Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 4, April, p. 459–468

doi: 10.17219/acem/116749

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Comparative biomechanical testing of customized three-dimensional printing acetabular-wing plates for complex acetabular fractures

Xiangyuan Wen1,B,D,E,F, Hai Huang1,B,F, Canbin Wang1,C,F, Jianghui Dong2,D,E,F, Xuezhi Lin1,C,F, Fuming Huang1,C,F, Hua Wang1,A,F, Liping Wang2,D,E,F, Shicai Fan1,A,F

1 The Third Affiliated Hospital, Southern Medical University, Guangzhou, China

2 UniSA Clinical & Health Sciences, UniSA Cancer Research Institute, University of South Australia, Adelaide, Australia

Abstract

Background. Three-dimensional (3D) printing of an acetabular wing-plate is a new minimally invasive surgical technique for complex acetabular fractures.
Objectives. To investigate the biomechanical stability of 3D printing acetabular wing-plates. The results were compared with 2 conventional fixation systems.
Material and Methods. Eighteen fresh frozen cadaveric pelvises with both column fractures were randomly divided to 3 groups: A – iliosciatic plates fixation system; B – 3D printing plates; C – 2 parallel reconstruction plates fixation system. These constructions were loaded onto a biomechanical testing machine. Longitudinal displacement and stiffness values of the constructs were measured to estimate their stability.
Results. When the load force reached 700 N, Group A was superior to Group B in the longitudinal displacement of point 1 (p > 0.05). The longitudinal displacement of point 2 showed no significant differences among Groups A, B and C, and the displacement of the fracture line over point 3 showed no significant differences between Groups A and B (p > 0.05). The axial stiffness of Groups A, B and C were 122.4800 ±8.8480 N/mm, 168.4830 ±14.8091 N/mm and 83.1300 ±3.8091 N/mm, respectively. Group B was significantly stiffer than A and C (p < 0.05). Loads at failure of internal fixation were 1378.83 ±34.383 N, 1516.83 ±30.896 N and 1351.00 ±26.046 N for Groups A, B and C, respectively. Group B was significantly superior to Groups A and C (p > 0.05).
Conclusion. Customized 3D printing acetabular-wing plates provide stability for acetabular fractures compared to intraspecific buttressing fixation.

Key words

internal fixation, three-dimensional printing, acetabular fracture, biomechanical tests

References (32)

