Three-dimensional printing of patient-specific plates for the treatment of acetabular fractures involving quadrilateral plate disruption

Wang et al. BMC Musculoskeletal Disorders https://doi.org/10.1186/s12891-020-03370-7 (2020) 21:451 RESEARCH ARTICLE Open Access Three-dimensional printing of patientspecific plates for the treatment of acetabular fractures involving quadrilateral plate disruption Canbin Wang1,2†, Yuhui Chen1†, Liping Wang3,4, Di Wang5, Cheng Gu1, Xuezhi Lin1, Han Liu1, Jiahui Chen1, Xiangyuan Wen1, Yuancheng Liu1, Fuming Huang1, Lufeng Yao3, Shicai Fan1*, Wenhua Huang1,6* and Jianghui Dong3,4* Abstract Background: Complicated acetabular fractures comprise the most challenging field for orthopedists. The purpose of this study was to develop three-dimensional printed patient-specific (3DPPS) Ti-6Al-4 V plates to treat complicated acetabular fractures involving quadrilateral plate (QLP) disruption and to evaluate their efficacy. Methods: Fifty patients with acetabular fractures involving QLP disruption were selected between January 2016 and June 2017. Patients were divided into a control group (Group A, 35 patients) and an experimental group (Group B, 15 patients), and were treated by the conventional method of shaping reconstruction plates or with 3DPPS Ti-6AL-4 V plates, respectively. The efficacy of Ti-6AL-4 V plates was evaluated by blood loss, operative time, reduction quality, postoperative residual displacement, and complications. Results: The operative time and blood loss in Group B were reduced compared to Group A, and the difference was statistically significant (P < 0.05). There was no significant difference in reduction quality between the two groups (P > 0.05). Reduction quality in Group B was anatomic in 10 (66.7%), satisfactory in four (26.7%), and poor in one (6.7%). In Group A, they were anatomic in 18 (51.4%), satisfactory in 13 (37.1%), and poor in four (11.4%). Residual displacement in Group B was less than that in Group A, and the difference was statistically significant (P < 0.05). In Group B, one case exhibited loosening of the pubic screw postoperatively. In Group A, there was one case of wound infection, one of deep vein thrombosis (DVT) in the ipsilateral lower limb, one case of traumatic arthritis and two obturator nerve injuries. (Continued on next page) * Correspondence: ; ; † Canbin Wang and Yuhui Chen contributed equally to this work. 1 The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Dadao West Street, Guangzhou 510600, Guangdong, China 3 Department of Hand Surgery, and Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo 315040, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Wang et al. BMC Musculoskeletal Disorders (2020) 21:451 Page 2 of 9 (Continued from previous page) Conclusions: The 3DPPS Ti-6AL-4 V plate is a feasible, accurate and effective implant for acetabular fracture treatment. Keywords: Acetabular fractures, Virtual surgical planning, Patient-specific implants, 3D printing patient-specific plates, Quadrilateral plate disruption Background Acetabular fracture is the most challenging injury for an orthopedist due to the complicated anatomy, complex fracture pattern and limited surgical access [1]. The goals of surgical treatment for acetabular fractures are anatomic reduction and rigid internal fixation to obtain a long-term functioning hip joint [2, 3]. For complicated acetabular fractures, disruption of the quadrilateral plate (QLP) is considered as the vital issue in surgical reduction and QLP disruption must be reduced and fixed to achieve adequate stability. Most complex acetabular fractures are caused by highenergy injuries, which are always associated with complex fracture patterns and displacement of the QLP and the femoral head [4, 5]. The only standard treatment for complex acetabular fractures is open reduction and internal fixation (ORIF). However, the complicated anatomy, complex fracture pattern and limited surgical access result in a high level of difficulty [5]. In addition, the secure positions of screw insertions are hard to verify intra-operatively [6–8]. Consequently, achieving stable and secure fixation with a simpler surgical procedure is a key issue in acetabular fracture treatment. Recently, life-size three-dimensional (3D)-printed models have been used for surgical simulation and the pre-operative selection of internal fixation methods. The outcomes of acetabular fracture were improved when using the pre-operative 3D-printed models [9–12]. Based on these results, the current study aimed to design 3D-printed patient-specific (3DPPS) plates which could be completely adapted to the acetabular fracture sites. These 3DPPS plates were used to treat complicated acetabular fractures (involving QLP disruption) to evaluate their efficacy. Methods Patients This study was implemented with the approval of the Ethics Committee of The Third Affiliated Hospital of Southern Medical University (approval No. 201704006). It was performed in strict accordance with the recommendations in the Guide for the Care and Use of Humans of the National Institutes of Health. The 3DPPS plates in this study have already been approved and certificated by the CFDA (Class III medical device, NO. 20163460576). Between January 2016 and June 2017, 50 patients in The Third Affiliated Hospital of Southern Medical University Clinical Center with acetabular fractures were included retrospectively according to our inclusion and exclusion criteria. All patients were treated with ORIF at our trauma center. Preoperatively, all patients were informed that they could choose 3DPPS plates or reconstruction plates for internal fixation. They were then divided into a control group and an experimental group based on their choice. The control group (Group A) comprised 35 patients treated by the conventional method of intraoperative contouring of reconstruction plates. The experimental group (Group B) consisted of 15 (...truncated)