Are Three-Dimensional Printed Models Useful for Preoperative Planning of Tibial Plafond Fractures?

Abstract

Computed tomography (CT) scans with 3-dimensional (3D) reconstruction are the gold standard of imaging for complex fractures. However, visualising CT imaging can be challenging. With increasing access to 3D printing, we postulate that life-sized 3D models can better assist in visualising CT images, aiding preoperative planning of tibial plafond fractures. 3D models of 3 tibial plafond fractures of differing complexities were printed. We approached surgeons in our institution who manage tibial plafond fractures to complete a questionnaire on preoperative planning of the cases based on CT scans. We then examined whether analysing the 3D models after that changed the plan. This included ratings on the usefulness, accuracy, and ease of use of the models. Six surgeons participated in the study. In the simple fracture model, median usefulness was graded as 4.5 (range minimum to maximum: 0 to 7), accuracy 8 (4 to 10), and ease of use 9 (7 to 10) with 0 being the lowest and 10 being the upper limit of how useful, accurate, or easy to use the models were. For the intermediate fracture, median usefulness was 6.5 (2 to 8), accuracy 7.5 (3 to 10), and ease of use 8.5 (7 to 10). For the complex fracture, median usefulness was 6 (1 to 9), accuracy 7.5 (1 to 9), and ease of use 8.5 (0 to 9). We attribute these poorer scores to difficulty in processing the scans, resulting in less accurate printing of the many fragments in complex impacted fractures. In conclusion, 3D-printed models are easy to use and accurate in preoperative planning of tibial plafond fractures. Most surgeons believe that 3D models and CT scans combined were more useful than CT scans alone.