Application of 3d Models in Preoperative Planning of Tibial Plateau Fractures: Can We Expect Changes?

Abstract

Introduction: Tibial Plateau fractures are complex lesions that require deep understanding of the lesion morphology.Computed tomography (CT) is essential for preoperative planning.Studies have shown clinical benefits in surgical management with the application of 3D models.The aim of the study is to analyze changes in preoperative planning by using 3D printing vs CT. Hypothesis:The use of 3D models generates important changes in preoperative planning of tibial plateau fractures. Material and Method:A descriptive observational study was performed.Patients with Schatzker V and VI tibial plateau fracture were included in the same center, with CT images in the local DICOM system.Patients who did not have a complete set of images or 3D reconstruction were excluded.The models were generated using Meshmixer version 3.5.4software, printing each case using Creality version CR-10 max printer.Preoperative planning surveys were completed by knee surgeons, using 3D models evaluating four variables (number of plates, surgical approach, position of the patient, use of bone graft).The survey was repeated a week later, using the respective CT, anonymizing each case.A descriptive analysis was performed and the intraobserver agreement was calculated by Cohen's Kappa test using Excel 16.70 for each independent variable and then, for each complete case.Results: Ten patients with tibial plateau fractures were evaluated by ten knee surgeons separated in two groups, according to less or more than 10 years of experience (five surgeons in each group).The agreement for the number of plates, surgical approach, position of the patient and use of bone graft, had a kappa value of 0.31, 0.16, 0.53 and 0.49 respectively, obtaining an overall result of 0.37.80% of the cases had at least one change within the 4 variables studied from the use of 3D models with a Kappa Cohen value of 0.The agreement in the group of surgeons with less than 10 years of experience had an average Kappa value of 0.34 and the group with more than 10 years an average of 0.39. Conclusion:The application of 3D models in tibial plateau fractures presents a high rate of changes in preoperative planning, especially in the choice of plate number and surgical approach.

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