Percutaneous Tibial Fracture Reduction Using Computed Tomography Imaging, Computer Modelling and 3D Printed Alignment Constructs: A Cadaveric Study.

Abstract

The main aim of this study was to evaluate a percutaneous method of bone alignment using a diaphyseal tibial fracture model. Mid-shaft diaphyseal fractures were created in 12 large-breed canine tibiae. Interaction pins were inserted into the proximal and distal bone segments. Computed tomography scans of the fractured tibiae and pins were imported into three-dimensional (3D) modelling software and the fractures were virtually reduced. A multi-component 3D printed alignment jig was created that encompassed the pins in their aligned configuration. Orthogonal radiographs were taken after alignment jig application. Intact and post-alignment tibial lengths and joint angles were compared. Rotational alignment was subjectively evaluated. Post-alignment tibial lengths differed on the mediolateral and craniocaudal radiographs by an average of 1.55 and 1.43% respectively. Post-alignment mechanical medial proximal tibial angle, mechanical medial distal tibial angle and mechanical caudal proximal tibial angle had an average difference of 1.67°, 1.92° and 2.17° respectively. Differences in tibial length and joint angles were not significant (p > 0.05). While in vivo evaluation is necessary, this technique to align diaphyseal fractures percutaneously using computer modelling and 3D printing is technically feasible and may facilitate the clinical use of minimally invasive osteosynthesis techniques.