Abstract
Introduction: Anatomical implants enable minimally invasive osteosynthesis (MIO) and represent ideal complements of computer-assisted surgical workflows. This 3D morphometric study analyzes anatomical implant forms (AIF) for acetabular fracture osteosynthesis (AFO).Materials and Methods: Three-dimensional pelvis models were created from clinical CT data of 99 European-Caucasian patients (50 females, 49 males). The mean age of the patients was 60.1 years (range: 20–89; SD 10.8). Definition of a referential region of interest (ROI) corresponding to an AIF for AFO was followed by automated ROI computation for each of the 198 hemipelvises. Three-dimensional statistical modeling and analysis of the resulting 198 homologous ROIs consisted of thin-plate spline transformation, generalized Procrustes fit, and principal component analysis.Results: The mean ROI length was 18.2 cm (range: 16.1–20.1 cm; SD 0.76). The first principal component (PC1) mainly modeled the ROI length, which correlated well with body height (r = 0.325; p < 0.001). PC1 comprised 47.4% of the overall ROI form variation. PC2 primarily influenced the ROI curvature in the anterior-posterior (inlet) view. Curvatures were more pronounced in female patients compared to males (p < 0.001). There was no gender-specific ROI size variation. PC1-4 contained 80.2% of the total ROI form variation. Left and right ROI forms displayed symmetry.Conclusion: This 3D morphometric study demonstrates the feasibility of anatomical implants for minimally invasive acetabular fracture osteosynthesis. Implant size/length is by far the most important variable of form variation. The necessity of gender-specific implant forms requires further investigation. The non-fractured, contralateral hemipelvis can be used for preoperative surgical planning. Ultimately, the plate design will depend on prospective implant fit tests based on the required fit as defined by the clinician.
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