3D Printing Combined with Osteotomy of the Lateral Tibial Condyle for the Treatment of Tibial Plateau Fractures Involving the Lateral Posterior Condyle

Abstract

The treatment of the fracture of the tibial plateau outside the posterior condyle is always a difficult problem in the clinical work of orthopedic surgeons. In this study, we aim to investigate the clinical effect of 3D printing combined with osteotomy of the tibial lateral condyle in the treatment of tibial plateau fractures involving the external posterior condyle. From January 2012 to February 2020, the data of 94 patients with fracture of tibial plateau external posterior condyle treated by 3D printing combined with osteotomy were retrospectively analyzed, including 38 males and 56 females. The 94 patients were divided into 2 groups (freehand osteotomy group and guided osteotomy group), with 47 patients in each group. All patients received preoperative CT 3D scan, and 3D printing was performed according to the converted data to make a 1 : 1 solid size fracture model. Two groups of patients were treated with anterolateral combined with posteromedial incision intraoperatively, and osteotomy lines were designed according to preoperative 3D model. After surgery, the fracture reduction was evaluated according to the Rasmussen knee scoring standard, and the knee function was evaluated by the Hospital for Special Surgery (HSS) score. One year after operation, the Rasmussen score of the knee joint was 13-18 points, with an average of 15.73 points, among which 66 cases were excellent, 24 cases were good, and 4 cases were fair, with an excellent and good rate of 95.7% (45/47). The HSS score is as follows: 67-94 points, with an average of 82.67 points, among which 62 cases were excellent, 26 cases were good, 4 cases were fair, and 2 cases were poor (joint stiffness caused by refusal of postoperative rehabilitation exercise), with an excellent and good rate of 89.9% (44/47). The range of motion of knee joint was -5°~0°~135°, and the average range of motion was 125.5°. At the last follow-up, there were no serious complications such as common peroneal nerve injury, popliteal vascular injury, postoperative infection, and failure of internal fixation. 3D printing combined with osteotomy of the tibial lateral condyle is an effective method for the treatment of fractures of the tibial plateau external posterior condyle, and the postoperative treatment results are satisfactory. The customized osteotomy guide plate is used for more accurate osteotomy, less injury, and more accurate fixation with support screws.