Use of Three-dimensional Printing for Tibial Pilon Fracture Diagnosis and Treatment

Wustro, Leonardo; Silva, João Luiz Vieira da; Moura, Bruno Arnaldo Bonacin; Schoenberger, Helena Squizatto; Takito, Debora; D'Agostini, Júlio César Honório

doi:10.1055/s-0044-1785514

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Revista Brasileira de Ortopedia

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Original Article • Rev bras ortop 59 (3) • 2024 • https://doi.org/10.1055/s-0044-1785514 copy

Use of Three-dimensional Printing for Tibial Pilon Fracture Diagnosis and Treatment

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate whether three-dimensional (3D) printing increases agreement in the classification of tibial pilon fractures.

Methods

Orthopedists and traumatologists reviewed radiographs, computed tomography scans with 3D reconstruction, and prototyping 3D printing, and classified the fractures based on the Rüedi-Allgöwer and Arbeitsgemeinschaft für Osteosynthesefragen (AO, Association for the Study of Internal Fixation) Foundation/Orthopedic Trauma Association (AO/OTA) classification systems. Next, data evaluation used Kappa agreement coefficients.

Results

The use of the 3D model did not improve agreement for tibial pilon fractures regarding the treatment proposed by the groups. Regarding the classification systems, the agreement only improved concerning the AO/OTA classification when the 3D model was used in the assessment by the foot and ankle specialists.

Conclusion

Although 3D printing is statistically relevant for surgeons specializing in foot and ankle, its values remain lower than optimal.

Keywords
fractures, bone; printing, three-dimensional; tibial fractures

Image	Physicians	Agreement among physicians (%)	Kappa coefficient	95% confidence interval	p-value
Radiograph	General	43.9%	0.307	0–0.697	0.141
	Residents	47.0%	0.340	0–0.841	0.310
	Orthopedists	33.3%	0.176	0–0.576	0.211
	Foot specialists	38.9%	0.245	0–0.683	0.019
Computed tomography	General	31.3%	0.154	0.039–0.269	0.007
	Residents	24.4%	0.049	0.021–0.078	0.135
	Orthopedists	44.4%	0.256	0–0.625	0.055
	Foot specialists	50.0%	0.348	0–0.709	0.015
3D computed tomography	General	34.9%	0.208	0.060–0.356	0.062
	Residents	30.4%	0.158	0–0.327	0.087
	Orthopedists	41.7%	0.266	0–0.589	0.016
	Foot specialists	36.1%	0.200	0.055–0.345	0.063
3D model	General	43.6%	0.282	0–0.586	0.150
	Residents	41.1%	0.267	0–0.670	0.062
	Orthopedists	47.2%	0.306	0–0.634	0.017
	Foot specialists	63.9%	0.450	0.122–0.778	0.098

Image	Physicians	Agreement among physicians (%)	Kappa coefficient	95% confidence interval	p-value
Radiograph	General	61.3%	0.415	0–0.892	0.076
	Residents	57.1%	0.347	0–0.840	0.130
	Orthopedists	55.6%	0.323	0–0.955	0.247
	Foot specialists	72.2%	0.556	0–1	0.064
Computed tomography	General	52.2%	0.196	0–0.430	0.083
	Residents	48.8%	0.094	0–0.328	0.348
	Orthopedists	52.8%	0.186	0–0.685	0.383
	Foot specialists	69.4%	0.385	0–1	0.216
3D computed tomography	General	49.3%	0.204	0–0.432	0.070
	Residents	46.4%	0.176	0–0.40	0.100
	Orthopedists	50.0%	0.168	0–0.559	0.321
	Foot specialists	50.0%	0.127	0–0.587	0.509
3D model	General	56.8%	0.304	0.004–0.605	0.048
	Residents	58.3%	0.369	0–0.831	0.095
	Orthopedists	63.9%	0.329	0–0.841	0.159
	Foot specialists	66.7%	0.329	0–0.706	0.076

Image	Physicians	Agreement among physicians (%)	Kappa coefficient	95% confidence interval	p-value
Radiograph	General	78.6%	0.311	0.216–0.406	< 0.001
	Residents	76.9%	0.233	0.115–0.351	< 0.001
	Orthopedists	79.9%	0.371	0.219–0.522	< 0.001
	Foot specialists	80.6%	0.390	0.212–0.569	< 0.001
Computed tomography	General	72.9%	0.181	0.109–0.254	< 0.001
	Residents	73.1%	0.133	0.063–0.203	< 0.001
	Orthopedists	72.5%	0.238	0.090–0.387	0.002
	Foot specialists	79.3%	0.393	0.227–0.558	< 0.001
3D computed tomography	General	74.0%	0.167	0.106–0.228	< 0.001
	Residents	72.9%	0.084	0.018–0.149	0.014
	Orthopedists	77.2%	0.271	0.157–0.384	< 0.001
	Foot specialists	73.2%	0.211	0.054–0.369	0.009
3D model	General	72.6%	0.168	0.091–0.246	< 0.001
	Residents	70.8%	0.093	0.001–0.186	0.048
	Orthopedists	76.5%	0.277	0.116–0.438	0.001
	Foot specialists	73.2%	0.234	0.083–0.386	0.003

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Helena Squizatto Schoenberger, Hospital da Santa Casa de Curitiba, Praça Rui Barbosa 694, Curitiba, PR, Zip Code 80010-030, Brazil (e-mail: helenass@unesc.net).