Advantages of 3D Printing in the Management of Acetabular Fractures
Condition: Acetabular Fracture
MeSH terms: Fractures, Bone
Study type: Interventional

Summary: 
      Background: Acetabular fractures result from violent trauma, and their incidence has been
      increasing in recent years. The Kocher-Langenbeck surgical approach is used for the internal
      fixation of displaced fractures of the posterior structures of the acetabulum. The quality of
      the reduction and the stability of osteosynthesis directly influence the function of the
      repaired acetabulum. In the surgical management of acetabulum fractures, 3D printing of a
      bone model is increasingly used during preoperative planning by trauma surgeons worldwide.

      Questions: Is there a difference in the surgical time of the Kocher-langenbeck reduction and
      fixation of the posterior structures of the acetabulum between 3D printing (which allows for
      shaping of the reconstruction plate prior to surgery) and the conventional technique? Are
      there any differences in complications between the two techniques? Are there any short-term
      differences in the functional and radiographic scores between 3D printing and the
      conventional technique? Methods: 109 consecutive patients who sustained fractures of the
      acetabulum were screened for inclusion. 43 patient were studied. The first group (G1)
      consisted of 20 patients who underwent prior molding of the osteosynthesis plate on a
      3D-printed model. The second group (G2 or control group) included 23 patients who underwent
      surgery using the conventional technique. We compared surgical time, intraoperative blood
      loss, the difference between pre- and postoperative hemoglobin, and the onset of early
      infection, paralysis of the sciatic nerve, and deep vein thrombosis.
    

Detailed description: 
      This randomized, prospective study included 109 consecutive patients who were treated for
      fractures of the acetabulum between September 2016 and February 2019 at our institution. This
      study was approved by the ethics committee at our institution and verbal and written informed
      consent was obtained from all patients. The final analysis included 43 patients (33 males and
      10 females) who underwent the Kocher-Langenbeck approach for the reduction and fixation of
      the posterior structures of the acetabulum.

      The patients were divided into two groups. Group 1 (G1) consisted of 20 patients who
      underwent preoperative molding of the osteosynthesis plate on a 3D printed model of the
      pelvis. Group 2 (G2 or control group) included 23 patients who underwent surgery using the
      conventional technique.

      All patients were examined in the outpatient department via clinical and radiographic
      evaluation at 3, 6, 12, and 24 weeks postoperatively, then every 6 months thereafter. A
      standard radiographic assessment including three views (AP, iliac oblique, and obturator
      oblique) and a pelvic CT scan were obtained for all patients at the last follow-up visit. The
      reductions were classified as one of three types: anatomical (residual displacement <1 mm),
      imperfect (residual displacement 1 to 3 mm), and poor (residual reduction >3 mm). Clinical
      outcomes were assessed using the modified Harris Hip score. Bone consolidation was obtained
      in all cases. Clinical and radiographic results at the last follow-up as well as the minimum
      follow-up duration were evaluated by one surgeon who did not participate in the surgical
      management of the patients.
    

Intervention name(s): Fractures of the posterior structures of the acetabulum treated by fixation using the Kocher-Langenbeck approach.
Intervention type(s): Procedure
Intervention description(s): Fracture fixation of posterior structures of acetabulum by using the surgical procedure of Kocher-Langenbeck approach
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two techniques for treatment of posterior structure of acetabular fracture
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Acetabulum