Beredjiklian Pedro, Fram Brianna, Core Jason, Ng Joshua I, Pugliese Robert, Kwan Stephanie A, Rivlin Michael
Arch Bone Jt Surg. 2025;13(6):337-344. doi: 10.22038/ABJS.2024.81232.3707.
Periarticular fractures of the shoulder and elbow are spatially complex injuries that may be challenging to interpret on radiographs and advanced imaging. As three-dimensional (3D) printing technology has become less expensive and more available, 3D printed fracture models have gained attention for use in surgical preparation. In this study, we evaluated the effects of 3D printed fracture models on orthopedic trainee surgical planning and injury understanding for injuries of the shoulder and elbow.
Models of periarticular fractures of the shoulder and elbow were manufactured by 3D printing at the medical school design lab. Eleven Orthopedic trainees viewed X-rays and computed tomography (CT) scans for each injury, and completed a preoperative questionnaires. They were then given access to the 3D model of each injury, in addition to the previously viewed imaging. They again completed a preoperative plan and questionnaire. Preoperative plans were graded for feasibility by a preestablished template. Results were compared for each participant with and without the 3D models.
Within all trainees and fractures, trainees were more likely to have feasible preoperative plans when given a 3D model, compared to access to x-rays and CT scans alone (74% vs. 62%). In all cases where preoperative plans were changed after handling the 3D models (46/77 changed, 60%), they stayed static or improved in feasibility. Participants reported significantly improved understanding of injury anatomy (P<0.0001), increased confidence in choosing operative positioning and surgical approaches (P<0.0001), desired implants (P=0.011), and better conceptualization of how to perform fracture reduction (P=0.0038).
Orthopedic trainees benefit from 3D printed fracture models when performing preoperative planning of complex periarticular shoulder and elbow injuries. Given the rarity and difficulty of these injuries, use of this technology could allow for shortened learning curves and improved surgical results in the field of orthopedic fracture care.
肩部和肘部关节周围骨折是空间复杂的损伤，在X线片和先进影像学检查上解读可能具有挑战性。随着三维（3D）打印技术成本降低且更易获取，3D打印骨折模型在手术准备中的应用受到关注。在本研究中，我们评估了3D打印骨折模型对骨科实习医生肩部和肘部损伤手术规划及损伤理解的影响。
肩部和肘部关节周围骨折模型在医学院设计实验室通过3D打印制作。11名骨科实习医生查看每种损伤的X线片和计算机断层扫描（CT），并完成术前问卷。然后，除了之前查看的影像资料外，他们还可使用每种损伤的3D模型。他们再次完成术前规划和问卷。术前规划根据既定模板进行可行性分级。比较每位参与者在有和没有3D模型情况下的结果。
在所有实习医生和骨折类型中，与仅查看X线片和CT扫描相比，给予3D模型时实习医生更有可能制定出可行的术前规划（74%对62%）。在所有处理3D模型后术前规划发生改变的情况中（46/77改变，60%），规划的可行性保持不变或有所提高。参与者报告对损伤解剖结构的理解显著改善（P<0.0001），在选择手术体位和手术入路方面的信心增强（P<0.0001），对所需植入物的了解（P=0.011），以及对如何进行骨折复位的概念化理解更好（P=0.0038）。
在对复杂的肩部和肘部关节周围损伤进行术前规划时，骨科实习医生可从3D打印骨折模型中获益。鉴于这些损伤的罕见性和复杂性，使用该技术可缩短骨科骨折治疗领域的学习曲线并改善手术效果。
