Skip to main content
SpringerLink
Log in

A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Good reduction and appropriate fixation are critical for long bone fractures, however, neither has been addressed satisfactorily. Robotic and navigation techniques can help improve the reduction accuracy. However, their clinical applications are limited by high cost and complexity in operation. The aim of this study was to discuss the feasibility of a customized external fixator in treating long bone fractures.

Methods

We combined a computer-assisted reduction technique with 3D printing to develop a customized external fixator for treating three cases of tibial fractures. The reduction accuracy and fixation results were discussed in terms of operation time, X-ray examinations after operation, and limb function recovery.

Results

Good reduction results were obtained on all three tibial fractures with an average lateral displacement of 2.04 mm (±1.53) and an angulation of 2.54° (±1.33). The surgery was not experience-dependent, and no intra-operative X-ray examinations were conducted. The average operative time was 8.67 minutes (±0.58).

Conclusions

A novel customized external fixator for the treatment of tibial fractures has the advantages of easy manipulation, accurate reduction, appropriate fixation, minimal invasion and experience-independence, and therefore has huge potential in clinical applications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Friedlaender GE, Perry CR, Cole JD, Cook SD, Cierny G, Muschler GF, Zych GA, Calhoun JH, LaForte AJ, Yin S (2001) Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions - A prospective, randomized clinical trial comparing rhOP-1 with fresh bone autograft. J Bone Joint Surg-Am 83A:S151–S158

    Google Scholar 

  2. Phieffer LS, Goulet JA (2006) Delayed unions of the tibia. J Bone Joint Surg-Am 88A:206–216

    Google Scholar 

  3. Bhandari M, Guyatt G, Tornetta P III, Schemitsch EH, Swiontkowski M, Sanders D, Walter SD, Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators (2008) Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg-Am 90A:2567–2578. doi:10.2106/jbjs.g.01694

  4. Lawyer RB, Lubbers LM (1980) Use of the Hoffmann apparatus in the treatment of unstable tibial fractures. J Bone Joint Surg-Am 62:1264–1273

    PubMed  Google Scholar 

  5. Wu JJ, Shyr HS, Chao EYS, Kelly PJ (1984) Comparison of osteotomy healing under external fixation devices with different stiffness characteristics. J Bone Joint Surg-Am 66A:1258–1264

    Google Scholar 

  6. Wilharm A, Gras F, Rausch S, Linder R, Marintschev I, Hofmann GO, Mueckley T (2011) Navigation in femoral-shaft fractures-from lab tests to clinical routine. Injury-Int J Care Injured 42:1346–1352. doi:10.1016/j.injury.2011.06.023

    Article  CAS  Google Scholar 

  7. Koo TKK, Mak AFT (2007) A knowledge-based computer-aided system for closed diaphyseal fracture reduction. Clin Biomech 22:884–893. doi:10.1016/j.clinbiomech.2007.05.005

    Article  Google Scholar 

  8. Kahler DM (2009) Navigated long-bone fracture reduction. J Bone Joint Surg-Am 91A:102–107. doi:10.2106/jbjs.h.01286

  9. Tang P, Hu L, Du H, Gong M, Zhang L (2012) Novel 3D hexapod computer-assisted orthopaedic surgery system for closed diaphyseal fracture reduction. Int J Med Robotics Com Assisted Surg 8:17–24. doi:10.1002/rcs.417

    Article  Google Scholar 

  10. Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta P, Hanson B, Weaver B, Sprague S, Schemitsch EH (2001) Surgeon’s preferences for the operative treatment of fractures of the tibial shaft - An international survey. J Bone Joint Surg-Am 83A:1746–1752

    Google Scholar 

  11. Fleming B, Paley D, Kristiansen T, Pope M (1989) A biomechanical analysis of the Ilizarov external fixator. Clin Orthopaedics Related Res 241:95–105

  12. Narayan B, Marsh DR (2003) (iv) The Ilizarov method in the treatment of fresh fractures. Curr Orthop 17:447–457. doi:10.1016/j.cuor.2003.11.002

    Article  Google Scholar 

  13. Feldman DS, Shin SS, Madan S, Koval KJ (2003) Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor spatial frame. J Orthopaedic Trauma 17:549–554. doi:10.1097/00005131-200309000-00002

