Application of three-dimensional printing technology in treatment of internal or external ankle distal avulsed fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHI Weixiang ¹ ,  LUO Xiaozhong ² , WU Gang ³ , DING Yong ³ , ZHOU Xin ³

1. Clinical Medical Academy of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Orthopedics, the First Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
3. Department of Orthopedics, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P.R.China;

Corresponding author：

LUO Xiaozhong, Email: luoxiaozhonglxz@sina.cn

Keywords：

Ankle; avulsed fracture; three-dimensional printing technology; shape-blocking steel plate; internal fixation

DOI：

10.7507/1002-1892.201710086

Video：

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ObjectiveTo explore the effectiveness and advantage of three-dimensional (3D) printing technology in treatment of internal or external ankle distal avulsed fracture.MethodsBetween January 2015 and January 2017, 20 patients with distal avulsed fracture of internal or external ankle were treated with the 3D guidance of shape-blocking steel plate fixation (group A), and 18 patients were treated with traditional plaster external fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, fracture side, and fracture type between 2 groups (P>0.05). Recording the fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, residual ankle pain, and evaluating ankle function recovery of both groups by the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsAll patients were followed up 8-24 months, with an average of 15.5 months. In group A: all incisions healed by first intention, the time of starting to ankle functional exercise was (14±3) days, fracture healing rate was 100%, and the fracture healing time was (10.15±2.00) weeks. At 6 months, the AOFAS score was 90.35±4.65. Among them, 13 patients were excellent and 7 patients were good. All patients had no post-operative incision infection, residual ankle pain, or dysfunction during the follow-up. In group B: the time of starting to ankle functional exercise was (40±10) days, the fracture healing rate was 94.44%, and the fracture healing time was (13.83±7.49) weeks. At 6 months, the AOFAS score was 79.28±34.28. Among them, 15 patients were good, 2 patients were medium, and 1 patient was poor. During the follow-up, 3 patients (16.67%) had pain of ankle joint with different degrees. There were significant differences in the postoperative fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, and postoperative AOFAS score between 2 groups (P<0.05).ConclusionApplication of 3D printing technology in treatment of internal or external ankle distal avulsed fracture is simple, safe, reliable, and effective. In particular, it is an ideal treatment for avulsed fracture.

Citation： SHI Weixiang, LUO Xiaozhong, WU Gang, DING Yong, ZHOU Xin. Application of three-dimensional printing technology in treatment of internal or external ankle distal avulsed fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 187-191. doi: 10.7507/1002-1892.201710086 Copy

