SLR - June 2023 - Robert G. Karman, DPM
Title: Percutaneous reduction and cannulated screw fixation assisted by 3D printing technology of calcaneal fractures in childrenReference: Keze Miao, Jianshun Wang, Kehe Yu, Jianjun Hong and Xiaolang Lu Percutaneous reduction and cannulated screw fixation assisted by 3D printing technology of calcaneal fractures in children. Journal of Orthopaedic Science, 2022 The Japanese Orthopaedic Association
Level of Evidence: III
Scientific Literature Review
Reviewed By: Robert G. Karman, DPM
Residency Program: New York Presbyterian-Queens. Flushing, New York
Podiatric Relevance: Calcaneal fractures in children can prove difficult due to limited exposure and difficulty reducing articular surfaces without direct vision. Direct vision comes at a compromise as the lateral extensile approach has increased soft tissue complications. New technology such as 3D printing allows surgeons to visualize fractures prior to surgery and perform preoperative preparation and rehearsal to improve outcomes, as well as decrease operative time and increase surgeon and patient satisfaction. This study reviews a sample of pediatric patients whose treatment was supplemented by pre-operative 3D printing of the CT reconstructed fracture pattern. In a world of increased technology developed to help improve outcomes, the purpose of the study was to analyze the outcome of this technique.
Methods: Pediatric patients with calcaneal fractures from January 2010 to December 2018 were reviewed. Preoperative CT scans were obtained of bilateral calcaneus and utilized to reconstruct 3D printed models in which the surgeon used preoperatively to determine fixation methods and approaches by simulating surgery and fracture manipulation with the model. The fractures were reduced with K-wires, Schanz pins and percutaneous screws. Blood loss, operative time, number of intra op fluoroscopy images were measured. Surgeon and patient satisfaction was recorded via a questionnaire and functional results via AOFAS hindfoot score were analyzed and used to assess the effectiveness of 3d printing technology.
Results: The study consisted of 82 cases of calcaneal fractures in children. The average operative time was 47.2 minutes, blood loss was 12.1 ml, and the number of fluoroscopies was 8.5 images. Average Bohler's angle was 19.2 degrees preoperatively and 35.6 degrees post operatively. All fractures improved on imaging results. The average subjective AOFAS hindfoot score was 94.1. The questionnaire survey showed surgeon and patient satisfaction with 3D printing technology. None of the patients developed wound infection, one patient with sural nerve injury resolved 6 months post operatively.
Conclusions: The authors concluded that 3D printed with percutaneous screw fixation proves useful for treatment of displaced intra articular calcaneal fractures in children. The study supports the literature for reduced incidence of wound complications while maintaining good outcomes through closed reduction and percutaneous fixations verified by improvement on post operative radiographs. Surgeon and patient families were satisfied with the models and provided a method of communication with family while improving understanding of the injury. It allows the surgeon to reduce operative time, blood loss and intraoperative imaging which may negate the cost of producing the model itself which in recent years has vastly decreased. The study shows that it is feasible to apply 3D printing technology to assist in treatment of displaced intra-articular calcaneal fractures in children and achieve satisfactory surgical and radiographic outcomes.