    Article  Google Scholar 

  14. Bose S, Vahabzadeh S, Bandyopadhyay A (2013) Bone tissue engineering using 3D printing. Materials Today 16:496–504. doi:10.1016/j.mattod.2013.11.017

    Article  CAS  Google Scholar 

  15. Giovinco NA, Dunn SP, Dowling L, Smith C, Trowell L, Ruch JA, Armstrong DG (2012) A novel combination of printed 3-dimensional anatomic templates and computer-assisted surgical simulation for virtual preoperative planning in Charcot foot reconstruction. J Foot Ankle Surg 51:387–393. doi:10.1053/j.jfas.2012.01.014

    Article  PubMed  Google Scholar 

  16. Qiao F, Li D, Jin Z, Gao Y, Zhou T, He J, Cheng L (2015) Application of 3D printed customized external fixator in fracture reduction. Injury 46:1150–1155. doi:10.1016/j.injury.2015.01.020

    Article  PubMed  Google Scholar 

  17. Leung KS, Cheung WH, Yeung HY, Lee KM, Fung KP (2004) Effect of weightbearing on bone formation during distraction osteogenesis. Clin Orthop Rel Res 419:251–257. DOI 10.1097/01.blo.0000111889.64238.6a

  18. Paley D, Fleming B, Catagni M, Kristiansen T, Pope M (1990) Mechanical evaluation of external fixators used in limb lengthening. Clin Orthop Rel Res 250:50–57

  19. Keast-Butler O, Lutz MJ, Angelini M, Lash N, Pearce D, Crookshank M, Zdero R, Schemitsch EH (2012) Computer navigation in the reduction and fixation of femoral shaft fractures: a randomized control study. Injury-Int J Care Injured 43:749–756. doi:10.1016/j.injury.2011.08.020

    Article  Google Scholar 

  20. Rubin C, Turner AS, Bain S, Mallinckrodt C, McLeod K (2001) Anabolism - Low mechanical signals strengthen long bones. Nature 412:603–604. doi:10.1038/35088122

    Article  CAS  PubMed  Google Scholar 

  21. Hente R, Fuchtmeier B, Schlegel U, Ernstberger A, Perren SM (2004) The influence of cyclic compression and distraction on the healing of experimental tibial fractures. J Orthopaedic Res 22:709–715. doi:10.1016/j.orthres.2003.11.007

    Article  CAS  Google Scholar 

  22. Larsson S, Kim W, Caja VL, Egger EL, Inoue N, Chao EYS (2001) Effect of early axial dynamization on tibial bone healing - A study in dogs. Clin Orthop Rel Res 338:240–251

  23. Li Y, Jiang X, Guo Q, Zhu L, Ye T, Chen A (2014) Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop 38:1261–1267. doi:10.1007/s00264-014-2294-1

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fadel M, Ahmed MA, Al-Dars AM, Maabed MA, Shawki H (2015) Ilizarov external fixation versus plate osteosynthesis in the management of extra-articular fractures of the distal tibia. Int Orthop 39:513–519. doi:10.1007/s00264-014-2607-4

    Article  PubMed  Google Scholar 

  25. Zhao H, Li Z (2015) Is there any difference in the management of extra-articular fractures of the distal tibia using Ilizarov external fixation versus plate osteosynthesis? Int Orthop 39:603–604. doi:10.1007/s00264-015-2681-2

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

No funding was received for the preparation of this manuscript. There have been no conflicts of interest in the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Hong-Hui Hospital, College of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, 710054, China

    Feng Qiao, Dingjun Hao, Yonghua Liao & Sihai Gong

  2. Xi’an Hong Hui Hospital, No.555, Youyidong Rd, Xi’an, Shaanxi, 710054, China

    Feng Qiao

  3. Department of Orthopaedics, Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, 710004, China

    Dichen Li

  4. State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, 710054, China

    Dichen Li & Zhongmin Jin

  5. Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK

    Zhongmin Jin

Authors
  1. Feng Qiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dichen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhongmin Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dingjun Hao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yonghua Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sihai Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Feng Qiao.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qiao, F., Li, D., Jin, Z. et al. A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures. International Orthopaedics (SICOT) 40, 835–841 (2016). https://doi.org/10.1007/s00264-015-2943-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-2943-z

Keywords

Search

Navigation