A Review on 3D-Printed Templates for Precontouring Fixation Plates in Orthopedic Surgery
Abstract
:1. Introduction
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- RQ1: What is the reported use of 3D-printed models for precontouring plates in orthopedic surgery? → Obj1. Presents a state of the art reference document through performing a systematic review.
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- RQ2: What are the approaches in developing and using 3D-printed models for precontouring plates? → Obj2. Identify the typical workflows currently used in this field.
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- RQ3: What are the reported advantages and challenges? → Obj3. Discuss the review results, reported benefits and shortcomings, and preferred anatomical zones for this type of application.
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection
2.3. Data Extraction
2.4. Data Analysis
3. Results
3.1. Studies Design
3.2. Studies Quality
3.3. Anatomical Locations of Reported Cases
3.4. Data on Reported Advantages
3.5. 3D Printing Based Approaches
3.6. Reviewed Studies Timeline
4. Discussions
4.1. 3DP Templating for Acetabular Zone
4.2. 3DP Templating for Clavicle Zone
4.3. 3DP Templating for Calcaneus Fractures
4.4. 3DP Templating for Chest Zone
4.5. 3DP Templating for Humeral Zone
4.6. 3DP Templating for Scaphoid Zone
4.7. 3D Printing Process Related Aspects: Manufacturing Time and Costs, Advantages and Disadvantages
5. Conclusions and Future Perspectives
Author Contributions
Funding
Conflicts of Interest
References
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Reference | Type of Intervention | No. of Patients Treated Using 3D Prints | Design Study, Level of Evidence | Approach | Software for 3D Model | 3D Printing (Printer, Material, Time, Cost) |
---|---|---|---|---|---|---|
Bagaria et al. [13] Year: 2011 Country: India, China | Acetabular fracture, femoral condyle fracture, calcaneal fracture | 4 | Case series LOE-IV | 3DP model of fractured acetabulum (with indelible ink marked zones of fracture) used as template for precontouring the plate | Mimics (Materialise, Leuven, Belgium) | FDM process, ABS 19 euros |
Battiato et al. [14] Year: 2017 Country: Italy | Both acetabular fractures | 1 | Case report LOE-V | 3DP of entire pelvis used for fractures reduction and then for precontouring the plates | Mimics (Materialise, Leuven, Belgium) | SLS process, Polyamide PA2200, 46 h the entire development process |
Belien et al. [15] Year: 2017 Country: Belgium | Os acromiale, acromial fracture | 5 | Case series LOE-IV | 3DP model of fractured bone after fracture reduction used as template for precontouring the plate | in Vesalius (CTI, SP, Brazil), Rhinoceros 5 (Robert McNeel & Associates, Seattle, USA), Meshmixer (Autodesk, San Rafael, USA), Netfabb Pro (Autodesk, San Rafael, USA) | Makerbot Replicator 2, FDM process |
Brown et al. [16] Year: 2002 Country: USA | Acetabular fracture | 8 | Case series LOE-IV | 3DP model of the mirrored model of uninjured acetabulum for precontouring the plate | Mimics (Materialise, Leuven, Belgium) | Actua 2100, SLA, Wax, then mould methyl methacrylate |
Chana-Rodriquez et al. [17] Year: 2016 Country: Spain | Acetabular fracture | 1 | Case report LOE-V | 3DP model of the mirrored model of uninjured acetabulum used as template for precontouring the plate | OsiriX (Pixmeo, Geneva, Switzerland), Meshlab V1.3.3 (Visual Computing Lab, Pisa, Italy), Meshmixer 2.4 (Autodesk, San Rafael, USA | Da Vinci 3D printer, FDM process, ABS, 11 h, 12 euros |
