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.	吳永偉, 劉軍, 芮永軍, 等. 自制尖齒鉤鋼板治療撕脫性骨折的療效評價. 中國現代醫學雜志, 2017, 27(4): 131-134.
5.	陳宇, 張暉, 黃富國, 等. 外踝鉤鋼板在Ⅱ度旋后-內收型內踝骨折中的應用. 中國修復重建外科雜志, 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.	趙宏謀, 張言, 胡東, 等. 支撐鋼板與螺釘固定治療旋后-內收型Ⅱ度踝關節骨折的比較研究. 中國修復重建外科雜志, 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.	湯樣華, 曾林如, 徐燦達, 等. 旋前-外旋型Ⅲ度踝關節骨折的手術治療. 中國修復重建外科雜志, 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.	劉軍, 芮永軍, 吳永偉, 等. 自制齒狀鉤鋼板治療后交叉韌帶脛骨止點撕脫骨折.中國修復重建外科雜志, 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.	林偉文, 賴茂松, 熊浩, 等. H 型微型鈦板治療肱三頭肌腱止點斷裂療效觀察. 中國修復重建外科雜志, 2013, 27(12): 1533-1534.
15.	殷渠東, 顧三軍, 劉軍, 等. 尖齒開口鉤鋼板治療尺骨鷹嘴骨折療效觀察. 中國修復重建外科雜志, 2016, 30(9): 1094-1097.
16.	王滿宜, 王軍強. 計算機輔助骨科手術在創傷骨科中的應用. 中華骨科雜志, 2006, 26(10): 703-706.
17.	楊志明. 加快發展 3-D 打印技術、擴展修復重建外科應用領域. 中國修復重建外科雜志, 2014, 28(3): 265.
18.	魏代清, 李翠, 徐楊博. 3-D 打印技術在足踝外科的應用進展. 中國修復重建外科雜志, 2017, 31(7): 880-884.
19.	夏勝利, 王秀會, 付備剛, 等. 計算機輔助術前計劃在踝關節骨折手術中的應用價值. 中國修復重建外科雜志, 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.	張云, 楊云峰. 踝關節骨折合并急性三角韌帶損傷的診斷和治療進展. 中國修復重建外科雜志, 2017, 31(5): 624-628.
26.	王海鵬, 顧崢嶸, 劉云吉, 等. 手術治療踝關節骨折伴三角韌帶損傷的療效觀察. 中國修復重建外科雜志, 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.	王江濤, 申學振, 劉暢, 等. 縫線領帶結套扎固定脛骨髁間嵴撕脫骨折的生物力學研究. 中國修復重建外科雜志, 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. 吳永偉, 劉軍, 芮永軍, 等. 自制尖齒鉤鋼板治療撕脫性骨折的療效評價. 中國現代醫學雜志, 2017, 27(4): 131-134.
5. 陳宇, 張暉, 黃富國, 等. 外踝鉤鋼板在Ⅱ度旋后-內收型內踝骨折中的應用. 中國修復重建外科雜志, 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. 趙宏謀, 張言, 胡東, 等. 支撐鋼板與螺釘固定治療旋后-內收型Ⅱ度踝關節骨折的比較研究. 中國修復重建外科雜志, 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. 湯樣華, 曾林如, 徐燦達, 等. 旋前-外旋型Ⅲ度踝關節骨折的手術治療. 中國修復重建外科雜志, 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. 劉軍, 芮永軍, 吳永偉, 等. 自制齒狀鉤鋼板治療后交叉韌帶脛骨止點撕脫骨折.中國修復重建外科雜志, 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. 林偉文, 賴茂松, 熊浩, 等. H 型微型鈦板治療肱三頭肌腱止點斷裂療效觀察. 中國修復重建外科雜志, 2013, 27(12): 1533-1534.
15. 殷渠東, 顧三軍, 劉軍, 等. 尖齒開口鉤鋼板治療尺骨鷹嘴骨折療效觀察. 中國修復重建外科雜志, 2016, 30(9): 1094-1097.
16. 王滿宜, 王軍強. 計算機輔助骨科手術在創傷骨科中的應用. 中華骨科雜志, 2006, 26(10): 703-706.
17. 楊志明. 加快發展 3-D 打印技術、擴展修復重建外科應用領域. 中國修復重建外科雜志, 2014, 28(3): 265.
18. 魏代清, 李翠, 徐楊博. 3-D 打印技術在足踝外科的應用進展. 中國修復重建外科雜志, 2017, 31(7): 880-884.
19. 夏勝利, 王秀會, 付備剛, 等. 計算機輔助術前計劃在踝關節骨折手術中的應用價值. 中國修復重建外科雜志, 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. 張云, 楊云峰. 踝關節骨折合并急性三角韌帶損傷的診斷和治療進展. 中國修復重建外科雜志, 2017, 31(5): 624-628.
26. 王海鵬, 顧崢嶸, 劉云吉, 等. 手術治療踝關節骨折伴三角韌帶損傷的療效觀察. 中國修復重建外科雜志, 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. 王江濤, 申學振, 劉暢, 等. 縫線領帶結套扎固定脛骨髁間嵴撕脫骨折的生物力學研究. 中國修復重建外科雜志, 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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