1.	Christey GR, Tomlinson M. Risk factors for ankle fracture requiring operative fixation. Aust N Z J Surg, 1999, 69(3): 220-223.
2.	Swart E, Bezhani H, Greisberg J, et al. How long should patients be kept non-weight bearing after ankle fracture fixation? A survey of OTA and AOFAS members. Injury, 2015, 46(6): 1127-1132.
3.	Ackermann J, Fraser EJ, Murawski CD, et al. Trends of concurrent ankle arthroscopy at the time of operative treatment of ankle fracture. Foot Ankle Spec, 2016, 9(2): 107-112.
4.	吴永伟, 刘军, 芮永军, 等. 自制尖齿钩钢板治疗撕脱性骨折的疗效评价. 中国现代医学杂志, 2017, 27(4): 131-134.
5.	陈宇, 张晖, 黄富国, 等. 外踝钩钢板在Ⅱ度旋后-内收型内踝骨折中的应用. 中国修复重建外科杂志, 2014, 28(9): 1077-1081.
6.	Nguyentat A, Camisa W, Patel S, et al. A biomechanical comparison of locking versus conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. J Foot Ankle Surg, 2016, 55(1): 132-135.
7.	赵宏谋, 张言, 胡东, 等. 支撑钢板与螺钉固定治疗旋后-内收型Ⅱ度踝关节骨折的比较研究. 中国修复重建外科杂志, 2017, 31(5): 553-558.
8.	Downey MW, Kyle D, Victor K, et al. Comparing the knotless tension band and the traditional stainless steel wire tension band fixation for medial malleolus fractures: A retrospective clinical study. Scientifica (Cairo), 2016, (2016): 3201678.
9.	汤样华, 曾林如, 徐灿达, 等. 旋前-外旋型Ⅲ度踝关节骨折的手术治疗. 中国修复重建外科杂志, 2017, 31(1): 31-35.
10.	Jason TB, Amanda F, Brad B, et al. A biomechanical evaluation of locked plating for distal fibula fractures in an osteoporotic sawbone model. J Foot Ankle Surg, 2014, 20(1): 44-47.
11.	Paul JS, Daniel F, Mohammed A, et al. A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures. J Foot Ankle Surg, 2016, 11(1): 435-445.
12.	刘军, 芮永军, 吴永伟, 等. 自制齿状钩钢板治疗后交叉韧带胫骨止点撕脱骨折.中国修复重建外科杂志, 2017, 31(6): 765-767.
13.	Sands A, White C, Blankstein M, et al. Assessment of ankle and hindfoot stability and joint pressures using a human cadaveric model of a large lateral talar process: a biomechanical study. Medicine (Baitimore), 2015, 94(11): e606.
14.	林伟文, 赖茂松, 熊浩, 等. H 型微型钛板治疗肱三头肌腱止点断裂疗效观察. 中国修复重建外科杂志, 2013, 27(12): 1533-1534.
15.	殷渠东, 顾三军, 刘军, 等. 尖齿开口钩钢板治疗尺骨鹰嘴骨折疗效观察. 中国修复重建外科杂志, 2016, 30(9): 1094-1097.
16.	王满宜, 王军强. 计算机辅助骨科手术在创伤骨科中的应用. 中华骨科杂志, 2006, 26(10): 703-706.
17.	杨志明. 加快发展 3-D 打印技术、扩展修复重建外科应用领域. 中国修复重建外科杂志, 2014, 28(3): 265.
18.	魏代清, 李翠, 徐杨博. 3-D 打印技术在足踝外科的应用进展. 中国修复重建外科杂志, 2017, 31(7): 880-884.
19.	夏胜利, 王秀会, 付备刚, 等. 计算机辅助术前计划在踝关节骨折手术中的应用价值. 中国修复重建外科杂志, 2015, 29(12): 1469-1473.
20.	Boutis K, Narayanan UG, Dong FF, et al. Magnetic resonance imaging of clinically suspected Salter-Harris I fracture of the distal fibula. Injury, 2010, 41(8): 852-856.
21.	Nguyentat A, Camisa W, Patel S, et al. A biomechanical comparison of locking versus conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. J Foot Ankle Surg, 2016, 55(1): 132-135.
22.	Michael CF, Kelsey Y, Elizabeth C, et al. Most readmissions following ankle fracture surgery are unrelated to surgical site issues: An analysis of 5,056 cases. Foot & Ankle Orthopaedics, 2016, 1(1): 2473011416S0023.
23.	Vamsi KS, Anoop P, Sudhir N, et al. Traumatic rupture of posterior tibial tendon following closed supination-adduction ankle fracture: A case report. JBJS Case Connector, 2016, 6(3): e75.
24.	Belmont PJ, Davey S, Rensing N, et al. Patient-based and surgical risk factors for 30-day postoperative complications and mortality after ankle fracture fixation. J Orthop Trauma, 2015, 29(12): e476-482.
25.	张云, 杨云峰. 踝关节骨折合并急性三角韧带损伤的诊断和治疗进展. 中国修复重建外科杂志, 2017, 31(5): 624-628.
26.	王海鹏, 顾峥嵘, 刘云吉, 等. 手术治疗踝关节骨折伴三角韧带损伤的疗效观察. 中国修复重建外科杂志, 2015, 29(4): 416-419.
27.	Song JW, Lee HS, Sang GS, et al. Clinical outcome after early rehabilitation according to injury type in ankle fracture. J Korean Foot Ankle Soc, 2017, 21(1): 21-24.
28.	Miyamura S, Ota H, Okamoto M, et al. Surgical treatment of calcaneal avulsion fracture in elderly patients using cannulated cancellous ccrews and titanium wire. J Foot Ankle Surg, 2016, 55(1): 157-160.
29.	王江涛, 申学振, 刘畅, 等. 缝线领带结套扎固定胫骨髁间嵴撕脱骨折的生物力学研究. 中国修复重建外科杂志, 2015, 29(9): 1080-1083.
30.	Khazen GE, Wilson AN, Ashfaq S, et al. Fixation of calcaneal avulsion fractures using screws with and without suture anchors: a biomechanical investigation. Foot Ankle Int, 2007, 28(11): 1183-1186.
31.	Angthong C. Ankle fracture configuration following treatment with and without arthroscopic-assisted reduction and fixation. World J Orthop, 2016, 7(4): 258-264.

