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Acetabular Fracture Repair Using Patient-Specific Osteosynthesis Plates and Drilling Guides

Achieving optimal articular surface reconstruction in acetabular fracture surgery decreases osteoarthritis risk and subsequent need for total hip arthroplasty. Currently, osteosynthesis plates to which fractured bone segments are fixed need to be manually contoured intraoperatively, often resulting in inadequate reduction and fixation. This video illustrates a process of fast-track 3-dimensional (3-D) virtual planning and synthesis of patient-specific osteosynthesis plates for complex acetabular fracture surgery.1. Computed tomography data are used to create a 3-D model. Each fracture fragment is assigned a different color and reduced to its anatomical position by using translational and rotational tools in the planning software. The contralateral hemipelvis is mirrored and used as a template to verify the accuracy of the virtual fracture reduction.2. Patient-specific osteosynthesis plates, tailored from the virtually reduced 3-D fracture model, are designed to achieve optimal support and stable internal fixation of fracture fragments. Drilling guides are designed to translate the virtual planning to the surgical procedure and guide the drill bit as well as the screws in the right direction.3. Custom-designed patient-specific osteosynthesis plates are manufactured, milled out of a medical-grade titanium alloy by a 5-axis milling machine, with drilling guides 3-D laser-printed from medical-certified polyamide powder.4. Standard fracture reduction is performed, during which patient-specific osteosynthesis plates are applied to put or keep the fracture fragments in place. Drilling guides are placed on top of the osteosynthesis plate to help aim the drill bit correctly.5. A postoperative computed tomography scan evaluates the accuracy of the acetabular reconstruction and screw positioning and is used to create a 3-D model of the reconstructed pelvis, which is matched with the preoperative 3-D surgical planning to assess the accuracy of the preoperative plan.Click the Related Article link for complete details.

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