Published online Feb 18, 2021. doi: 10.5312/wjo.v12.i2.82
Peer-review started: August 6, 2020
First decision: December 3, 2020
Revised: December 8, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: February 18, 2021
There are numerous studies examining the reliability of the Judet-Letounel classification system for acetabular fractures using traditional radiographs and computed tomography (CT). However, 3-dimensional (3-D) printing is an emerging technology that hasn't been thoroughly investigated in the field of orthopedics in terms of imaging and pre-operative planning.
We evaluated the intra and inter-observer reliability of the Judet-Letournel classification system, with respect to fracture classification and preferred surgical approach. We compared the use of 3-D printed models of acetabular fractures to the current standard use of CT scans.
The study aims to illustrate the added value of 3-D printed models as a reliable method to more accurately characterize a patient’s acetabular fracture, and aid in the decision regarding the preferred surgical approach.
Seven patients with acetabular fractures underwent a CT scan with 3-D reconstructions. We then created 3-D printed models of the fractured acetabula. Eighteen trauma surgeons were surveyed to classify each fracture and identify their preferred surgical approach, on two separate occasions, using one of each imaging modality alone.
The inter-observer agreement regarding fracture classification based on CT and 3-D printed models was moderate for both: κ = 0.44 (SE range: 0.0-0.24), and κ = 0.55 (SE range: 0.0-0.22), respectively; this difference was statistically significant (P < 0.001). The inter-observer agreement regarding the preferred surgical approach based on CT and 3-D printed models was fair for both: κ = 0.34, and κ = 0.29 (SE range: 0.0-0.39), respectively; this difference was statistically significant (P < 0.005). The intra-observer agreement regarding fracture classification among all 18 surgeons when comparing the two imaging modalities was moderate: κ = 0.48, as for the preferred surgical approach: κ = 0.41.
3-D printed models improve the inter-observer reliability of the Judet-Letournel classification system, when compared to the use of standard CT scans. However, the inter-observer agreement regarding the surgical approach was decreased, likely due to the added perspective and visualization of the fractures.
3-D printed models improve visuospatial understanding of complex fractures. Its utility and contribution for better patient outcomes should be investigated in future prospective randomized controlled trials.