Efficacy and safety of 3D print-assisted surgery for the treatment of pilon fractures: a meta-analysis of randomized controlled trials

Jianzhong Bai,Peian Wang,Pei Zhang,Jingcheng Wang,Yongxiang Wang,Meiying Liu,Yuan Liang

doi:10.1186/s13018-018-0976-x

Abstract

ObjectiveTo compare the effects of 3D print-assisted surgery and conventional surgery in the treatment of pilon fractures.MethodsPubMed, Embase, Web of Science, CNKI, CBM, and WanFang data were searched until July 2018. Two reviewers selected relevant studies, assessed the quality of studies, and extracted data. For continuous data, a weighted mean difference (WMD) and 95% confidence intervals (CI) were used. For dichotomous data, a relative risk (RR) and 95% CI were calculated as the summary statistics.ResultsThere were seven randomized controlled trials (RCT) enrolling a total of 486 patients, 242 patients underwent 3D print-assisted surgery and 244 patients underwent conventional surgery. The pooled outcomes demonstrate 3D print-assisted surgery was superior to conventional surgery in terms of operation time [WMD = − 26.16, 95% CI (− 33.19, − 19.14), P < 0.001], blood loss [WMD = − 63.91, 95% CI (− 79.55, − 48.27), P < 0.001], postoperative functional scores [WMD = 8.16, 95% CI (5.04, 11.29), P < 0.001], postoperative visual analogue score (VAS) [WMD = − 0.59, 95% CI (− 1.18, − 0.01), P = 0.05], rate of excellent and good outcome [RR = 1.20, 95% CI (1.07, 1.34), P = 0.002], and rate of anatomic reduction [RR = 1.35, 95% CI (1.19, 1.53), P < 0.001]. However, there was no significant difference between the groups regarding the rate of infection [RR = 0.51, 95% CI (0.20, 1.31), P = 0.16], fracture union time [WMD = − 0.85, 95% CI (− 1.79, 0.08), P = 0.07], traumatic arthritis [RR = 0.34, 95% CI (0.06, 2.09), P = 0.24], and malunion [RR = 0.34, 95% CI (0.06, 2.05), P = 0.24].ConclusionsOur meta-analysis demonstrates 3D print-assisted surgery was significantly better than conventional surgery in terms of operation time, blood loss, postoperative functional score, postoperative VAS, rate of excellent and good outcome, and rate of anatomic reduction. Concerning postoperative complications, there were no significant differences between the groups.

Highlights

Pilon fractures are usually caused by high energy trauma, accompanied by multiple metaphyseal fragments, displaced intra-articular comminution, and severe soft tissue injuries: this is a substantial problem for experienced orthopedic surgeons [1, 2]
The pooled outcomes demonstrate 3D print-assisted surgery was superior to conventional surgery in terms of operation time [weighted mean difference (WMD) = − 26.16, 95% confidence intervals (CI) (− 33.19, − 19.14), P < 0.001], blood loss [WMD = − 63.91, 95% CI (− 79.55, − 48.27), P < 0.001], postoperative functional scores [WMD = 8.16, 95% CI (5.04, 11.29), P < 0.001], postoperative visual analogue score (VAS) [WMD = − 0.59, 95% CI (− 1.18, − 0.01), P = 0.05], rate of excellent and good outcome [relative risk (RR) = 1.20, 95% CI (1.07, 1.34), P = 0.002], and rate of anatomic reduction [RR = 1.35, 95% CI (1.19, 1.53), P < 0.001]
Our meta-analysis demonstrates 3D print-assisted surgery was significantly better than conventional surgery in terms of operation time, blood loss, postoperative functional score, postoperative VAS, rate of excellent and good outcome, and rate of anatomic reduction

Summary

Introduction

Pilon fractures are usually caused by high energy trauma, accompanied by multiple metaphyseal fragments, displaced intra-articular comminution, and severe soft tissue injuries: this is a substantial problem for experienced orthopedic surgeons [1, 2]. Surgeons can perform a pre-operation to identify unforeseen problems during surgery that could assist in formulation of preoperative planning, simulation of the surgical procedure, and achievement of better surgical outcomes [8]. There are no relevant meta-analyses or clinical guides to assess the effects of 3D print-assisted surgery for the treatment of pilon fractures. It is unclear whether 3D print-assisted surgery can significantly improve the postoperative outcomes of patients compared to conventional surgery. We performed this meta-analysis to identify the issue and provided a better treatment strategy for clinicians

Methods

Results

Discussion

Conclusion