CT based Patient Specific 3D printed real size models, a missing link in management of complex fractures around the shoulder

Introduction: Virtual Reality (VR) images are considered reliable for perception of pathological anatomy. Our hypothesis was that CT based 3D printed models provide realistic perception of anatomy and pathology, thus allowing precise preoperative planning and potentially improve intraoperative performance. Our aim was to asses advantages of 3D printed models over VR images in management of complex fractures around the shoulder.

Materials and methods: Five 3D printed models of selected complex Shoulder fractures, 3 Humerus (1 Varus, 1 Valgus and 1 Head Split), 1 Humerus and anterior Glenoid and 1 comminuted Glenoid were assessed. Female/male 2/3, mean age: 51.4.

CT data was processed on Dicom to Print (D2P) software and sent to 3D printer. Initially fractures were assessed by X-Rays, CT with 3D reconstructions and compared with 3D printed models. The images were analyzed and fractures classified accordingly. 3D printed models were analyzed and classified in separate session. In four cases 3D printed model was demonstrated to patients within preoperative informed consent process.

Results: 3D printed models allowed accurate understanding of the fracture configuration and displacement, especially rotational deformities. 2/5 patients were operated when a surgeon could observe the 3D printed models in real time in OR. In one of the operated patients the use of the 3D model changed the pre-operative planning. 3/5 patients declined surgery. 3D printed models allowed straightforward communication with the patients by providing realistic and accurate information regarding the fracture and treatment options.

Conclusion: Patient specific 3D printing can improve procedure planning and selection of treatment strategy, and enhance confidence in real procedure. We believe that 3D printing will become a standard tool in the management of complex fractures understanding by the surgeons and pre-operative planning as well as intra-operative decision making. It improves communication with patients.