Summary

The application of 3D models in tibial plateau fractures presents a high rate of changes in preoperative planning, especially in the choice of number of plates and surgical approach.

Abstract

Introduction

Tibial plateau fractures are complex lesions, with computed tomography (CT) being essential for surgical planning. The application of 3D printing has demonstrated clinical benefits, improving efficiency and precision in its handling. The aim of the study is to analyze changes in preoperative planning by using 3D printing.

Material And Method

A descriptive observational study was performed. Patients from one center with Schatzker V and VI tibial plateau fracture were included with CT images in the local DICOM system. Patients who did not have a complete set of images or did not have 3D reconstruction were excluded. The images were extracted and the models were generated using Meshmixer version 3.5.4 software, printing for each case by Creality printer (version CR-10 max). Preoperative planning survey was completed by Knee surgeons using the 3D models (variables: number of plates, surgical approach, operating table position, use of bone graft), the same survey was repeated a week later with the respective CT, anonymizing each case. A descriptive analysis was performed and then the intraobserver variability was calculated by Cohen’s Kappa test using STATA v. 17.0 program for each independent variable and then for each case, defining as "agreement" the 4 variables of the same case without changes.

Results

A total of 10 patients with tibial plateau fracture were evaluated by 12 Knee surgeons. Among the variables studied, the average intraobserver agreement was 73.3% (k = 0.5), 40% (k = 0.29), 93.3% (k = 0.81) and 81% (k = 0.63) for the number of plates, surgical approach, operating table position and bone graft use respectively. The average agreement level for the cases was 37% (k = 0.25).

Conclusion

The application of 3D models in tibial plateau fractures presents a high rate of changes in preoperative planning, especially in the choice of number of plates and surgical approach.