Prebending of osteosynthesis plate using 3D printed models to treat symptomatic os acromiale and acromial fracture
Beliën et al. Journal of Experimental Orthopaedics
Prebending of osteosynthesis plate using 3D printed models to treat symptomatic os acromiale and acromial fracture
Hanne Beliën 0
Hanne Biesmans 0
Anny Steenwerckx 2
Eric Bijnens 1
Carl Dierickx 2 3
0 Bachelor of science in Biomedical Sciences, University Hasselt , Hasselt , Belgium
1 Radiology department Jessa Hospital , Hasselt , Belgium
2 Orthopedic surgeon Jessa Hospital , Hasselt , Belgium
3 Orthopedics, University Hasselt , Hasselt , Belgium
Background: A symptomatic os acromiale can lead to impingement syndrome and rotator cuff tendinopathy. An acromion fracture is often part of a more complex scapular trauma that needs stabilisation. Methods: We developed a new technique using a three-dimensional (3D) model and a distal clavicle reconstruction plate to treat os acromiale and acromion fractures. Our hypothesis was that such an approach would be a useful addition to the existing techniques. First, a 3D model of the acromion was printed, then an osteosynthesis plate was pre-bent to fit the exact shape and curve of the acromion. We tested this technique and present reports on five patients, three with os acromiales and two with acromial fractures. We followed these patients during their rehabilitation and evaluated them using the Constant-Murley and the Disabilities of the Arm, Shoulder and Hand scores. Results: In every case the fracture or non-union healed. If the surgery was performed before additional damage (such as an impingement syndrome) occurred, we saw that the patient's pain completely disappeared. This new technique also has other advantages because the surgeon can prepare the entire operation in advance, which reduces the duration of surgery. Another advantage of using a 3D model is that it can also be used to inform the patient and the surgical team about the planned operation. Conclusion: This new technique using a preoperative patient-customized plate is a good alternative for use in open reduction and internal fixation, particularly if the patient has no other conditions.
Os acromiale; Acromial fracture; 3D printing; Osteosynthesis plate; Case report
Background
An os acromiale results from non-union of the three
ossification centres in the acromion. Under normal
conditions, the pre-acromion, the meso-acromion and the
meta-acromion should fuse by union of these centres.
This normally occurs in adolescents between 15 and
18 years old
(Abboud et al., 2006; Atoun et al., 2012;
Barbier et al., 2013; Boehm et al., 2003; Frizziero et al.,
2012; Harris et al., 2011; Ortiguera and Buss, 2002;
Pagnani et al., 2006; Peckett et al., 2004; Sahajpal et al.,
2007; Spiegl et al., 2015; Yammine, 2014)
. There are two
competing hypotheses about the aetiology of non-fusion:
some researchers believe that it is a consequence of a
genetic defect, while others believe that it results from
mechanical stress during the development of the acromion.
Os acromiale is uncommon. Several studies have
investigated its prevalence, reporting varying frequencies,
although most describe a frequency of 1%–15%
(Ortiguera
and Buss, 2002; Spiegl et al., 2015; Yammine, 2014)
or
1%–30%
(Harris et al., 2011; Sahajpal et al., 2007)
. Of these
cases, 33%–62% show bilateral involvement
(Harris et al.,
2011; Ortiguera and Buss, 2002; Sahajpal et al., 2007;
Yammine, 2014)
. Higher rates of os acromiale have been
noted in Africans and men
(Ortiguera and Buss, 2002;
Sahajpal et al., 2007)
.
The method for treatment of a symptomatic os acromiale
depends on its type, the severity of the pain and the
preference of the surgeon, and there is no gold standard.
If an operation is necessary, there are several options. The
most frequently used procedures are open or arthroscopic
excision of smaller os acromiales, arthroscopic
decompression and open reduction and internal fixation (ORIF)
of larger os acromiales.
The first approach is the open or arthroscopic excision
of the unstable fragment. This operation has the highest
success rate if it is performed on a pre-acromion.
However, excision of a larger fragment will cause instability
and often persistent postoperative deltoid dysfunction
(Atoun et al., 2012; Boehm et al., 2003; Ortiguera and
Buss, 2002; Pagnani et al., 2006; Peckett et al., 2004;
Sahajpal et al., 2007; Spiegl et al., 2015)
.
The next option is an arthroscopic sub-acromial
decompression. With this technique, the surgeon removes some
bone from the anterior site of the acromion to create
space for the underlying supraspinatus. This is a
commonly used technique to treat impingement syndromes if
the os acromiale is stable
(Harris et al., 2011)
. However,
this procedure has one major disadvantage: it is a salvage
operation that does not treat the underlying cause of the
condition, so relapses are very common
(Ortiguera and
Buss, 2002; Sahajpal et al., 2007)
.
The last option is an ORIF. The purpose of this
technique is to set the fracture, reduce the inferior (...truncated)