Chana- Rodriquez et al. [18] Year: 2018 Country: Spain | Acetabular fractures | 20 | Prospective case series LOE-IV | 3DP model of the mirrored model of uninjured acetabulum used as template for precontouring the plate | OsiriX (Pixmeo, Geneva, Switzerland), Meshmixer (Autodesk, San Rafael, USA) Mean of 10.7 min for medical modeling | Da Vinci 3D printer, FDM process, ABS Mean of 385 min for 3D prints manufacturing 12 euros |
Chen YY et al. [19] Year: 2018 Country: China | Rib fractures | 16 | Retrospective review 48 patients LOE-IV | 3DP model of fractured ribs/rib (with indelible ink marked zones of fractures) used as template for precontouring the plate | - | UP-BOX 3D Printer, FDM process, ABS 5–6 h for 3DP printing |
Chen K et al. [20] Year 2019 Country: China | Bicolumnar acetabular fracture | 28 | Retrospective analysis, 52 patients, LOE-III | Virtual fracture reduction + 3DP reduced fracture model for precontouring the plate | Mimics 16.0 (Materialise, Leuven, Belgium) | PLA, 36 h total time (including sterilization, bending), 65 euro |
Chung et al. [21] Year: 2014 Country: S. Korea | Calcaneal fracture | 1 | Case report LOE-V | 3DP model of contralateral uninjured calcaneus used as template for precontouring the plate | Mimics (Materialise, Leuven, Belgium), 30 min modeling | Probably FDM process 3 h printing |
Hao et al. [22] Year: 2019 Country: China | Midshaft clavicle fracture | 1 | Case report LOE-V | 3DP model of contralateral uninjured clavicle used as template for precontouring plate | Mimics 17.0 (Materialise, Leuven, Belgium) | DLP process |
Hsu et al. [23] Year: 2019 Country: China | Acetabular fracture | 12 | Retrospective study with control group LOE-III Total of 29 patients | Virtual reduction of fracture + 3DP model of reduced fracture used as template for precontouring plate | Mimics 19.0 (Materialise, Leuven, Belgium) | Up Box+, FDM process |
Hung et al. [24] Year: 2019 Country: China | Pelvic ring fractures | 16 | Retrospective study, non-randomized with control group LOE-III Total of 30 patients | Virtual reduction of fracture + 3DP model of reduced fracture used as template for precontouring the plate | Mimics 19.0 (Materialise, Leuven, Belgium) Up to 90 min virtual reduction for complex cases | UP BOX+ 3D printer, FDM process Less than 24 h the entire process, 20 euros |
Jeong et al. [25] Year: 2014 Country: S. Korea | Clavicle shaft fracture | 1 | Case report LOE-V | 3DP of contralateral clavicle used as template for precontouring the plate | - | $20, 3 h for 3DP, 3 h for plate bending and sterilization |
Kataoka et al. [26] Year: 2013 Country: Japan | 4 cubitus varus, 1 cubitus valgus, 4 diaphyseal malunions of the forearm | 9 | Series of cases, LOE-Therapeutic IV | Virtual planning and simulation using contralateral normal bone as template + 3DP of repositioned bone models as template for precontouring the plate | Bone Simulator (Orthree, Osaka, Japan) | Eden 250, Objet, Medical grade resin |
Kim et al. [27] Year: 2015 Country: S. Korea, China | Midshaft clavicle fracture | 7 | Series of cases (technical note) LOE-IV | 3DP model of contralateral uninjured clavicle used as template for precontouring the plate | Mimics (Materialise, Leuven, Belgium) | Project x60 series, $100, 2–3 days the whole process CT to solid model |
Li L et al. [28] Year: 2017 Country: China | Pelvic fracture | 28 | Retrospective review (long-term follow up study with control group), Total of 64 patients LOE-III | 3DP model of pelvis used for simulating operation and then for precontouring the plates | Mimics 14.0 (Materialise, Leuven, Belgium) | Yinhua Rapid Prototyping 3D printer, probably FDM process |
