A versatile three-dimensional printing-technology-based digital design and experimental study for acetabular fracture surgery

The aim of this study was to investigate a versatile digital design platform for acetabular fracture reduction with internal fixation, and its specific implementation and evaluation. Fourteen adult cadaveric pelvises were selected, scanned using thin-section CT scans, and subjected to virtual fracture modeling to induce 28 fractures. The folding module was cut and printed three-dimensionally and the reconstructed steel plate was precisely prebent accordingly before implantation in the optimized position in the cadaver. The 3-dimensional (3D) images were reconstructed and 3D registration of pelvises was implemented pre- and postoperatively. The 3D coordinates of both preoperative design and postoperative screw channel entry points were collected and the difference of the eligible nail points at 2 different precision levels was statistically analyzed usingthe chi-square test. Results showed that Sixty-four pre-bent steel plates were implanted during surgery and achieved full card-bit unique position, with anchor point precision of >= 1.3 mm (chi(2)=2.26; P>0.05) for 335 eligible screw entry points. In conclusion, the application of digital design and 3D printing allows the doctors to perform virtual reduction and pre-design the personalized steel plate. The pre-curved personalized steel plate could guide the reduction of acetabular fracture and achieve full card-bit unique position with high precision.