scholarly journals Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients

2021 ◽  
Author(s):  
Nick Assink ◽  
Inge H. F. Reininga ◽  
Kaj ten Duis ◽  
Job N. Doornberg ◽  
Harm Hoekstra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
3D Imaging ◽  
Tibial Plateau ◽  
Operation Time ◽  
Tibial Plateau Fractures ◽  
Conventional Surgery ◽  
Surgical Guides ◽  
Fracture Models ◽  
3D Printed

Abstract Purpose The aim of this systematic review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess whether 3D-assisted surgery results in improved clinical outcome as compared to surgery based on conventional imaging modalities. Methods A literature search was performed in Pubmed and Embase for articles reporting on the use of 3D techniques in operative management of tibial plateau fractures. This systematic review was performed in concordance with the PRISMA-guidelines. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Differences in terms of operation time, blood loss, fluoroscopy frequency, intra-operative revision rates and patient-reported outcomes between 3D-assisted and conventional surgery were assessed. Data were pooled using the inverse variance weighting method in RevMan. Results Twenty articles evaluating 948 patients treated with 3D-assisted surgery and 126 patients with conventional surgery were included. Five different concepts of 3D-assisted surgery were identified: ‘3D virtual visualization’, ‘3D printed hand-held fracture models’, ‘Pre-contouring of osteosynthesis plates’, ‘3D printed surgical guides’, and ‘Intra-operative 3D imaging’. 3D-assisted surgery resulted in reduced operation time (104.7 vs. 126.4 min; P < 0.01), less blood loss (241 ml vs. 306 ml; P < 0.01), decreased frequency of fluoroscopy (5.8 vs. 9.1 times; P < 0.01). No differences in functional outcome was found (Hospital for Special Surgery Knee-Rating Scale: 88.6 vs. 82.8; P = 0.23). Conclusions Five concepts of 3D-assisted surgical management of tibial plateau fractures emerged over the last decade. These include 3D virtual fracture visualization, 3D-printed hand-held fracture models for surgical planning, 3D-printed models for pre-contouring of osteosynthesis plates, 3D-printed surgical guides, and intra-operative 3D imaging. 3D-assisted surgery may have a positive effect on operation time, blood loss, and fluoroscopy frequency.

scholarly journals Treatment of choice for bicondylar tibial plateau fractures between open reduction with internal fixation versus hybrid circular external fixator: a systematic review

2020 ◽  
Vol 9 (1) ◽  
pp. 262
Author(s):  
I. Made Arya Susila ◽  
Sherly Desnita Savio ◽  
Cokorda Gde Oka Dharmayuda
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Tibial Plateau ◽  
Operation Time ◽  
Tibial Plateau Fractures ◽  
Similar Operation ◽  
Bicondylar Tibial Plateau

The high complication rate is closely related to the incidence of bicondylar tibial plateau fractures (BTPF) due to the involvement of the articular surface. The aim of this study is to compare open reduction with internal fixation (ORIF) and hybrid circular external fixation (HCEF) as the choice of surgical procedure for BTPF because these two procedures is still controversial until now. A systematic review using Cochrane library, PubMed, and Google Scholar was conducted based on PRISMA guideline. Inclusion criteria were studies comparing HCEF and ORIF of BTPF. Studies of only one surgical technique modality, schatzker types I-IV tibial plateau fractures, and case reports were excluded, resulting in six included studies. There is no significant difference in radiographs, functional and anatomical outcomes in both group (ORIF vs HCEF). Complications that measured are higher infection rate found in the ORIF group. Blood loss was higher in the ORIF group, while both procedures have similar operation time and functional outcome. The mean of hospital length of stay (LoS) seems to be higher 6.83 days (95%CI 0.96-12.70; P<0.00001) on ORIF group from the random effect of forest plot evaluation. According to this study, HCEF is more beneficial in terms of blood loss and hospital LoS. But overall ORIF and HCEF carry similar operation time, functional outcome, union rate, and complication.

scholarly journals Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
pp. 219256822110164
Author(s):  
Elsayed Said ◽  
Mohamed E. Abdel-Wanis ◽  
Mohamed Ameen ◽  
Ali A. Sayed ◽  
Khaled H. Mosallam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Interbody Fusion ◽  
Revision Rate ◽  
Meta Analysis ◽  
Posterior Lumbar Interbody Fusion ◽  
Operation Time ◽  
Controlled Trials ◽  
Lumbar Interbody Fusion ◽  
Randomized Controlled

