3D Printed Models of Periarticular Fractures of the Shoulder and Elbow Improve Surgical Decision Making in Orthopedic Trainees

Document Type : RESEARCH PAPER

Authors

1 Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA

2 Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA

3 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA- Thomas Jefferson University Health Design Lab, Philadelphia, PA, USA

4 Thomas Jefferson University Health Design Lab, Philadelphia, PA, USA

5 University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

10.22038/abjs.2024.81232.3707

Abstract

Objectives: Periarticular fractures of the shoulder and elbow are spatially complex injuries that may be 
challenging to interpret on radiographs and advanced imaging. As three-dimensional (3D) printing 
technology has become less expensive and more available, 3D printed fracture models have gained 
attention for use in surgical preparation. In this study, we evaluated the eff ects of 3D printed fracture 
models on orthopedic trainee surgical planning and injury understanding for injuries of the shoulder 
and elbow.
Methods: Models of periarticular fractures of the shoulder and elbow were manufactured by 3D printing at the 
medical school design lab. Eleven Orthopedic trainees viewed X-rays and computed tomography (CT) scans for 
each injury, and completed a preoperative questionnaires. They were then given access to the 3D model of each 
injury, in addition to the previously viewed imaging. They again completed a preoperative plan and questionnaire. 
Preoperative plans were graded for feasibility by a preestablished template. Results were compared for each 
participant with and without the 3D models.
Results: Within all trainees and fractures, trainees were more likely to have feasible preoperative plans when given 
a 3D model, compared to access to x-rays and CT scans alone (74% vs. 62%). In all cases where preoperative 
plans were changed after handling the 3D models (46/77 changed, 60%), they stayed static or improved in feasibility. 
Participants reported significantly improved understanding of injury anatomy (P<0.0001), increased confidence in 
choosing operative positioning and surgical approaches (P<0.0001), desired implants (P=0.011), and better 
conceptualization of how to perform fracture reduction (P=0.0038).
Conclusion: Orthopedic trainees benefit from 3D printed fracture models when performing preoperative planning 
of complex periarticular shoulder and elbow injuries. Given the rarity and difficulty of these injuries, use of this 
technology could allow for shortened learning curves and improved surgical results in the field of orthopedic fracture 
care.
 Level of evidence: IV

Keywords

Main Subjects

References

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The Archives of Bone and Joint Surgery
Volume 13, Issue 6
June 2025
Pages 337-344

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History

  • Receive Date: 03 August 2024
  • Revise Date: 31 October 2024
  • Accept Date: 28 December 2024

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