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Abstract
To evaluate the use of rapid prototyping in the assessment, classification and preoperative
planning of acetabular fractures.
The complex three-dimensional anatomy of the pelvis and acetabulum make assessment,
classification and treatment of fractures of these structures notoriously difficult.
Conventional imaging only provides two-dimensional images of these fractures. While
interpretation of traditional imaging techniques becomes better with experience, novel
techniques may assist in the understanding of these complex injuries.
Twenty patients with acetabular fractures were studied. Life size three-dimensional
models were manufactured from standardised CT scans, using the rapid prototyping process,
selective laser sintering. Each model was presented to the operating surgeon prior
to surgery. The surgeons found that the models greatly assisted in their understanding
of the personality of the fracture. Three consultant orthopaedic surgeons and three
senior trainees were asked to classify each fracture using conventional radiographs
(AP pelvis, Judet views and CT scans) and then using the model. The kappa statistic
was used to evaluate inter- and intraobserver agreement.
Interobserver agreement was not absolute using either conventional radiographs or
the models. For the consultants the kappa statistic using conventional radiographs
was 0.61 while the kappa value using the model was 0.76 (p<0.05). For the trainees
the kappa value was 0.42, using conventional radiographs and 0.71 using the model
(p<0.01).
Full sized models of acetabular fractures greatly assisted surgeons understand the
personality of complex fractures prior to surgery and have been shown in this study
to significantly reduced the degree of interobserver variability in fracture classification.
This effect is particularly evident for less experienced surgeons. This technique
is available and relatively inexpensive. The use of these models should prove invaluable
as a tool to aid clinical practice.