Li YT et al. [29] Year: 2019 Country: China | Hip dislocation combined with acetabular fracture | 7 | Retrospective review control group Total of 16 patients LOE-III | Virtual reduction by mirroring contralateral, uninjured side + 3DP model of reduced model used as template for precontouring the plate | Mimics 19.0 (Materialise, Leuven, Belgium), 11 min for modeling | Up Box+ 3D printer, FDM process, 10 h for 3D printing |
Maini et al. [30] Year: 2018 Country: India | Acetabular fracture | 10 | Prospective randomized case control study Total of 21 patients LOE-II | 3DP model of fractured acetabulum followed by its reduction and its use as template for precontouring the plate | Mimics 8.13 (Materialise, Leuven, Belgium) | Eosint P380, SLS, nylon polyamide, $15–20 |
Maini et al. [31] Year: 2018 Country: India | Acetabular fracture | 12 | Randomized case control study 25 patients LOE-II | Virtual planning and simulation for reducing fracture followed by virtual modeling the plate (virtual plating) + 3D-printed plate model as template for precontouring the metal plate | Mimics and 3-Matic (Materialise, Leuven, Belgium), Average time: 4.3 h | FDM, PLA, $4 |
Nie et al. [32] Year: 2018 Country: China | Pubic rami fractures | 30 | Consecutive case series LOE-IV | Virtual planning and reduction of fracture + 3DP model of reduced fracture used as template for precontouring plate | Mimics 10.01 (Materialise, Leuven, Belgium) | FDM process, ABS material probably |
Shon et al. [33] Year: 2018 Country: S. Korea | Both-column acetabular fractures | 5 | Series of cases LOE-IV | 3DP model of fractured acetabulum (with indelible ink marked fracture line) followed by reduction and fixation with glue, thus reduced model being used as template for precontouring the plate | - | Edison 3D printer, FDM process, PLA, 3 h total development time for the 3D print, $30 |
Smith et al. [34] Year: 2018 Country: USA | Rib fractures | 1 | Case report LOE-V | Virtual reduction using mirroring of contralateral uninjured side + 3DP model with reduced fractured and marked fracture lines used as template for precontouring plates | D2P (3D Systems, Rock Hill, USA), Geomagic Freeform Plus (3D Systems, Rock Hill, USA) | ProX 800 3D printer, SLA, ClearView polycarbonate-like resin |
ten Berg et al. [35] Year: 2017 Country: The Netherlands | Nonunion of scaphoid fracture | 8 | Series of cases (short report letter) LOE-V | 3DP model of uninjured contralateral bone for plate bending | Custom software (C++(Visual Studio 2005, Microsoft, Redmond, USA), Visualization ToolKit (VTK 5.0.4, Kitware, Inc., NY, USA), Insightt ToolKit (ITK 3.6.0, Kitware, Inc., NY, USA) | Blue printer M2, Selective Heat Sintering, Thermoplastic powder |
Upex et al. [36] Year: 2017 Country: France | Acetabular fracture | 1 | Case report (technical note) LOE-V | 3DP model of the healthy hemipelvis used as template for precontouring plate | OsiriX (Pixmeo, Geneva, Switzerland), Meshmixer (Autodesk, San Rafael, USA) | Ultimaker, FDM process, PLA, 6 euros |
Van Doremalen et al. [37] Year: 2016 Country: The Netherlands | Midshaft clavicle fracture | 1 | Case report LOE-V | 3DP model of contralateral intact clavicle for plate bending | Matlab(MathWorks, Natick, USA), Meshlab (Visual Computing Lab, Pisa, Italy | BQ Witbox, FDM process, PLA, 4 h total time for the whole process (modeling, 3DP, bending) |
Wang et al. [38] Year: 2018 Country: China | Humeral shaft fracture | 21 | Retrospective review, 46 patients, comparison 3DP model with Synbone model LOE-IV | 3DP model of intact bone used as template for precontouring the plate | Mimics 16.0 (Materialise, Leuven, Belgium) 3 h modeling time | Lite, RS6000, DLP process, ultraviolet curable resin |
