Enhancing Preoperative Planning in Tibial Plateau Fractures: A Comparative Study of 3D Printing's Impact on Surgical Decision-Making

Background: Treatment of complex tibial plateau fractures remains a challenging task in clinical practice. Sufficient and appropriate preoperative decision making is essential for optimal treatment success and ultimately influences patient outcomes. Recently, the novel technique of 3D printing has proven to be beneficial for the preoperative management in other joint regions.

Methods: To investigate the impact of point-of-care 3D printing on the preoperative management of tibial plateau fractures, we asked 5 students, 10 surgical residents, 3 junior surgeons and 5 senior surgeons, to simulate the preoperative planning of 22 tibial plateau fractures (11 AO B and 11 AO C fractures) regarding the treatment concept, patient positioning, operative approach and implant selection and positioning. First with CT scans only, second with 3D volumetric reconstructions, and finally with 3D printed fracture models. We analyzed the inter- and intraobserver agreement and the subjective perceived confidence of the rater regarding his decision with the different imaging modalities across the different levels of professional experience. Statistics were performed using kappa values, percentage match (PM) analysis and a univariate one-way analysis of variance.

Results: The use of 3D printing had no effect on the interobserver reliability of treatment concept selection (PM CT 83% > 3DCT 83% > 3D 82%). However, kappa and percentage match values increased for agreement on patient positioning (k CT 0.25 > 3DCT 0.26 > 3D 0.36; PM CT 46% > 3DCT 36% > 3D 53%) and surgical approach (k CT 0.23 > 3DCT 0.22 > 3D 0.27; PM CT 29% > 3DCT 29% > 3D 33%). In addition, the raters selected the implants that were actually used to treat the fractures in 63% of the cases. The subjective perceived certainty of the raters increased with the use of 3D printing technology from 45% (CT and 3DCT) to 60% (3D). Additionally, raters changed their treatment plan in 36% of the cases and gained additional information 76% of the time when using the 3D printed specimen.

Conclusion: The use of 3D printed fracture models provides a relevant benefit for the preoperative management of tibial plateau fractures. Even experienced surgeons benefit from the haptic impression of the 3D model.