Abstract
In acetabular fracture surgery, achieving an optimal reconstruction of the articular surface decreases the risk of osteoarthritis and the subsequent need for total hip arthroplasty. However, no one-size-fits-all osteosynthesis plate is available owing to differences in fracture patterns and variations in pelvic anatomy. Currently, osteosynthesis plates need to be manually contoured intraoperatively, often resulting in inadequate reduction and fixation of the fractured segments. To determine the feasibility and accuracy of a novel concept of fast-track 3-dimensional (3-D) virtual surgical planning and patient-specific osteosynthesis for complex acetabular fracture surgery. This case series study examines the use of patient-specific osteosynthesis plates for patients needing operative treatment for displaced associated-type acetabular fractures at a tertiary university-affiliated referral center and level 1 trauma center between January 1, 2017, and December 31, 2018. Models were created in 3-D based on computed tomography (CT) data, fractures were virtually reduced, and implant positions were discussed in a multidisciplinary team of clinicians and engineers. Patient-specific osteosynthesis plates with drilling guides were designed, produced, sterilized and clinically applied within 4 days. Data were analyzed at the 1-year follow-up. Development and clinical implementation of personalized fracture surgery. The primary outcome was the quality of the reduction as determined by the postoperative CT scan. The secondary outcomes were accuracy of the screw placement and clinical outcome using patient-reported outcome measures. Ten patients with a median (range) age of 63 (46-79) years with an acetabular fracture were included. The median (interquartile range [IQR]) preoperative gap was 20 (15-22) mm, and the median (IQR) step-off was 5 (3-11) mm. Postoperatively, the median (IQR) gap was reduced to 3 (2-5) mm (P = .005), and the median (IQR) step-off was reduced to 0 (0-2) mm (P = .01), indicating good fracture reduction, indicating good fracture reduction. The mean difference between the preoperative and postoperative gap was 14.6 (95% CI, 10-19) mm, and the mean difference in step-off was 5.7 (95% CI, 2-9) mm. The median (IQR) difference in screw direction between the planning and actual surgery was only 7.1° (7°-8°). All patients retained their native hip and reported good physical functioning at follow-up. These findings suggest that 3-D virtual surgical planning, manufacturing, and clinical application of patient-specific osteosynthesis plates and drilling guides was feasible and yielded good clinical outcomes. Fast-track personalized surgical treatment could open a new era for the treatment of complex injuries.
Highlights
The overall incidence of acetabular fractures is estimated as 5 to 8 per 100 000 people per year, which accounts for approximately 60 000 injured individuals annually in Europe.1,2 A pelvic injury can have major consequences for physical functioning, participating in social activities, and the ability to work
The median (IQR) difference in screw direction between the planning and actual surgery was only 7.1° (7°-8°). All patients retained their native hip and reported good physical functioning at follow-up. These findings suggest that 3-D virtual surgical planning, manufacturing, and clinical application of patient-specific osteosynthesis plates and drilling guides
Key Points Question What is the feasibility of using a personalized approach for reconstruction of complex fractures? Findings In this case series study, 10 patients with severe acetabular fractures were surgically treated using 3-dimensional (3-D) surgical planning, patient-specific osteosynthesis plates, and drilling guides. These were designed, produced, sterilized and clinically applied within 4 days and were associated with an accurate reconstruction of the fractured articular surface and a good 1-year clinical outcome. Meaning These findings suggest that 3-D virtual surgical planning, manufacturing, and clinical application of patient-specific osteosynthesis plates and drilling guides were feasible and yielded good clinical outcomes
Summary
The overall incidence of acetabular fractures is estimated as 5 to 8 per 100 000 people per year, which accounts for approximately 60 000 injured individuals annually in Europe. A pelvic injury can have major consequences for physical functioning, participating in social activities, and the ability to work. Acetabular fracture treatment consists of either nonoperative treatment (56% of patients), open reduction and internal fixation (38% of patients) or primary total hip arthroplasty (THA; 6% of patients).. Achieving an optimal reconstruction of the articular surface is associated with improved functional outcome and decreased risk of progressive osteoarthritis and subsequent need for THA, but this is challenging for associated-type (ie, more complex) fractures, according to the Letournel-Judet classification, with substantial displacement.. Postoperative computer tomography (CT) analysis of acetabular fractures has demonstrated inadequate reductions in up to 53% of patients in a study by Verbeek et al.. 36% of patients with an inadequate reduction in the study by Verbeek et al eventually need a conversion to THA, compared with only 10% of patients with an adequate reduction Achieving an optimal reconstruction of the articular surface is associated with improved functional outcome and decreased risk of progressive osteoarthritis and subsequent need for THA, but this is challenging for associated-type (ie, more complex) fractures, according to the Letournel-Judet classification, with substantial displacement. Postoperative computer tomography (CT) analysis of acetabular fractures has demonstrated inadequate reductions in up to 53% of patients in a study by Verbeek et al. 36% of patients with an inadequate reduction in the study by Verbeek et al eventually need a conversion to THA, compared with only 10% of patients with an adequate reduction
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