The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : RESEARCH PAPER

Authors
Pedro K. Beredjiklian 1
Brianna Fram 2
Jason Core 3
Joshua I. Ng 3
Robert Pugliese 4
Stephanie A. Kwan 5
Michael Rivlin 1
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
3D printing
Education
Elbow fracture
Orthopedic surgery
Preoperative planning
Proximal humerus fracture
Subjects
  1. Han RJ, Sing DC, Feeley BT, Ma CB, Zhang AL. Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population. J Shoulder Elbow Surg. 2016; 25(2):256-261. doi:10.1016/j.jse.2015.07.015.
  2. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006; 37(8):691-697. doi:10.1016/j.injury.2006.04.130.
  3. Buckley R, Moran C, Apivatthakakul T, eds. AO Principles of Fracture Management. 3st ed. Georg Thieme Verlag; 2017.
  4. Wu AM, Wang K, Wang JS, et al. The addition of 3D printed models to enhance the teaching and learning of bone spatial anatomy and fractures for undergraduate students: a randomized controlled study. Ann Transl Med. 2018; 6(20):403-403. doi:10.21037/atm.2018.09.59.
  5. Lim PK, Stephenson GS, Keown TW, et al. Use of 3D Printed Models in Resident Education for the Classification of Acetabulum Fractures. J Surg Educ. 2018; 75(6):1679-1684. doi:10.1016/j.jsurg.2018.04.019.
  6. AlAli AB, Griffin MF, Calonge WM, Butler PE. Evaluating the Use of Cleft Lip and Palate 3D-Printed Models as a Teaching Aid. J Surg Educ. 2018; 75(1):200-208. doi:10.1016/j.jsurg.2017.07.023.
  7. Langridge B, Momin S, Coumbe B, Woin E, Griffin M, Butler P. Systematic Review of the Use of 3-Dimensional Printing in Surgical Teaching and Assessment. J Surg Educ. 2018; 75(1):209-221. doi:10.1016/j.jsurg.2017.06.033.
  8. Huang Z, Song W, Zhang Y, et al. Three-dimensional printing model improves morphological understanding in acetabular fracture learning: A multicenter, randomized, controlled study. PLoS One. 2018; 13(1):e0191328. doi:10.1371/journal.pone.0191328.
  9. Yang L, Shang XW, Fan JN, et al. Application of 3D Printing in the Surgical Planning of Trimalleolar Fracture and Doctor-Patient Communication. Biomed Res Int. 2016; 2016:1-5. doi:10.1155/2016/2482086.
  10. Bizzotto N, Sandri A, Regis D, Romani D, Tami I, Magnan B. Three-Dimensional Printing of Bone Fractures: A New Tangible Realistic Way for Preoperative Planning and Education. Surg Innov. 2015; 22(5):548-551. doi:10.1177/1553350614547773.
  11. Zheng W, Tao Z, Lou Y, et al. Comparison of the Conventional Surgery and the Surgery Assisted by 3d Printing Technology in the Treatment of Calcaneal Fractures. J Invest Surg. 2018; 31(6):557-567. doi:10.1080/08941939.2017.1363833.
  12. Starosolski ZA, Kan JH, Rosenfeld SD, Krishnamurthy R, Annapragada A. Application of 3-D printing (rapid prototyping) for creating physical models of pediatric orthopedic disorders. Pediatr Radiol. 2014; 44(2):216-221. doi:10.1007/s00247-013-2788-9.
  13. Mizutani J, Matsubara T, Fukuoka M, et al. Application of full-scale three-dimensional models in patients with rheumatoid

 

       cervical spine. Eur Spine J. 2008; 17(5):644-649. doi:10.1007/s00586-008-0611-3.

  1. Li C, Yang M, Xie Y, et al. Application of the polystyrene model made by 3-D printing rapid prototyping technology for operation planning in revision lumbar discectomy. J Orthop Sci. 2015; 20(3):475-480. doi:10.1007/s00776-015-0706-8.
  2. Campana V, Cardona V, Vismara V, et al. 3D printing in shoulder surgery. Orthop Rev (Pavia). 2020; 12(Suppl 1):8681. doi:10.4081/or.2020.8681.
  3. Hurson C, Tansey A, O’Donnchadha B, Nicholson P, Rice J, McElwain J. Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures. Injury. 2007; 38(10):1158-1162. doi:10.1016/j.injury.2007.05.020.
  4. Maini L, Sharma A, Jha S, Sharma A, Tiwari A. Three-dimensional printing and patient-specific pre-contoured plate: future of acetabulum fracture fixation? Eur J Trauma Emerg Surg. 2018; 44(2):215-224. doi:10.1007/s00068-016-0738-6.
  5. Yang L, Grottkau B, He Z, Ye C. Three dimensional printing technology and materials for treatment of elbow fractures. Int Orthop. 2017; 41(11):2381-2387. doi:10.1007/s00264-017-3627-7.
  6. Xie L, Chen C, Zhang Y, Zheng W, Chen H, Cai L. Three-dimensional printing assisted ORIF versus conventional ORIF for tibial plateau fractures: A systematic review and meta-analysis. Int J Surg. 2018; 57:35-44. doi:10.1016/j.ijsu.2018.07.012.
  7. Chung KJ, Huang B, Choi CH, Park YW, Kim HN. Utility of 3D Printing for Complex Distal Tibial Fractures and Malleolar Avulsion Fractures: Technical Tip. Foot Ankle Int. 2015; 36(12):1504-1510. doi:10.1177/1071100715595695.
  8. Yang L, Shang XW, Fan JN, et al. Application of 3D Printing in the Surgical Planning of Trimalleolar Fracture and Doctor-Patient Communication. Biomed Res Int. 2016; 2016:1-5. doi:10.1155/2016/2482086.
  9. Bagaria V, Chaudhary K. A paradigm shift in surgical planning and simulation using 3Dgraphy: Experience of first 50 surgeries done using 3D-printed biomodels. Injury. 2017; 48(11):2501-2508. doi:10.1016/j.injury.2017.08.058.
  10. Awan OA, Sheth M, Sullivan I, et al. Efficacy of 3D Printed Models on Resident Learning and Understanding of Common Acetabular Fracturers. Acad Radiol. 2019; 26(1):130-135. doi:10.1016/j.acra.2018.06.012.
  11. Kim JW, Lee Y, Seo J, et al. Clinical experience with three-dimensional printing techniques in orthopedic trauma. J Orthop Sci. 2018; 23(2):383-388. doi:10.1016/j.jos.2017.12.010.
  12. Jiang M, Chen G, Coles‐Black J, Chuen J, Hardidge A. Three‐dimensional printing in orthopaedic preoperative planning improves intraoperative metrics: a systematic review. ANZ J Surg. 2020; 90(3):243-250. doi:10.1111/ans.15549.
  13. Wang Q, Hu J, Guan J, Chen Y, Wang L. Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: benefit of pre-contouring plates on a 3D-printed model—a retrospective study. J Orthop Surg Res. 2018; 13(1):203. doi:10.1186/s13018-018-0908-9.
The Archives of Bone and Joint Surgery
Volume 13, Issue 6
June 2025
Pages 337-344

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