Efficacy of Virtual Surgical Planning and 3D-Printed, Patient-Specific Reduction Guides to Facilitate Alignment of Diaphyseal Tibial Fractures Stabilized via Minimally Invasive Plate Osteosynthesis in Dogs: A Prospective Clinical Study

Introduction: A 3D-printed patient-specific fracture reduction system (3D-PSFRS) may facilitate accurate fracture reduction during minimally invasive plate osteosynthesis (MIPO). The objective of this study was to assess the feasibility and accuracy of creating and applying a 3D-PSFRS to facilitate reduction and alignment of diaphyseal tibial fractures in dogs. We hypothesized that a 3D-PSFRS could be prepared in a clinically acceptable timeline and facilitate acceptable restoration of tibial morphology.

Materials and Methods: Virtual 3D models of both pelvic limbs were created using computed tomography (CT) data of 11 dogs with diaphyseal tibial fractures. Proximal and distal pin guides were designed to conform to the tibial topography. A reduction bridge was designed to align the pin guides. Guides were 3D-printed, sterilized, and applied, in conjunction with a transient circular external fixator, to facilitate fracture realignment, prior to locking plate application. Postoperative CT scans were obtained to compare the stabilized and contralateral tibial alignment.

Results: Mean virtual surgical planning duration was 2.8 hours with a mean of 55.2 hours lapsing between presentation and surgery. Pin guide placement was accurate with only minor positioning discrepancies compared to the virtual plan. 3D-PSFRS application restored mean tibial length and frontal, sagittal, and axial alignment within 2 mm, 2.5º, 2º, and 5º, respectively, of the contralateral tibiae.

Discussion/Conclusion: Design and fabrication of a 3D-PSFRS is feasible in a relevant clinical timeline. Pin guide placement was accurate with only minor discrepancies. Application of a 3D-PSFRS to facilitate MIPO resulted in near-anatomic or acceptable fracture reduction in all dogs.

Acknowledgments: Funding was provided by the University of Florida's Mark S. Bloomberg Memorial Small Animal Surgery Research Fund, the University of Florida's College of Veterinary Medicine Faculty Development Research Grant Competition, and the Veterinary Orthopedic Society's Wade O. Brinker Research Award.

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Artikel online veröffentlicht:
11. September 2023