  1. Tile M. Pelvic ring fractures: Should they be fixed? J Bone Joint Surg Br. 1988;70(1):1–12.
  2. Peter RE. Open reduction and internal fixation of osteoporotic acetabular fractures through the ilio-inguinal approach: Use of buttress plates to control medial displacement of the quadrilateral surface. Injury. 2015;46(Suppl 1)S2–S7.
  3. Wu XB, Wang JQ, Sun X, Zhao CP. Guidance for treatment of pelvic acetabular injuries with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system. Orthop Surg. 2019;11(3):341–347.
  4. Laflamme GY, Hebert-Davies J, Rouleau D, Benoit B, Leduc S. Internal fixation of osteopenic acetabular fractures involving the quadrilateral plate. Injury. 2011;42(10):1130–1134.
  5. Culemann U, Holstein JH, Kohler D, et al. Different stabilisation techniques for typical acetabular fractures in the elderly – a biomechanical assessment. Injury. 2010;41(4):405–410.
  6. Butterwick D, Papp S, Gofton W, Liew A, Beaule PE. Acetabular fractures in the elderly: Evaluation and management. J Bone Joint Surg Am. 2015;97(9):758–768.
  7. Boelch SP, Jordan MC, Meffert RH, Jansen H. Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: A retrospective clinical study. Int Orthop. 2017;41(9):1831–1837.
  8. Letournel E. Acetabulum fractures: Classification and management. Clin Orthop Relat Res. 1980(151):81–106.
  9. White G, Kanakaris NK, Faour O, Valverde JA, Martin MA, Giannoudis PV. Quadrilateral plate fractures of the acetabulum: An update. Injury. 2013;44(2):159–167.
  10. Sen RK, Tripathy SK, Aggarwal S, Goyal T, Mahapatra SK. Comminuted quadrilateral plate fracture fixation through the iliofemoral approach. Injury. 2013;44(2):266–273.
  11. Russell GV Jr., Nork SE, Chip Routt ML Jr. Perioperative complications associated with operative treatment of acetabular fractures. J Trauma. 2001;51(6):1098–1103.
  12. Bott A, Odutola A, Halliday R, Acharya MR, Ward A, Chesser TJS. Long-term patient-reported functional outcome of polytraumatized patients with operatively treated pelvic fractures. J Orthop Trauma. 2019;33(2):64–70.
  13. Mehin R, Jones B, Zhu Q, Broekhuyse H. A biomechanical study of conventional acetabular internal fracture fixation versus locking plate fixation. Can J Surg. 2009;52(3):221–228.
  14. Maini L, Sharma A, Jha S, Sharma A, Tiwari A. Three-dimensional printing and patient-specific pre-contoured plate: Future of acetabulum fracture fixation? Eur J Trauma Emerg Surg. 2018;44(2):215–224.
  15. Malik HH, Darwood AR, Shaunak S, et al. Three-dimensional printing in surgery: A review of current surgical applications. J Surg Res. 2015;199(2):512–522.
  16. Fang C, Cai H, Kuong E, et al. Surgical applications of three-dimensional printing in the pelvis and acetabulum: From models and tools to implants. Unfallchirurg. 2019;122(4):278–285.
  17. Letournel E. Fractures of the acetabulum: A study of a series of 75 cases – Les fractures du cotyle, etude d’une serie de 75 cas. J de Chirurgie. 1961;82:47–87 [translated and substantially abridged]. J Orthop Trauma. 2006;20(1 Suppl):S15–S19.
  18. Wang D, Wang Y, Wu S, et al. Customized a Ti6Al4V bone plate for complex pelvic fracture by selective laser melting. Materials (Basel). 2017;10(1):35.
  19. Gillispie GJ, Babcock SN, McNamara KP, et al. Biomechanical comparison of intrapelvic and extrapelvic fixation for acetabular fractures involving the quadrilateral plate. J Orthop Trauma. 2017;31(11):570–576.
  20. Barnes SN, Stewart MJ. Central fractures of the acetabulum: A critical analysis and review of literature. Clin Orthop Relat Res. 1976;(114):276–281.
  21. Matta JM. Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78(11):1632–1645.
  22. Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: Indicators of outcome. Clin Orthop Relat Res. 2003;(407):173–186.
  23. Ziran N, Soles GLS, Matta JM. Outcomes after surgical treatment of acetabular fractures: A review. Patient Saf Surg. 2019;13:16. doi: 10.1186/s13037-019-0196-2
  24. Boudissa M, Courvoisier A, Chabanas M, Tonetti J. Computer assisted surgery in preoperative planning of acetabular fracture surgery: State of the art. Expert Rev Med Devices. 2018;15(1):81–89.
  25. Cromeens BP, Ray WC, Hoehne B, Abayneh F, Adler B, Besner GE. Facilitating surgeon understanding of complex anatomy using a three-dimensional printed model. J Surg Res. 2017;216:18–25.
  26. Aimar A, Palermo A, Innocenti B. The role of 3D printing in medical applications: A state of the art. J Healthc Eng. 2019;2019:5340616.
  27. Wan L, Zhang X, Zhang S, et al. Clinical feasibility and application value of computer virtual reduction combined with 3D printing technique in complex acetabular fractures. Exp Ther Med. 2019;17(5):3630–3636.
  28. Weidert S, Andress S, Suero E, et al. 3D printing in orthopedic and trauma surgery education and training: Possibilities and fields of application [in German]. Unfallchirurg. 2019;122(6):444–451. doi:10.1007/s00113-019-0650-8
  29. Karim MA, Abdelazeem AH, Youness M, El Nahal WA. Fixation of quadrilateral plate fractures of the acetabulum using the buttress screw: A novel technique. Injury. 2017;48(8):1813–1818.
  30. Khajavi K, Lee AT, Lindsey DP, Leucht P, Bellino MJ, Giori NJ. Single column locking plate fixation is inadequate in two column acetabular fractures. A biomechanical analysis. J Orthop Surg Res. 2010;5:30.
  31. Ryken TC, Owen BD, Christensen GE, Reinhardt JM. Image-based drill templates for cervical pedicle screw placement. J Neurosurg Spine. 2009;10(1):21–26.
  32. Ma T, Xu YQ, Cheng YB, et al. A novel computer-assisted drill guide template for thoracic pedicle screw placement: A cadaveric study. Arch Orthop Trauma Surg. 2012;132(1):65–72.