Effect of three-dimensional printing-assisted minimally invasive plate osteosynthesis on anti-malrotation for different types of tibial fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Yuwei ¹ , DUAN Jingrui ² , FANG Lei ¹ , XU Shengming ¹ ,  ZHANG Lei ¹

1. The First Department of Orthopaedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, P.R.China;
2. Department of Bone and Joint Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, P.R.China;

Corresponding author：

ZHANG Lei, Email: doc-zl@163.com

Keywords：

Three-dimensional printing; minimally invasive plate osteosynthesis; tibial fracture; tibial malrotation; fracture classification

DOI：

10.7507/1002-1892.201903109

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Objective To compare the postoperative tibial malrotation between traditional minimally invasive plate osteosynthesis (MIPO) and three-dimensional printing-assisted MIPO (3D-MIPO) for different types of tibial fractures, and explore the change of these differences.Methods A prospective randomized controlled trial was conducted. The 120 patients with unilateral tibial fracture who met the selection criteria between January 2016 and October 2018 (40 patients in each of AO types A, B, and C) into the trial group (20 patients, 3D-MIPO) and the control group (20 patients, traditional MIPO) at ratio of 1∶1. There was no significant difference between the two groups (P>0.05) in gender, age, fracture site, and other general information. The bilateral tibial rotation angles were measured on the CT images within 1 week after operation, and the difference of tibial rotation angle between affected and unaffected sides was calculated. The tibial malrotation was defined when the difference exceeded 10°. The degree of tibial rotation and the incidence of malrotation between the two groups in different types of tibial fractures were compared. Results Postoperative infection occurred in 1 case, and improved after the dressing change and anti-inflammatory treatment. No complications such as loosening and displacement of internal fixation occurred. There was no significant difference in the difference of bilateral tibial rotation angles between the two groups in type A fractures after operation (t=0.559, P=0.580); while in types B and C fractures, the differences of bilateral tibial rotation angles in control group were significantly higher than those in trial group (P<0.05). There was no significant difference in distribution of internal or external rotation between the two groups in types A, B, and C fractures (P>0.05). No malrotation occurred in type A fractures, and there was no significant difference in the incidence of malrotation between the two groups in type B fractures (P=1.000). The incidence of malrotation in control group was significantly higher than that in trial group in type C fractures (P=0.044).Conclusion 3D-MIPO has the same anti-malrotation effect as traditional MIPO for type A tibial fracture, but for types B and C tibial fractures, the anti-malrotation effect of 3D-MIPO is significantly better than that of traditional MIPO. The more complex the fracture type is, the more significant this advantage is.

Citation： CAI Yuwei, DUAN Jingrui, FANG Lei, XU Shengming, ZHANG Lei. Effect of three-dimensional printing-assisted minimally invasive plate osteosynthesis on anti-malrotation for different types of tibial fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1510-1515. doi: 10.7507/1002-1892.201903109 Copy

