PREOPERATIVE 3D-PRINTED MODELS FOR LOCKING PLATE FIXATION OF DISTAL TIBIAL FRACTURES
Main Article Content
Abstract
Background: Distal tibial fractures remain a therapeutic challenge because of severe softtissue injury and complex fracture morphology. Recently, 3D-printed bone models have been applied to describe fracture characteristics and for preoperative planning of locking plate fixation with promising results. Objectives: To investigate several fracture characteristics on radiographs and 3Dprinted bone models and to evaluate the treatment outcomes of distal tibial fractures managed with locking plates using preoperative 3D-printed models. Materials and methods: A cross-sectional descriptive study was conducted on 31 patients with distal tibial fractures were enrolled at Can Tho Central General Hospital, Can Tho University of Medicine and Pharmacy Hospital, and Can Tho City General Hospital from June 2024 to January 2026. All patients underwent radiographic evaluation, and 3D-printed bone models were created to assist preoperative planning; fracture classification, the number of fragments, and impacted fragments were recorded on both radiographs and 3D models. Intraoperative parameters included operative time and blood loss, and postoperative functional outcomes were assessed using the AOFAS score at 3 months. Results: According to the AO/OTA classification, type 43B fractures predominated, accounting for 22 cases (71%) on radiographs and 20 cases (64.5%) on the 3D-printed models. Compared with radiographs, the 3D-printed models revealed a higher number of fragments in 17 patients (54.8%) and a greater number of impacted fragments in 11 patients (35.5%). The mean operative time and mean intraoperative blood loss were 98.1 ± 21.4 minutes and 83.39 ± 16.71 mL, respectively. At 3 months postoperatively, the mean AOFAS score in 31 patients was 89.87 ± 9.01, with good and excellent outcomes in 83.9%. Conclusion: Locking plate fixation using preoperative 3D-printed bone models facilitates the evaluation of fracture characteristics, provides good functional outcomes, and is associated with improved operative time and reduced intraoperative blood loss.
Keywords
Distal tibial fractures, 3D printing, preoperative planning, locking plate fixation
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
2. Gullì C, Ferravante E, Di D M, Ferrara G, Perla D, et al. Tibial pilon fractures: A radiological review of imaging patterns and classification. Journal of Medical Imaging and Interventional Radiology. 2025. 12(1), 30, https://doi.org/10.1007/s44326-025-00077-8.
3. Nguyễn Bá Ngọc, Phạm Ngọc Thắng, Nguyễn Sỹ Triều, Thái Ngọc Bình. Kết quả điều trị gãy kín đầu dưới xương chày bằng kết hợp xương nẹp khóa tại Bệnh viện Quân y 103. Tạp chí Y học Việt Nam. 2023. 532(1B), https://doi.org/10.51298/vmj.v532i1B.7360.
4. Magadum M, Chitragar D D, Zalariya S, Kl Manjunath. Clinical and radiological outcome of minimally invasive plate osteosynthesis in distal tibial fractures: A retrospective analysis. Original Research Article. 2025. 11(3), 550-55.
5. Morgan C, Khatri C, Hanna S A, Ashrafian H, Sarraf K M. Use of three-dimensional printing in preoperative planning in orthopaedic trauma surgery: A systematic review and meta-analysis. World journal of orthopedics. 2020. 11(1), 57, https://doi.org/10.5312/wjo.v11.i1.57.
6. Liu W, Zhang C, Liu J, Feng P, Yi P, et al. Efficacy and safety of three-dimensional printing technology assisted open reduction and internal fixation versus conventional surgery in the treatment of acetabular fractures: A meta-analysis of randomized controlled trials. Journal of orthopaedic surgery and research. 2025. 20(1), 518, https://doi.org/10.1186/s13018-02505940-8.
7. Lê Hồng Phúc. Kết hợp xương nẹp vít ít xâm lấn có ứng dụng dựng hình in 3D và nội soi hỗ trợ trong điều trị gãy mâm chày phẫu thuật muộn: Nhân 03 trường hợp và nhìn lại y văn. Tạp Chí Y học lâm sàng Bệnh viện Trung Ương Huế. 2025. 17(1), 108–114, https://doi.org/10.38103/jcmhch.17.1.16.
8. Lâm Đạo Giang, Phan Tiến Bảo Anh. Ứng dụng công nghệ in 3D trong phẫu thuật gãy ổ cốibáo cáo ca lâm sàng và nhìn lại y văn. Tạp chí Y học Cộng đồng. 2025. 66(CĐ12-NCKH), https://doi.org/10.52163/yhc.v66iCD12.2945.
9. Nguyễn Bá Ngọc, Thái Ngọc Bình. Kết quả điều trị gãy kín đầu dưới hai xương cẳng chân bằng nắn chỉnh mở, kết xương bên trong bằng nẹp khóa. Tạp chí Y Dược học Quân sự. 2025. 50(7), 233-240, https://doi.org/10.56535/jmpm.v50i7.1391.
10. Nguyễn Minh Anh, Nguyễn Xuân Thuỳ. Đánh giá kết quả điều trị gãy đầu dưới xương chày bằng nẹp vít khóa tại Bệnh viện Hữu nghị Việt Đức. Tạp chí Y học Việt Nam. 2024. 535(1), https://doi.org/10.51298/vmj.v535i1.8347.
11. Huang Z, Song W, Zhang Y, Zhang Q, Zhou D, et al. Three-dimensional printing model improves morphological understanding in acetabular fracture learning: A multicenter, randomized, controlled study. PloS one. 2018. 13(1), e0191328, https://doi.org/10.1371/journal.pone.0191328.
12. Bai J, Wang Y, Zhang P, Liu M, Wang P, et al. Efficacy and safety of 3D print-assisted surgery for the treatment of pilon fractures: A meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2018. 13(1), 283, https://doi.org/10.1186/s13018-0180976-x.
13. Huỳnh Thành Phương Nhân, Trần Anh Dũng, Nguyễn Lê Hoan, Nguyễn Thành Tấn. Kết quả điều trị gãy kín đầu dưới xương cẳng chân bằng phẫu thuật kết hợp xương nẹp vít với kỹ thuật ít xâm lấn. Tạp chí Y học Việt Nam. 2024. 540(3), https://doi.org/10.51298/vmj.v540i3.10453.
14. Nguyễn Văn Nam, Hoàng Văn Dung, Trịnh Thị Hiền, Trần Chiến, Mai Đức Dũng và cộng sự. Kết quả phẫu thuật điều trị gãy kín đầu dưới hai xương cẳng chân bằng nẹp vít tại Bệnh viện Trung ương Thái Nguyên. Tạp chí Y học Việt Nam. 2025. 555(1), https://doi.org/10.51298/vmj.v555i1.15961.
15. Barış A, Çirci E, Demirci Z, Öztürkmen Y. Minimally invasive medial plate osteosynthesis in tibial pilon fractures: Longterm functional and radiological outcomes. Acta Orthopaedica et Traumatologica Turcica. 2020. 54(1), 20, https://doi.org/10.5152/j.aott.2020.01.489.