Yao et al. [39] Year: 2019 Country: China, Australia | Calcaneal fractures | 25 | Case series LOE-IV | 3DP model of uninjured calcaneus used as template for precontouring plate | Mimics 15.0 (Materialise, Leuven, Belgium) | Makerbot Replicator 3D printer |
Yu et al. [40] Year: 2015 Country: UK | Both column acetabulum fractures | 2 | Cases report LOE-V | 3DP model of contralateral uninjured side used as template for precontouring the plate | - | Objet Eden 250 3D printer, SLS process, MED610 polymer |
Zeng et al. [41] Year: 2016 Country: China | Acetabular fracture | 10 | Series of cases LOE-IV | Virtual fracture reduction + 3DP reduced fracture model for precontouring the plate | Mimics 14.0 (Materialise, Leuven, Belgium) | Makerbot Replicator 2, FDM process |
Zhuang et al. [42] Year: 2016 Country: China | Acetabular fractures (7 fractures anterior column, 4 anterior column with posterior hemitransverse, 1 anterior column with the pubic symphysis) | 12 | Case series LOE-IV | 3D printed model on uninjured hemipelvis with marked fracture lines used as template for precontouring the plate | - | Mira ProJet 3510 3D printer, MJ process, ultraviolet curable resin |
Studies Design | Case Reports | Series of Cases | Non-Randomized Clinical Studies | Randomized-Clinical Studies |
---|---|---|---|---|
Representing % from the total No. of papers | 36.67% | 33.33% | 23.33% | 6.67% |
No. of patients in 3DP group | 10 | 143 | 128 | 22 |
No. of patients in control group | - | - | 233 | 24 |
Anatomical Location | Total No. of Patients Using 3D Prints | Total No. of Studies Per Anatomical Location | Total No. of Patients in Studies |
---|---|---|---|
Acetabulum | 206 | 18 (60%) | 415 (206 3DP + 209 control) |
Clavicle | 15 | 5 (17%) | 15 |
Rib | 17 | 2 (6.8%) | 65 (17 3DP + 48 control) |
Humerus | 21 | 1 | 21 |
Cubitus | 9 | 1 | 9 |
Scaphoid | 8 | 1 | 8 |
Calcaneus | 27 | 2 | 27 |
Study | Mean Blood Loss (mL) | Mean Surgical Time (min)/Instrumentation Time (Min) | Quality of Reduction | ||
---|---|---|---|---|---|
3DP Group | Conventional Group | 3DP Group | Conventional Group | ||
Chen YY et al. [19] | - | - | 125 ± 33.44 | 175.24 ± 60.58 | - |
Chen K et al. [20] | 696.0 7 ± 66.54 | 833.75 ± 227.44 | 157.5 ± 20.48 | 187.08 ± 35.81 | Similar |
Hsu et al. [23] | 433.33 ± 317.28 | 958.33 ± 427.10 | 199.00 ± 50.29 | 274.17 ± 80.95 | Similar |
Hung et al. [24] | 275.00 ± 196.64 | 549.29 ± 404.43 | 206.13 ± 70.32/ 45.63 ± 15.26 | 276.21 ± 89.53/ 102.86 ± 25.85 | Similar |
Li L et al. [28] | 481.4 ± 103.2 | 771.1 ± 114.4 | 128.9 ± 59.2 | 191.4 ± 85.1 | Better in 3DP group (Matta score) |
Li YT et al. [29] | 735.71 ± 614.22 | 742.22 ± 228.68 | 211.71 ± 52.23/ 38.43 ± 10.81 | 254.44 ± 34.46/ 71.78 ± 9.69 | Similar |
Maini et al. [30] | 620 ± 246.9 | 720 ± 286.2 | 120 ± 37.7 | 132 ± 41.0 | Better in 3DP group (Matta score) |
Maini et al. [31] | 467 | 525 | 111 | 119 | Better in 3DP group |
Wang et al. [38] | 105.19 ± 14.67 | 120.80 ± 10.61 | 42.62 ± 7.61 | 60.36 ± 10.20 | Similar |
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Marinescu, R.; Popescu, D.; Laptoiu, D. A Review on 3D-Printed Templates for Precontouring Fixation Plates in Orthopedic Surgery. J. Clin. Med. 2020, 9, 2908. https://doi.org/10.3390/jcm9092908
Marinescu R, Popescu D, Laptoiu D. A Review on 3D-Printed Templates for Precontouring Fixation Plates in Orthopedic Surgery. Journal of Clinical Medicine. 2020; 9(9):2908. https://doi.org/10.3390/jcm9092908
Chicago/Turabian StyleMarinescu, Rodica, Diana Popescu, and Dan Laptoiu. 2020. "A Review on 3D-Printed Templates for Precontouring Fixation Plates in Orthopedic Surgery" Journal of Clinical Medicine 9, no. 9: 2908. https://doi.org/10.3390/jcm9092908