Feasibility of patient-specific 3D-printed fragment models for preoperative planning in bicondylar tibial plateau fractures: a retrospective case series

Purpose Schatzker type V and VI tibial plateau fractures have complex three-dimensional patterns that complicate surgical planning and coronal alignment restoration. This study assessed the feasibility of patient-specific 3D-printed fragment models for planning combined medial and lateral approaches and described radiographic and functional outcomes. Methods We retrospectively reviewed 22 patients with Schatzker type V or VI fractures treated at Foshan Hospital of Traditional Chinese Medicine from January 2023 to July 2024. Preoperative CT data enabled fragment segmentation, color coding, virtual reduction, and fabrication of patient-specific physical models. Posterior tibial slope, medial proximal tibial angle, articular depression, and tibial plateau width were compared pre- and postoperatively. Rasmussen functional and radiological scores and Knee Society Scores were assessed at 3 and 6 months, 1 year, and final follow-up; complications were recorded. Results All 22 patients completed follow-up (mean, 30.73 ± 3.20 months). A mean of 24.41 ± 2.26 tibial fragments were identified and segmented per patient. Mean articular depression decreased from 6.70 ± 3.07 to 1.74 ± 0.48 mm. Posterior tibial slope, medial proximal tibial angle, and tibial plateau width improved significantly after surgery (all P < 0.001). Mean postoperative coronal alignment was within the predefined normal range in both preoperative varus and valgus subgroups. All three scores differed significantly across follow-up (all P < 0.001). At final follow-up, mean Rasmussen functional and Knee Society Scores were 27.18 ± 1.84 and 87.55 ± 4.92, respectively, with excellent-or-good rates of 100% and 95.45%. Mild post-traumatic knee osteoarthritis, superficial infection, and deep-vein thrombosis occurred in 5, 1, and 2 patients, respectively. No secondary varus or valgus deformity was observed. Conclusions In complex bicondylar tibial plateau fractures, patient-specific 3D-printed fragment models provided a practical three-dimensional reference for fragment identification, reduction sequencing, and planning of combined medial and lateral approaches. Satisfactory articular reduction, maintenance of proximal tibial coronal alignment, and favorable functional outcomes at final follow-up were observed in this cohort. These findings support the feasibility of incorporating 3D-printed fragment models into preoperative planning for these fractures.