BACKGROUND: Open reduction and internal fixation of rib fractures is recommended to decrease mortality, shorten the duration of mechanical ventilation, and lower hospital length of stay. Prosthetic titanium plates are frequently used to repair chest wall trauma, and are typically contoured to the patient's anatomy at the time of implant in the operating room. We describe the use of 3-dimensional (3D) digitally corrected rapid prototyping to generate a model of a patient's skeletal anatomy for the purposes of preoperative customization of standard titanium plates for fixation of rib fractures. METHODS: A computed tomography imaging Digital Imaging and Communication in Medicine data set was segmented. Rib fractures were virtually realigned using the mirrored normal anatomy as a guide. The model was printed and used to customize titanium rib fixation plates prior to the procedure. RESULTS: Preoperative shaping of 5 titanium plates using the final 3D model required a total of 5.65 minutes. Surgical fixation of 4 of the patient's 5 fractures was accomplished using the titanium plates that were preoperatively shaped using our 3D model. DISCUSSION: We demonstrate successful use of a digitally rendered model to preoperatively customize standard titanium rib fixation plates. Compared with intraoperative contouring of rib fixation plates, we believe that this approach facilitates repair of complex rib fractures, saving time in the operating room. We believe this technique can improve the accuracy of reductions, increase the ease and efficiency of these procedures, and afford benefits in reducing surgical stress on patients who have already suffered significant trauma.
BACKGROUND: Open reduction and internal fixation of rib fractures is recommended to decrease mortality, shorten the duration of mechanical ventilation, and lower hospital length of stay. Prosthetic titanium plates are frequently used to repair chest wall trauma, and are typically contoured to the patient's anatomy at the time of implant in the operating room. We describe the use of 3-dimensional (3D) digitally corrected rapid prototyping to generate a model of a patient's skeletal anatomy for the purposes of preoperative customization of standard titanium plates for fixation of rib fractures. METHODS: A computed tomography imaging Digital Imaging and Communication in Medicine data set was segmented. Rib fractures were virtually realigned using the mirrored normal anatomy as a guide. The model was printed and used to customize titanium rib fixation plates prior to the procedure. RESULTS: Preoperative shaping of 5 titanium plates using the final 3D model required a total of 5.65 minutes. Surgical fixation of 4 of the patient's 5 fractures was accomplished using the titanium plates that were preoperatively shaped using our 3D model. DISCUSSION: We demonstrate successful use of a digitally rendered model to preoperatively customize standard titanium rib fixation plates. Compared with intraoperative contouring of rib fixation plates, we believe that this approach facilitates repair of complex rib fractures, saving time in the operating room. We believe this technique can improve the accuracy of reductions, increase the ease and efficiency of these procedures, and afford benefits in reducing surgical stress on patients who have already suffered significant trauma.
Entities:
Keywords:
biomedical engineering; image-guided surgery; orthopedic surgery
Authors: Diogo de Freitas Valeiro Garcia; Andre Vinicio Cruz Mesias; Luiza Vieites; Paula Morais Pereira Mendes; João Paulo Sousa Ripardo Journal: Trauma Case Rep Date: 2020-02-22