1.	刘承涛, 赵锦阳, 王晓光, 等. 外固定支架术与经皮微创钢板内固定术治疗胫腓骨骨折的临床效果比较. 中国当代医药, 2016, 23(10): 99-101, 104.
2.	He GC, Wang HS, Wang QF, et al. Effect of minimally invasive percutaneous plates versus interlocking intramedullary nailing in tibial shaft treatment for fractures in adults: a meta-analysis. Clinics (Sao Paulo), 2014, 69(4): 234-240.
3.	Sitnik AA, Beletsky AV. Minimally invasive percutaneous plate fixation of tibia fractures: results in 80 patients. Clin Orthop Relat Res, 2013, 471(9): 2783-2789.
4.	Toivanen JA, Väistö O, Kannus P, et al. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg (Am), 2002, 84(4): 580-585.
5.	Kienapfel H, Springorum HP, Ziegler A, et al. Effect of rotation of the femoral and tibial components on patellofemoral malalignment in knee arthroplasty. Orthopade, 2003, 32(4): 312-318.
6.	Kahn KM, Beals RK. Malrotation after locked intramedullary tibial nailing: three case reports and review of the literature. J Trauma, 2002, 53(3): 549-552.
7.	Jend HH, Heller M, Dallek M, et al. Measurement of tibial torsion by computer tomography. Acta Radiol Diagn (Stockh), 1981, 22(3A): 271-276.
8.	Dickschas J, Tassika A, Lutter C, et al. Torsional osteotomies of the tibia in patellofemoral dysbalance. Arch Orthop Trauma Surg, 2017, 137(2): 179-185.
9.	张磊, 房雷, 匡勇, 等. 胫骨骨折微创接骨板内固定术后发生胫骨旋转不良的临床研究. 中国骨与关节损伤杂志, 2018, 33(4): 357-359.
10.	张磊, 房雷, 陈晓, 等. 3D 打印辅助微创接骨板内固定术 (MIPO) 改善胫骨旋转不良的前瞻性随机对照研究. 第二军医大学学报, 2018, 39(2): 177-181.
11.	Puloski S, Romano C, Buckley R, et al. Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma, 2004, 18(7): 397-402.
12.	郭世绂. 骨科临床解剖学. 山东科学技术出版社, 2002: 942-944.
13.	Joveniaux P, Ohl X, Harisboure A, et al. Distal tibia fractures: management and complications of 101 cases. Int Orthop, 2010, 34(4): 583-588.
14.	Gupta RK, Rohilla RK, Sangwan K, et al. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients. Int Orthop, 2010, 34(8): 1285-1290.
15.	Dos Santos Cerqueira F, T Araújo Motta GA, Rocha de Faria JL, et al. Minimally invasive quadricepsplasty. Arthrosc Tech, 2019, 8(3): e343-e347.
16.	Walsh S, Reindl R, Harvey E, et al. Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech (Bristlo, Avon), 2006, 21(10): 1027-1031.
17.	He X, Zhang J, Li M, et al. Surgical treatment of extra-articular or simple intra-articular distal tibial fractures: MIPO versus supercutaneous plating. Orthopedics, 2014, 37(10): e925-e931.
18.	张庆熙, 高福强, 孙伟, 等. 经皮微创钢板内固定与切开复位内固定治疗成人胫骨远端骨折的 Meta 分析. 中国骨伤, 2015, 28(8): 757-762.
19.	Buckley R, Mohanty K, Malish D. Lower limb malrotation following MIPO technique of distal femoral and proximal tibial fractures. Injury, 2011, 42(2): 194-199.
20.	张权, 黄煌渊, 夏军, 等. 胫骨旋转对髌股关节应力分布的影响. 中国运动医学杂志, 1999, 18(3): 218-220, 225.
21.	Hwang TJ, Kiang C, Paul M. Surgical applications of 3-dimensional printing and precision medicine. JAMA Otolaryngol Head Neck Surg, 2015, 141(4): 305-306.
22.	赵景新, 马雅昌, 韩栋, 等. 3-D 打印在青少年胫骨远端骨折累及骺板损伤手术中的应用. 中国修复重建外科杂志, 2017, 31(10): 1195-1199.
23.	赵星, 余黎, 陶圣祥, 等. 3D 打印技术在严重肱骨远端骨缺损治疗中的应用观察. 中国修复重建外科杂志, 2018, 32(12): 1534-1539.
24.	Panou A, Stanitski DF, Stanitski C, et al. Intra-observer and inter-observer errors in CT measurement of torsional profiles of lower limbs: a retrospective comparative study. J Orthop Surg Res, 2015, 10: 67.
25.	郝申申, 刘志斌, 王飞, 等. 3D 打印技术在成人锁骨中段移位骨折治疗中的应用价值. 中国综合临床, 2017, 33(10): 873-877.
26.	Jeong HS, Park KJ, Kil KM, et al. Minimally invasive plate osteosynthesis using 3D printing for shaft fractures of clavicles: technical note. Arch Orthop Trauma Surg, 2014, 134(11): 1551-1555.
27.	Kumta S, Kumta M, Jain L, et al. A novel 3D template for mandible and maxilla reconstruction: Rapid prototyping using stereolithography. Indian J Plast Surg, 2015, 48(3): 263-273.

