3D Printed Models of Periarticular Fractures of the Shoulder and Elbow Improve Surgical Decision Making in Orthopedic Trainees.

Abstract

Periarticular fractures of the shoulder and elbow are spatially complex injuries that may be challenging to interpret on radiographs and advanced imaging. As three-dimensional (3D) printing technology has become less expensive and more available, 3D printed fracture models have gained attention for use in surgical preparation. In this study, we evaluated the effects of 3D printed fracture models on orthopedic trainee surgical planning and injury understanding for injuries of the shoulder and elbow. Models of periarticular fractures of the shoulder and elbow were manufactured by 3D printing at the medical school design lab. Eleven Orthopedic trainees viewed X-rays and computed tomography (CT) scans for each injury, and completed a preoperative questionnaires. They were then given access to the 3D model of each injury, in addition to the previously viewed imaging. They again completed a preoperative plan and questionnaire. Preoperative plans were graded for feasibility by a preestablished template. Results were compared for each participant with and without the 3D models. Within all trainees and fractures, trainees were more likely to have feasible preoperative plans when given a 3D model, compared to access to x-rays and CT scans alone (74% vs. 62%). In all cases where preoperative plans were changed after handling the 3D models (46/77 changed, 60%), they stayed static or improved in feasibility. Participants reported significantly improved understanding of injury anatomy (P<0.0001), increased confidence in choosing operative positioning and surgical approaches (P<0.0001), desired implants (P=0.011), and better conceptualization of how to perform fracture reduction (P=0.0038). Orthopedic trainees benefit from 3D printed fracture models when performing preoperative planning of complex periarticular shoulder and elbow injuries. Given the rarity and difficulty of these injuries, use of this technology could allow for shortened learning curves and improved surgical results in the field of orthopedic fracture care.