Surgical Treatment of an Open Comminuted Fracture of Distal Metaepiphyses of Lower Leg Bones: 3D Planning as a Way to Reduce Traumaticity of the Operation

INTRODUCTION: The article presents a clinical case of surgical treatment of a 74-year-old female patient with the diagnosis: Open comminuted intra-articular fracture of both left leg bones with displacement of fragments. The patient signed an informed consent to use her clinical case for scientific purposes. A peculiarity of the given clinical case was a necessity to perform the surgical operation on an elderly patient with severe concomitant diseases (postinfarction cardiosclerosis, cerebrovascular disease with vestibular ataxia, history of knee arthroplasty on the same side) with minimization of intra- and postoperative risk (reducing the operation time, the extent of injury, intraoperative blood loss, X-ray exposure while maintaining the reposition quality and stable fixation). For this, in preoperative planning, a 3D printed model of the fracture was used, based on the computed tomography data obtained with fixation in an external fixation apparatus. Use of a full-size 3D prototype permitted to select a surgical access taking into account location of key fragments, to select a fixator of a certain shape and size, gave the members of the operating team an opportunity to discuss reposition maneuvers and to tell the patient about the upcoming operation. The article contains a brief description of 3D model manufacture process and discusses the result of the operation and early postoperative results. CONCLUSION: The introduction of 3D printing technology in modern traumatology helps to increase the safety and accuracy of surgical operations and reduce the operation time. Future efforts on routine application of this technology should be directed at reducing cost and increasing the availability of 3D printing.