Dataset Information

Clinical efficacy and safety of surgery combined with 3D printing for tibial plateau fractures: systematic review and meta-analysis.

ABSTRACT:

Background

The aim of the present study was to systematically evaluate the application value and complications of 3D printing technology on Schatzker tibial platform fracture surgery.

Methods

By searching the Cochrane Library, PubMed, Web of Science, Embase, Chinese Biomedical Literature Database (CBM), screening randomized controlled trials (RCTs), and two researchers included the study according to PICOS criteria and performed bias risk assessments. Quality evaluation and data extraction were performed for the included literatures, and meta-analysis was performed for RCTs included at using Review Manager 5.2 software.

Results

A total of 15 articles were included in the present study, which included a total of 758 patients, 342 3D printing techniques, 416 conventional surgical procedures. Meta-analysis showed 3D printing operation time [risk difference (RD) =-0.12, 95% CI: -0.16, -0.08, I²=46%, P<0.00001], surgical bleeding [odds ratio (OR) =0.59, 95% CI: 0.45-0.77, I²=0%, P<0.001), intraoperative fluoroscopy (OR =0.59, 95% CI: 0.41-0.85, I²=0%, P=0.004), fracture healing time (OR =0.46, 95% CI: 0.33-0.63, I²=0%, P<0.00001), and complication morbidity (OR =0.60, 95% CI: 0.45-0.81, I²=0%, P=0.001) were significantly lower than in the traditional group.

Discussion

3D printing technology for tibia platform fracture surgery has advantages of reduced operation time, less surgical bleeding, less complications, less intraoperative perspective, fast fracture healing, and can improve the accuracy of tibial platform fracture reduction and postoperative knee function recovery.

SUBMITTER: He Y

PROVIDER: S-EPMC9073782 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Clinical efficacy and safety of surgery combined with 3D printing for tibial plateau fractures: systematic review and meta-analysis.

He Yanwei Y Zhou Peng P He Chengsong C

Annals of translational medicine 20220401 7

<h4>Background</h4>The aim of the present study was to systematically evaluate the application value and complications of 3D printing technology on Schatzker tibial platform fracture surgery.<h4>Methods</h4>By searching the Cochrane Library, PubMed, Web of Science, Embase, Chinese Biomedical Literature Database (CBM), screening randomized controlled trials (RCTs), and two researchers included the study according to PICOS criteria and performed bias risk assessments. Quality evaluation and data e ...[more]

PMID: 35530967

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Project description:PurposeThe 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.MethodsA 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.ResultsTwenty 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).ConclusionsFive 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.

Project description:PurposeTo examine the condition and triggers of stress fractures of the lateral tibial plateau (LTP) similar to type III lateral hinge fractures (LHFs) after open wedge high tibial osteotomy (OWHTO).MethodsOWHTO was performed in 118 knees. They were examined for LHFs by computed tomography (CT). Patients were divided into the stress fracture group (Group SF) if they showed fracture lines on CT performed after starting weight-bearing walking and the normal group (Group N) for others.ResultsThe mean age was significantly older in Group SF (P = 0.022). Preoperatively, Group SF showed a significantly higher tibio-femoral angle (TFA, P = 0.014). No significant differences were observed in TFA and weight-bearing line ratio after surgery. Correction angle was significantly higher in the SF group. And all of the SF were more than 13 degrees. There was no significant difference in LHF incidence between groups, whereas stress fracture incidence differed significantly for each type of LHF (chi-squared test, P = 0.0001): 14.6% of type I cases, 100% of type II cases, 0% of type III cases, and 6.1% of those without LHF.DiscussionThe load on the LTP is assumed to act as a shearing force in type II fractures, which may contribute greatly to stress fractures. In type III, stress fractures may not occur because of the load dispersed at the fracture part. The stress fracture site is similar to type III LHF, and this kind of fracture is thought to be a delayed type III because it occurs after patients start weight-bearing walking. Moreover, they are observed in type I cases with a stable hinge and in 6% of cases without LHF. This study showed that high varus knees corrected with a large correction angle may develop stress fractures. OWHTO requires attention to stress fractures of the LTP, which can be regarded as delayed type III, in those developing LHFs postoperatively or having a high varus knee preoperatively.ConclusionThese results indicated the possibility of stress fracture in LTP during weight-bearing exercise after OWHTO, which was regarded as a delayed type III fracture. The results showed that Correction angle was more than 13 degrees, and lateral hinge fracture type II of the Takeuchi classification was an inducement of this stress fracture.Level of evidenceLevel IV.

Project description:To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords "tibial", "plateau", "fractures", "knee", "athletes", "sports", "non-operative", "conservative", "operative", "return to sport". All studies which recorded return rates and times to sport following tibial plateau fractures were included.Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management (n = 3); 27 reported on the outcome of surgical management (n = 917). Nine studies reported on Open Reduction Internal Fixation (ORIF) (n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation (ARIF) (n = 253) and 7 on Frame-Assisted Fixation (FRAME) (n = 262). All studies recorded "return to sport" rates. Only one study recorded a "return to sport" time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF (OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME (OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME (OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo (median), from a study reporting on ORIF.Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.

Dataset Information

Clinical efficacy and safety of surgery combined with 3D printing for tibial plateau fractures: systematic review and meta-analysis.

Background

Methods

Results

Discussion

Publications

Clinical efficacy and safety of surgery combined with 3D printing for tibial plateau fractures: systematic review and meta-analysis.

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