Date Published: October 4, 2018
Publisher: Public Library of Science
Author(s): Ying-Yi Chen, Kuan-Hsun Lin, Hsu-Kai Huang, Hung Chang, Shih-Chun Lee, Tsai-Wang Huang, Mikko Juhani Lammi.
The beneficial application of three-dimensional (3D) printing for surgical stabilization of rib fractures (SSRF) has never been proposed in the literature before. The aim of this study was to verify patients’ surgical outcomes when utilizing preoperative three-dimensional printing for SSRF.
We retrospectively reviewed the records of all consecutive patients who were treated at our hospital for SSRF from July 2015 to December 2017. The patients were divided into two groups according to whether or not 3D printing was utilized.
Forty-eight patients who underwent SSRF at our hospital were enrolled. Of them, three patients underwent bilateral surgeries. The patients with application of preoperative 3D printing for SSRF had statistically significant associations with shorter operation time per fixed plate (p < 0.001), and a smaller incision length (p < 0.001). We present an useful technique involving 3D printing for promoting SSRF significantly with shorter operation time and an appropriate incision length.
Three-dimensional (3D) printing is a spectacular manufacturing technology with rapid prototyping, which enables the creation of 3D structures from computer-aided design data sets via an additive layering process. Until this report, there have been no definite conclusions in the literature about the clinical application of 3D printing in patients with rib fractures. Rib fractures are noted in 10% of all trauma patients and in about 30% of patients with significant chest trauma. Surgical stabilization of rib fractures (SSRF) has traditionally required a big incision wound for adequate exposure; however, the degree of chest wall instability is determined by palpation, and the planned approach for surgery is fine-tuned on the basis of direct visualization of the rib fracture location during surgery. Recently, Schots et al. mentioned that video-assisted thoracoscopic surgery (VATS) is effective and safe and can be of additional value by providing the possibility to adjust the planned incision for SSRF and to decrease the area of muscle destruction. However, the preoperative preparation of VATS is time-consuming, and single-lung ventilation and a prolonged operation time are expected. Moreover, at least one additional assistant is required to control the thoracoscopy process. We utilized 3D reconstruction from computed tomographic images to simulate the patient’s rib cage to determine the length and curve of the titanium plates before surgery to decrease the length of the incisions, identify the precise location of the fracture sites, and easily measure the rib thickness using a caliper to determine the proper screw length.
Forty-eight patients who received SSRF during the study period were included in the analysis, while five patients were excluded because of loss follow-up. In sixteen patients (33.3%) (17 surgeries), preoperative 3D printing was used to precontour plates for surgical reconstruction. Only three patients had bilateral procedures. In 28 of 48 patients, a motorcycle accident was the most common cause of the rib fractures. In 23 of 48 patients, a prominent hemothorax or lung penetrating injuries were present and needed proper evacuation or stapled wedge resection. Other bone fractures and brain injuries were the second most commonly associated injuries. In ten patients undergoing 3D printing with SSRF, we used VATS to explore the thoracic cavity and evacuate the hemothorax. Only one patient had traumatic aortic dissection, type B, and needed stenting of the descending aorta. All relevant mechanisms and associated injuries are listed in Table 1.
3D printing has been developed in many fields of biomedicine. Vivek Baskaran  investigated the applications of 3D printing for anatomy and surgical education and neurosurgery in the literature review of the PubMed and Web of Science databases. These applications significantly improved the quality of anatomy and surgical education and practices. 3D printing produced accurate simulations of patient-specific anatomy, which can then be used for preoperative planning and skill acquisition and demonstrates advantages in cadaveric dissection, plastic models, and plastination of cadaver specimens . We propose that our data is the first retrospective cohort study to identify the efficacy and benefits of 3D printing for SSRF.
3D printing for SSRF is a safe and practical technique because of no complications compared with SSRF. We also proved that it resulted in a significantly shorter operation time and an appropriate incision length.