Case report: The use of three-dimensional biomodels for surgical planning of rib fixation.

Background: Prosthetic titanium plates are frequently used in the stabilization of rib fractures and are typically contoured to the patient's anatomy at the time of implant in the operating room. Smith et al. [17] described the use of a 3D prototype biomodel of his patient's skeletal anatomy for preoperative customization of standard titanium plates for rib fractures. This process facilitated the preoperative planning and provided implants appropriate for a patient's unique anatomy. Further, the approach facilitated repair of complex fractures and may decrease operating time. Besides that, it provides idealized conditions for plate shaping and may facilitate implantation.

Methods: We performed rib fixation combined with 3D biomodels for surgical planning for the first time in Brazil, achieving reduced operating time with a good outcome for our patient.

Results: Surgical planning was conducted one day before the surgery using a 3D printer to make a patient-specific model. The printing time of the model was 16 h. The 3D biomodel was used for simulating the surgical procedure, pre-molding the titanium plates, and measuring the screw sizes that would be used in the procedure. All five fractures were fixed on the 3D biomodel and the total simulation time was 58 min. We used four pre-contoured titanium plates of 1.5 mm thickness and one straight 1.5 mm thickness titanium plate. We used the printed model to measure screw size, as we would do in the surgery. After planning, the material was processed and sterilized according to the hospital standards to be implanted in the patient the following day.

Conclusion: This is the second reported case of surgical stabilization of rib fractures using a 3D model. Both cases demonstrated the advantages of this approach. More studies are needed to validate the safety and benefits for the patient, as well as the impact on cost savings.