1. Christey GR, Tomlinson M. Risk factors for ankle fracture requiring operative fixation. Aust N Z J Surg, 1999, 69(3): 220-223.
2. Swart E, Bezhani H, Greisberg J, et al. How long should patients be kept non-weight bearing after ankle fracture fixation? A survey of OTA and AOFAS members. Injury, 2015, 46(6): 1127-1132.
3. Ackermann J, Fraser EJ, Murawski CD, et al. Trends of concurrent ankle arthroscopy at the time of operative treatment of ankle fracture. Foot Ankle Spec, 2016, 9(2): 107-112.
4. 吴永伟, 刘军, 芮永军, 等. 自制尖齿钩钢板治疗撕脱性骨折的疗效评价. 中国现代医学杂志, 2017, 27(4): 131-134.
5. 陈宇, 张晖, 黄富国, 等. 外踝钩钢板在Ⅱ度旋后-内收型内踝骨折中的应用. 中国修复重建外科杂志, 2014, 28(9): 1077-1081.
6. Nguyentat A, Camisa W, Patel S, et al. A biomechanical comparison of locking versus conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. J Foot Ankle Surg, 2016, 55(1): 132-135.
7. 赵宏谋, 张言, 胡东, 等. 支撑钢板与螺钉固定治疗旋后-内收型Ⅱ度踝关节骨折的比较研究. 中国修复重建外科杂志, 2017, 31(5): 553-558.
8. Downey MW, Kyle D, Victor K, et al. Comparing the knotless tension band and the traditional stainless steel wire tension band fixation for medial malleolus fractures: A retrospective clinical study. Scientifica (Cairo), 2016, (2016): 3201678.
9. 汤样华, 曾林如, 徐灿达, 等. 旋前-外旋型Ⅲ度踝关节骨折的手术治疗. 中国修复重建外科杂志, 2017, 31(1): 31-35.
10. Jason TB, Amanda F, Brad B, et al. A biomechanical evaluation of locked plating for distal fibula fractures in an osteoporotic sawbone model. J Foot Ankle Surg, 2014, 20(1): 44-47.
11. Paul JS, Daniel F, Mohammed A, et al. A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures. J Foot Ankle Surg, 2016, 11(1): 435-445.
12. 刘军, 芮永军, 吴永伟, 等. 自制齿状钩钢板治疗后交叉韧带胫骨止点撕脱骨折.中国修复重建外科杂志, 2017, 31(6): 765-767.
13. Sands A, White C, Blankstein M, et al. Assessment of ankle and hindfoot stability and joint pressures using a human cadaveric model of a large lateral talar process: a biomechanical study. Medicine (Baitimore), 2015, 94(11): e606.
14. 林伟文, 赖茂松, 熊浩, 等. H 型微型钛板治疗肱三头肌腱止点断裂疗效观察. 中国修复重建外科杂志, 2013, 27(12): 1533-1534.
15. 殷渠东, 顾三军, 刘军, 等. 尖齿开口钩钢板治疗尺骨鹰嘴骨折疗效观察. 中国修复重建外科杂志, 2016, 30(9): 1094-1097.
16. 王满宜, 王军强. 计算机辅助骨科手术在创伤骨科中的应用. 中华骨科杂志, 2006, 26(10): 703-706.
17. 杨志明. 加快发展 3-D 打印技术、扩展修复重建外科应用领域. 中国修复重建外科杂志, 2014, 28(3): 265.
18. 魏代清, 李翠, 徐杨博. 3-D 打印技术在足踝外科的应用进展. 中国修复重建外科杂志, 2017, 31(7): 880-884.
19. 夏胜利, 王秀会, 付备刚, 等. 计算机辅助术前计划在踝关节骨折手术中的应用价值. 中国修复重建外科杂志, 2015, 29(12): 1469-1473.
20. Boutis K, Narayanan UG, Dong FF, et al. Magnetic resonance imaging of clinically suspected Salter-Harris I fracture of the distal fibula. Injury, 2010, 41(8): 852-856.
21. Nguyentat A, Camisa W, Patel S, et al. A biomechanical comparison of locking versus conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. J Foot Ankle Surg, 2016, 55(1): 132-135.
22. Michael CF, Kelsey Y, Elizabeth C, et al. Most readmissions following ankle fracture surgery are unrelated to surgical site issues: An analysis of 5,056 cases. Foot & Ankle Orthopaedics, 2016, 1(1): 2473011416S0023.
23. Vamsi KS, Anoop P, Sudhir N, et al. Traumatic rupture of posterior tibial tendon following closed supination-adduction ankle fracture: A case report. JBJS Case Connector, 2016, 6(3): e75.
24. Belmont PJ, Davey S, Rensing N, et al. Patient-based and surgical risk factors for 30-day postoperative complications and mortality after ankle fracture fixation. J Orthop Trauma, 2015, 29(12): e476-482.
25. 张云, 杨云峰. 踝关节骨折合并急性三角韧带损伤的诊断和治疗进展. 中国修复重建外科杂志, 2017, 31(5): 624-628.
26. 王海鹏, 顾峥嵘, 刘云吉, 等. 手术治疗踝关节骨折伴三角韧带损伤的疗效观察. 中国修复重建外科杂志, 2015, 29(4): 416-419.
27. Song JW, Lee HS, Sang GS, et al. Clinical outcome after early rehabilitation according to injury type in ankle fracture. J Korean Foot Ankle Soc, 2017, 21(1): 21-24.
28. Miyamura S, Ota H, Okamoto M, et al. Surgical treatment of calcaneal avulsion fracture in elderly patients using cannulated cancellous ccrews and titanium wire. J Foot Ankle Surg, 2016, 55(1): 157-160.
29. 王江涛, 申学振, 刘畅, 等. 缝线领带结套扎固定胫骨髁间嵴撕脱骨折的生物力学研究. 中国修复重建外科杂志, 2015, 29(9): 1080-1083.
30. Khazen GE, Wilson AN, Ashfaq S, et al. Fixation of calcaneal avulsion fractures using screws with and without suture anchors: a biomechanical investigation. Foot Ankle Int, 2007, 28(11): 1183-1186.
31. Angthong C. Ankle fracture configuration following treatment with and without arthroscopic-assisted reduction and fixation. World J Orthop, 2016, 7(4): 258-264.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional printing technology in treatment of internal or external ankle distal avulsed fracture

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