Virtual surgical planning and use of a 3D-printed, patient-specific reduction system for minimally invasive plate osteosynthesis of diaphyseal tibial fractures in dogs: A historic case control study.

Abstract

OBJECTIVE: To compare the efficacy and clinical outcomes of computed tomography (CT)-based virtual surgical planning (VSP) and a three-dimensional (3D)-printed, patient-specific reduction system to conventional indirect reduction techniques for diaphyseal tibial fractures stabilized using minimally invasive plate osteosynthesis (MIPO) in dogs. STUDY DESIGN: A prospective clinical study with a historic control cohort. SAMPLE POPULATION: Dogs undergoing MIPO stabilization of diaphyseal tibial fractures using a custom 3D-printed reduction system (3D-MIPO; n&#x2009;=&#x2009;15) or conventional indirect reduction techniques (c-MIPO; n&#x2009;=&#x2009;14). METHODS: Dogs were prospectively enrolled to the 3D-MIPO group and CT scans were used to design and fabricate a custom 3D-printed reduction system to facilitate MIPO. Medical records were searched to identify dogs for the c-MIPO group. Pre-, intra- and postoperative parameters were compared between groups. RESULTS: The duration from presentation until surgery was 23&#x2009;h longer in the 3D-MIPO group (p&#x2009;=&#x2009;.002). Fewer intraoperative fluoroscopic images were acquired (p&#x2009;<&#x2009;.001) and mean surgical duration was 34&#x2009;min shorter in the 3D-MIPO group (p&#x2009;=&#x2009;.014). Median postoperative tibial length, frontal alignment, and sagittal alignment were within 4&#x2009;mm, 3&#xb0; and 3&#xb0;, respectively, of the contralateral tibia in both groups and did not differ between reduction groups (p&#x2009;>&#x2009;.1). Postoperative complications occurred in 27% and 14% of fractures in the 3D-MIPO and c-MIPO groups, respectively. CONCLUSION: Both reduction methods yielded comparable results. Although the preoperative planning and guide preparation was time consuming, surgery times were shorter and fluoroscopy use was less&#xa0;in the 3D-MIPO group. CLINICAL SIGNIFICANCE: VSP and the custom 3D-printed reduction system facilitated efficient MIPO.