Comparative use of the computer-aided angiography and rapid prototyping technology versus conventional imaging in the management of the Tile C pelvic fractures

IntroductionComputed tomography (CT) scan with three-dimensional (3D) reconstruction has been used to evaluate complex fractures in pre-operative planning. In this study, rapid prototyping of a life-size model based on 3D reconstructions including bone and vessel was applied to evaluate the feasibility and prospect of these new technologies in surgical therapy of Tile C pelvic fractures by observing intra- and perioperative outcomes.Materials and methodsThe authors conducted a retrospective study on a group of 157 consecutive patients with Tile C pelvic fractures. Seventy-six patients were treated with conventional pre-operative preparation (A group) and 81 patients were treated with the help of computer-aided angiography and rapid prototyping technology (B group). Assessment of the two groups considered the following perioperative parameters: length of surgical procedure, intra-operative complications, intra- and postoperative blood loss, postoperative pain, postoperative nausea and vomiting (PONV), length of stay, and type of discharge.ResultsThe two groups were homogeneous when compared in relation to mean age, sex, body weight, injury severity score, associated injuries and pelvic fracture severity score. Group B was performed in less time (105 ± 19 minutes vs. 122 ± 23 minutes) and blood loss (31.0 ± 8.2 g/L vs. 36.2 ± 7.4 g/L) compared with group A. Patients in group B experienced less pain (2.5 ± 2.3 NRS score vs. 2.8 ± 2.0 NRS score), and PONV affected only 8 % versus 10 % of cases. Times to discharge were shorter (7.8 ± 2.0 days vs. 10.2 ± 3.1 days) in group B, and most of patients were discharged to home.ConclusionsIn our study, patients of Tile C pelvic fractures treated with computer-aided angiography and rapid prototyping technology had a better perioperative outcome than patients treated with conventional pre-operative preparation. Further studies are necessary to investigate the advantages in terms of clinical results in the short and long run.

[1]  M. Stover,et al.  What Is the Infection Rate of the Posterior Approach to Type C Pelvic Injuries? , 2012, Clinical orthopaedics and related research.

[2]  P. Giannoudis,et al.  Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. , 2009, Injury.

[3]  H Handels,et al.  Three-dimensional planning and simulation of hip operations and computer-assisted construction of endoprostheses in bone tumor surgery. , 2001, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[4]  Yanling Hu,et al.  Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures , 2009 .

[5]  C. Hurson,et al.  Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures. , 2007, Injury.

[6]  W. Dongmei,et al.  Superior border of the arcuate line: Three dimension reconstruction and digital measurements of the fixation route for pelvic and acetabular fractures , 2013, International Orthopaedics.

[7]  D. Poenaru,et al.  Emergency pelvic stabilization in patients with pelvic posttraumatic instability , 2015, International Orthopaedics.

[8]  Krishna Kumar,et al.  Femoral artery intimal injury following open reduction of an acetabular fracture. , 2009, Orthopedics.

[9]  Beat Hammer,et al.  Computer‐Assisted Secondary Reconstruction of Unilateral Posttraumatic Orbital Deformity , 2002, Plastic and reconstructive surgery.

[10]  M Heuschmid,et al.  Computer-aided surgical planning for implantation of hearing aids based on CT data in a VR environment. , 2001, Radiographics : a review publication of the Radiological Society of North America, Inc.

[11]  R. Neugebauer,et al.  The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures. Clinical and radiological mid-term results , 2013, International Orthopaedics.

[12]  L-P Nolte,et al.  Computer assisted screw insertion into real 3D rapid prototyping pelvis models. , 2002, Clinical biomechanics.

[13]  A. G. Schneeberger.  Two and Three-Dimensional Computed Tomography for the Classification and Management of Distal Humeral Fractures: Evaluation of Reliability and Diagnostic Accuracy , 2007 .

[14]  S. Stawicki,et al.  The impact of antiplatelet therapy on pelvic fracture outcomes , 2011, Journal of emergencies, trauma, and shock.

[15]  R. Vaidya,et al.  Sequential reduction and fixation for windswept pelvic ring injuries (LC3) corrects the deformity until healed , 2013, International Orthopaedics.

[16]  G. Harris,et al.  The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. , 2006, The Journal of bone and joint surgery. American volume.

[17]  F. Haddad,et al.  Pelvic fractures and high energy traumas. , 2005, Hospital medicine.

[18]  Branislav Jaramaz,et al.  Three-dimensional planning and virtual radiographs in revision total hip arthroplasty for instability. , 2006, Clinical orthopaedics and related research.

[19]  Vaibhav Bagaria,et al.  Use of rapid prototyping and three-dimensional reconstruction modeling in the management of complex fractures. , 2011, European journal of radiology.

[20]  Didier A. Rajon,et al.  An investigation of the potential of rapid prototyping technology for image‐guided surgery , 2006, Journal of applied clinical medical physics.

[21]  Yanling Hu,et al.  Computer-assisted virtual surgical procedure for acetabular fractures based on real CT data. , 2011, Injury.

[22]  Safdar N. Khan,et al.  Complications of temporary and definitive external fixation of pelvic ring injuries. , 2005, Injury.