The following is a summary of “Does a novel 3D printed individualized guiding template based on cutaneous fiducial markers contribute to accurate percutaneous insertion of pelvic screws? A preliminary phantom and cadaver study,” published in the April 2024 issue of Surgery by Tao et al.
In orthopedic surgery, achieving precise percutaneous screw placement for pelvic fractures poses a significant challenge, often requiring invasive techniques and complex instrumentation. This study delves into the innovative realm of three-dimensional (3D) printing technology to explore a novel approach aimed at enhancing accuracy and efficiency in pelvic screw placement. Unlike traditional guiding templates, which typically necessitate soft tissue dissection for alignment, this study introduces a pioneering method leveraging cutaneous fiducial markers. By employing these markers, the guiding template is meticulously customized to the patient’s anatomy, offering a tailored approach that optimizes accuracy while minimizing invasiveness.
The study design encompasses two distinct phases, each meticulously crafted to evaluate the efficacy and feasibility of the novel guiding template. In the initial phase, a series of high-fidelity biomimetic phantom models, meticulously crafted to replicate the complexities of the bony pelvis and surrounding soft tissues, serve as the testing ground. Through the strategic placement of cutaneous fiducial markers and subsequent computed tomography (CT) scanning, personalized templates are meticulously designed to guide screw insertion. Seasoned orthopedic surgeons then undertake the percutaneous insertion of supra-pubic and sacroiliac screws under the guidance of these 3D-printed templates. The accuracy of screw placement is meticulously assessed through postoperative imaging, with deviations between planned and actual screw paths meticulously measured.
Results from this initial phase reveal a remarkable success rate, with all screws being securely implanted within the bony pelvic channels without any breaches of the far cortex. Moreover, analysis of longitudinal and angular deviations showcases a high level of precision in screw placement, affirming the efficacy of the guiding template. Surgeon feedback, gauged through a Likert scale questionnaire, underscores high satisfaction with the innovative technique, further validating its potential clinical utility.
In the subsequent phase, the study protocol is replicated on fresh frozen cadavers to demonstrate the reproducibility and validity of the findings. Consistent with the initial phase, results from cadaveric testing reaffirm the accuracy and feasibility of the novel 3D-printed guiding template. Taken together, these findings underscore the transformative potential of this innovative approach in enhancing the precision and safety of percutaneous pelvic screw placement, thereby paving the way for its broader adoption in clinical practice.
Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02402-6