1. 刘承涛, 赵锦阳, 王晓光, 等. 外固定支架术与经皮微创钢板内固定术治疗胫腓骨骨折的临床效果比较. 中国当代医药, 2016, 23(10): 99-101, 104.
2. He GC, Wang HS, Wang QF, et al. Effect of minimally invasive percutaneous plates versus interlocking intramedullary nailing in tibial shaft treatment for fractures in adults: a meta-analysis. Clinics (Sao Paulo), 2014, 69(4): 234-240.
3. Sitnik AA, Beletsky AV. Minimally invasive percutaneous plate fixation of tibia fractures: results in 80 patients. Clin Orthop Relat Res, 2013, 471(9): 2783-2789.
4. Toivanen JA, Väistö O, Kannus P, et al. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg (Am), 2002, 84(4): 580-585.
5. Kienapfel H, Springorum HP, Ziegler A, et al. Effect of rotation of the femoral and tibial components on patellofemoral malalignment in knee arthroplasty. Orthopade, 2003, 32(4): 312-318.
6. Kahn KM, Beals RK. Malrotation after locked intramedullary tibial nailing: three case reports and review of the literature. J Trauma, 2002, 53(3): 549-552.
7. Jend HH, Heller M, Dallek M, et al. Measurement of tibial torsion by computer tomography. Acta Radiol Diagn (Stockh), 1981, 22(3A): 271-276.
8. Dickschas J, Tassika A, Lutter C, et al. Torsional osteotomies of the tibia in patellofemoral dysbalance. Arch Orthop Trauma Surg, 2017, 137(2): 179-185.
9. 张磊, 房雷, 匡勇, 等. 胫骨骨折微创接骨板内固定术后发生胫骨旋转不良的临床研究. 中国骨与关节损伤杂志, 2018, 33(4): 357-359.
10. 张磊, 房雷, 陈晓, 等. 3D 打印辅助微创接骨板内固定术 (MIPO) 改善胫骨旋转不良的前瞻性随机对照研究. 第二军医大学学报, 2018, 39(2): 177-181.
11. Puloski S, Romano C, Buckley R, et al. Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma, 2004, 18(7): 397-402.
12. 郭世绂. 骨科临床解剖学. 山东科学技术出版社, 2002: 942-944.
13. Joveniaux P, Ohl X, Harisboure A, et al. Distal tibia fractures: management and complications of 101 cases. Int Orthop, 2010, 34(4): 583-588.
14. Gupta RK, Rohilla RK, Sangwan K, et al. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients. Int Orthop, 2010, 34(8): 1285-1290.
15. Dos Santos Cerqueira F, T Araújo Motta GA, Rocha de Faria JL, et al. Minimally invasive quadricepsplasty. Arthrosc Tech, 2019, 8(3): e343-e347.
16. Walsh S, Reindl R, Harvey E, et al. Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech (Bristlo, Avon), 2006, 21(10): 1027-1031.
17. He X, Zhang J, Li M, et al. Surgical treatment of extra-articular or simple intra-articular distal tibial fractures: MIPO versus supercutaneous plating. Orthopedics, 2014, 37(10): e925-e931.
18. 张庆熙, 高福强, 孙伟, 等. 经皮微创钢板内固定与切开复位内固定治疗成人胫骨远端骨折的 Meta 分析. 中国骨伤, 2015, 28(8): 757-762.
19. Buckley R, Mohanty K, Malish D. Lower limb malrotation following MIPO technique of distal femoral and proximal tibial fractures. Injury, 2011, 42(2): 194-199.
20. 张权, 黄煌渊, 夏军, 等. 胫骨旋转对髌股关节应力分布的影响. 中国运动医学杂志, 1999, 18(3): 218-220, 225.
21. Hwang TJ, Kiang C, Paul M. Surgical applications of 3-dimensional printing and precision medicine. JAMA Otolaryngol Head Neck Surg, 2015, 141(4): 305-306.
22. 赵景新, 马雅昌, 韩栋, 等. 3-D 打印在青少年胫骨远端骨折累及骺板损伤手术中的应用. 中国修复重建外科杂志, 2017, 31(10): 1195-1199.
23. 赵星, 余黎, 陶圣祥, 等. 3D 打印技术在严重肱骨远端骨缺损治疗中的应用观察. 中国修复重建外科杂志, 2018, 32(12): 1534-1539.
24. Panou A, Stanitski DF, Stanitski C, et al. Intra-observer and inter-observer errors in CT measurement of torsional profiles of lower limbs: a retrospective comparative study. J Orthop Surg Res, 2015, 10: 67.
25. 郝申申, 刘志斌, 王飞, 等. 3D 打印技术在成人锁骨中段移位骨折治疗中的应用价值. 中国综合临床, 2017, 33(10): 873-877.
26. Jeong HS, Park KJ, Kil KM, et al. Minimally invasive plate osteosynthesis using 3D printing for shaft fractures of clavicles: technical note. Arch Orthop Trauma Surg, 2014, 134(11): 1551-1555.
27. Kumta S, Kumta M, Jain L, et al. A novel 3D template for mandible and maxilla reconstruction: Rapid prototyping using stereolithography. Indian J Plast Surg, 2015, 48(3): 263-273.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of three-dimensional printing-assisted minimally invasive plate osteosynthesis on anti-malrotation for different types of tibial fractures

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