Clinical significance of three-dimensional skeleton-arterial model in the management of delayed reconstruction of acetabular fractures

Abstract

Background: Delayed reconstruction of acetabular fractures remains a challenging task for orthopedists because of malunion, fracture line absorption, and scar formation. Accurate osteotomy, interfragmentary release, and proper adaptation of plates are keys to successful surgery. Prevention of superior gluteal artery (SGA) injury induced by cleaning of the osteotylus and reduction of the sciatic notch is also important. Therefore, sufficient preoperative planning is essential. However, traditional planning methods do not readily provide direct visual and tactile feedback to surgeons. Rapid prototyping (RP) models have provided new opportunities in the preoperative planning of delayed reconstruction of acetabular fractures. We hypothesized that a three-dimensional (3D) skeleton-arterial model would improve both preoperative planning in the management of fractures and arteries and intraoperative assistance during delayed reconstruction of complex acetabular fractures. Methods: Eight patients were enrolled in this study. Data on the skeleton and arteries were obtained from computed tomography and angiography scans and used to produce RP models. Preoperative surgical planning and intraoperative assistance were performed using these models as references. Results: All 3D skeleton-arterial models were extremely accurate. Reduction and fixation were performed programmatically and smoothly, and management of the SGA was reliably executed according to a thorough preoperative plan. The mean surgical time and intraoperative blood loss were 224.4 min and 1250 ml, respectively. Among the eight patients, four underwent anatomic reduction and five had excellent functional outcomes at the final follow-up. No significant complications occurred. Conclusions: This 3D skeleton-arterial model is helpful for orthopedists in preoperative planning and intraoperative assistance.