Session III - Polytrauma

Rapid Prototyping: Future of Orthopaedic Trauma Surgery?

George A. Brown, MD, MS; Keikhosrow Firoozbakhsh, PhD; Jose R. Reyna, MD; David Huberty, MD; Brenton Milner, MD; Kenna Larsen, BS; Heather Hansen-Dispenza, BS; Rick J. Gehlert, MD; Thomas A. DeCoster, MD; Moheb S. Moneim, MD; University of New Mexico, School of Medicine, Department of Orthopaedics and Rehabilitation, Albuquerque, New Mexico, USA

Purpose: "Rapid Prototyping is the future of paleontology." (Jurassic Park III) Is cost-effective in-hospital application of rapid prototyping modeling technology the future for orthopaedic trauma surgeons? We report on 117 patients treated for a spectrum of severe fractures.

Methods: Three-dimensional models of complex fractures were produced overnight using modern rapid prototyping software (Materialise) and equipment (3-D Systems). Computer-reversed contralateral nonfractured anatomy nearly matches reduced fractures allowing implant pre-contouring (plate for joint fracture and rod for spine fracture). Midline split, trajectory-containing spine models allowed accurate assessment of fracture fragment location, spinal canal compromise, and 360° visualization of pedicles for proposed screw starting points, trajectories, and lengths. Phantom studies confirmed precision (± 1 mm). The study included 117 patients (41 acetabula, 35 spines, 13 ankles/feet, 11 pelvic rings, 8 shoulders, 8 knees, and 1 wrist).

Results: Fluoroscopy was only needed to confirm plate position and fracture reduction, and the time needed for fluoroscopy was decreased. All pre-contoured hardware fit well enough to eliminate the need for re-contouring surgery. Inexpensive wax models were precise, easily produced, durable enough, and impressive.

Discussion: Complex fracture evaluation has changed to rapid hands-on evaluation of wax models of fractured anatomy. Fixation hardware is pre-planned, pre-contoured and fits intraoperatively. Complex fractures with overlapping bony structures (pelvis, spine, shoulder, knee, ankle, foot, wrist, elbow, and hand) are now easily evaluated. The need for special oblique radiographs or special CT reconstruction is eliminated. Anatomic fracture models on hand during surgery are now reasonable and very useful.