseal closure and oblique, or uneven ankle surface occurred, and there was no complication such as osteomyelitis, varus or valgus of ankle joint, joint stiffness, traumatic arthritis. Helfet scores of ankle function were measured at 12 months after operation, the results were excellent in 15 cases and good in 1 case. The angulation of introversion and extroversion for the affected limb was (6.56±2.48)°, and the growth length was (4.44±2.31) mm, and there was no significant difference ( t=0.086, P=0.932; t=0.392, P=0.697) when compared with the uninjured side [(6.50±1.51)°, (4.69±1.08) mm]. As the assistive technology, 3-D printing technology has a certain clinical application value in improving the effectiveness of distal tibia fracture involving epiphyseal plate injury.