Study Design: Systematic review and meta-analysis. Objectives: Arthrodesis has been a valid treatment option for spinal diseases, including spondylolisthesis and lumbar spinal stenosis. Posterolateral and posterior lumbar interbody fusion are amongst the most used fusion techniques. Previous reports comparing both methods have been contradictory. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to establish substantial evidence on which fusion method would achieve better outcomes. Methods: Major databases including PubMed, Embase, Web of Science and CENTRAL were searched to identify studies comparing outcomes of interest between posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF). We extracted data on clinical outcome, complication rate, revision rate, fusion rate, operation time, and blood loss. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome and the odds ratio with 95% confidence intervals (CIs) for binary outcomes. P < 0.05 was considered significant. Results: We retrieved 8 studies meeting our inclusion criteria, with a total of 616 patients (308 PLF, 308 PLIF). The results of our analysis revealed that patients who underwent PLIF had significantly higher fusion rates. No statistically significant difference was identified in terms of clinical outcomes, complication rates, revision rates, operation time or blood loss. Conclusions: This systematic review and meta-analysis provide a comparison between PLF and PLIF based on RCTs. Although PLIF had higher fusion rates, both fusion methods achieve similar clinical outcomes with equal complication rate, revision rate, operation time and blood loss at 1-year minimum follow-up.

scholarly journals Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Nils Beisemann ◽  
Holger Keil ◽  
Benedict Swartman ◽  
Marc Schnetzke ◽  
Jochen Franke ◽  
...  
Keyword(s):  
3D Imaging ◽  
Tibial Plateau ◽  
Revision Rate ◽  
Tibial Plateau Fractures ◽  
Intraoperative 3D Imaging

scholarly journals The Application of 3D Printing Technology in the Classification and Preoperative Planning of Complex Tibial Plateau Fractures

2020 ◽  
Author(s):  
Fuyang Chen ◽  
Chenyu Huang ◽  
Chen Ling ◽  
Jinming Zhou ◽  
Yufeng Wang ◽  
...  
Keyword(s):  
3D Printing ◽  
Tibial Plateau ◽  
3D Model ◽  
Preoperative Planning ◽  
Tibial Plateau Fracture ◽  
Tibial Plateau Fractures ◽  
Printing Technology ◽  
3D Printing Technology ◽  
Plateau Fracture ◽  
3D Printed

Abstract Background: Tibial plateau fracture is one of the common intra-articular fractures in clinic. And its accurate classification and treatment is a difficult problem for orthopedic surgeons. Our research aims to investigate the application value of 3D printing in the classification and preoperative planning of complex tibial plateau fractures.Methods: 28 cases of complex tibial plateau fractures diagnosed and treated in our hospital from January, 2017 to January, 2019.01 were analyzed. Preoperative spiral CT scan was performed and then DICOM data were input into the computer. We use Mimics to process data. And 3D printing technology was applied to print the 3D model of fracture (1:1). Combined with the 3D printed model, the tibial plateau fractures were subdivided into seven types according to the geometric plane of the tibial plateau. The surgical approach was determined on the 3D printed model. And then simulated operations such as accurate reduction of fracture and selection of plate placement were performed.Results: The reconstructed 3D model of tibial plateau fracture can accurately reflect the direction of fracture displacement and the degree of plateau collapse. Also, it and can help with the preoperative surgical design of tibial plateau fracture. The intraoperative fracture details were basically the same as the 3D printed model. And the fracture surface of the tibial plateau was well improved in all 28 cases.Conclusion: 3D printing technology can be used to guide the classification and preoperative planning of complex tibial plateau fractures.

scholarly journals Does 3D-Assisted Acetabular Fracture Surgery Improve Surgical Outcome and Physical Functioning?—A Systematic Review

2021 ◽  
Vol 11 (10) ◽  
pp. 966
Author(s):  
Anne M. L. Meesters ◽  
Neeltje M. Trouwborst ◽  
Jean-Paul P. M. de Vries ◽  
Joep Kraeima ◽  
Max J. H. Witjes ◽  
...  
Keyword(s):  
Blood Loss ◽  
Physical Functioning ◽  
Acetabular Fracture ◽  
Three Dimensional ◽  
Operation Time ◽  
Fracture Reduction ◽  
Intraoperative Blood Loss ◽  
Odds Ratios ◽  
Conventional Surgery ◽  
Fracture Surgery

Three-dimensional technology is increasingly being used in acetabular fracture treatment. No systematic reviews are available about the added clinical value of 3D-assisted acetabular fracture surgery compared to conventional surgery. Therefore, this study aimed to investigate whether 3D-assisted acetabular fracture surgery compared to conventional surgery improves surgical outcomes in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy usage, complications, and postoperative fracture reduction, and whether it improves physical functioning. Pubmed and Embase databases were searched for articles on 3D technologies in acetabular fracture surgery, published between 2010 and February 2021. The McMaster critical review form was used to assess the methodological quality. Differences between 3D-assisted and conventional surgery were evaluated using the weighted mean and odds ratios. Nineteen studies were included. Three-dimensional-assisted surgery resulted in significantly shorter operation times (162.5 ± 79.0 versus 296.4 ± 56.0 min), less blood loss (697.9 ± 235.7 mL versus 1097.2 ± 415.5 mL), and less fluoroscopy usage (9.3 ± 5.9 versus 22.5 ± 20.4 times). The odds ratios of complications and fracture reduction were 0.5 and 0.4 for functional outcome in favour of 3D-assisted surgery, respectively. Three-dimensional-assisted surgery reduces operation time, intraoperative blood loss, fluoroscopy usage, and complications. Evidence for the improvement of fracture reduction and functional outcomes is limited.

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