Use of Three-dimensional Printing for Tibial Pilon Fracture Diagnosis and Treatment

Abstract

Objective To evaluate whether three-dimensional (3D) printing increases agreement in the classification of tibial pilon fractures.

Methods Orthopedists and traumatologists reviewed radiographs, computed tomography scans with 3D reconstruction, and prototyping 3D printing, and classified the fractures based on the Rüedi-Allgöwer and Arbeitsgemeinschaft für Osteosynthesefragen (AO, Association for the Study of Internal Fixation) Foundation/Orthopedic Trauma Association (AO/OTA) classification systems. Next, data evaluation used Kappa agreement coefficients.

Results The use of the 3D model did not improve agreement for tibial pilon fractures regarding the treatment proposed by the groups. Regarding the classification systems, the agreement only improved concerning the AO/OTA classification when the 3D model was used in the assessment by the foot and ankle specialists.

Conclusion Although 3D printing is statistically relevant for surgeons specializing in foot and ankle, its values remain lower than optimal.

Keywords

fractures, bone - printing, three-dimensional - tibial fractures

Work developed at the Hospital da Santa Casa de Curitiba, Curitiba, Paraná, Brazil.

Publication History

Received: 08 August 2023

Accepted: 06 November 2023

Article published online:
22 June 2024

• Referências

• 1 Yaradilmis YU, Okkaoglu MC, Kılıç A, Haberal B, Demirkale İ, Altay M. The mid-term effects on quality of life and foot functions following pilon fracture. Ulus Travma Acil Cerrahi Derg 2020; 26 (05) 798-804
• 2 Rushdi I, Che-Ahmad A, Abdul-Ghani K, Mohd-Rus R. Surgical management of distal tibia fracture: Towards an outcome-based treatment algorithm. Malays Orthop J 2020; 14 (03) 57-65
• 3 Biçici V, Bingöl İ. Do different surgical techniques in tibia pilon fractures change the results of the midterm?. Turk J Med Sci 2020; 50 (06) 1559-1565
• 4 Silluzio N, De Santis V, Marzetti E, Piccioli A, Rosa MA, Maccauro G. Clinical and radiographic outcomes in patients operated for complex open tibial pilon fractures. Injury 2019; 50 (Suppl. 02) S24-S28
• 5 Lai TC, Fleming JJ. Minimally invasive plate osteosynthesis for distal tibia fractures. Clin Podiatr Med Surg 2018; 35 (02) 223-232
• 6 Bastias C, Lagos L. New principles in pilon fracture management: revisiting rüedi and allgöwer concepts. Foot Ankle Clin 2020; 25 (04) 505-521
• 7 Bear J, Rollick N, Helfet D. Evolution in Management of Tibial Pilon Fractures. Curr Rev Musculoskelet Med 2018; 11 (04) 537-545
• 8 Qiu XS, Li XG, Qi XY, Wang Z, Chen YX. What Is the Most Reliable Classification System to Assess Tibial Pilon Fractures?. J Foot Ankle Surg 2020; 59 (01) 48-52
• 9 Tomás-Hernández J. High-energy pilon fractures management: State of the art. EFORT Open Rev 2017; 1 (10) 354-361
• 10 Saad BN, Yingling JM, Liporace FA, Yoon RS. Pilon Fractures: Challenges and Solutions. Orthop Res Rev 2019; 11: 149-157
• 11 Carter TH, Duckworth AD, Oliver WM, Molyneux SG, Amin AK, White TO. Open reduction and internal fixation of distal tibial pilon fractures. JBJS Essential Surg Tech 2019; 9 (03) e29
• 12 Malik-Tabassum K, Pillai K, Hussain Y. et al. Post-operative outcomes of open reduction and internal fixation versus circular external fixation in treatment of tibial plafond fractures: A systematic review and meta-analysis. Injury 2020; 51 (07) 1448-1456
• 13 Hebert-Davies J, Kleweno CP, Nork SE. contemporary strategies in pilon fixation. J Orthop Trauma 2020; 34 (Suppl. 01) S14-S20
• 14 Chen H, Cui X, Ma B, Rui Y, Li H. Staged procedure protocol based on the four-column concept in the treatment of AO/OTA type 43-C3.3 pilon fractures. J Int Med Res 2019; 47 (05) 2045-2055
• 15 Lee KB, Jeong SY, Kim SH, Shim DG. Complete reduction for pilon fracture can make complete failure. J Am Podiatr Med Assoc 2018; 108 (03) 257-261
• 16 Zheng W, Chen C, Zhang C, Tao Z, Cai L. The feasibility of 3D printing technology on the treatment of pilon fracture and its effect on doctor-patient communication. BioMed Res Int 2018; 2018: 8054698
• 17 Swiontkowski MF, Sands AK, Agel J, Diab M, Schwappach JR, Kreder HJ. Interobserver variation in the AO/OTA fracture classification system for pilon fractures: is there a problem?. J Orthop Trauma 1997; 11 (07) 467-470
• 18 Bernstein J, Adler LM, Blank JE, Dalsey RM, Williams GR, Iannotti JP. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg Am 1996; 78 (09) 1371-1375
• 19 Byun SE, Choi W, Choi Y. et al. Impact of two- and three-dimensional computed tomography use on intraobserver and interobserver reliabilities of pilon fracture classification and treatment recommendation. Orthop Traumatol Surg Res 2019; 105 (07) 1407-1412
• 20 Martin JS, Marsh JL, Bonar SK, DeCoster TA, Found EM, Brandser EA. Assessment of the AO/ASIF fracture classification for the distal tibia. J Orthop Trauma 1997; 11 (07) 477-483
• 21 Dirschl DR, Adams GL. A critical assessment of factors influencing reliability in the classification of fractures, using fractures of the tibial plafond as a model. J Orthop Trauma 1997; 11 (07) 471-476
• 22 Ramappa M, Bajwa A, Singh A, Mackenney P, Hui A, Port A. Interobserver and intraobserver variations in tibial pilon fracture classification systems. Foot 2010; 20 (2-3): 61-63
• 23 Keiler A, Riechelmann F, Thöni M, Brunner A, Ulmar B. Three-dimensional computed tomography reconstruction improves the reliability of tibial pilon fracture classification and preoperative surgical planning. Arch Orthop Trauma Surg 2020; 140 (02) 187-195