Enhancing Preoperative Planning for Pilon Fracture: Clinical Utility of 3D Computer Modeling in Surgical Planning and Internal Fixation – A Case Report

Abstract

Background: A Pilon fracture is a complex ankle fracture that, if not properly reduced, can lead to poor alignment of the articular surface and abnormal widening or narrowing of the ankle mortise. This misalignment may result in traumatic arthritis and severe dysfunction. Therefore, it is crucial to select an appropriate technique to optimally display the anatomy and disease processes. The use of 3D computer modeling in medical procedures has demonstrated promising results in improving surgical outcomes. In this case, we used 3D printing technology to reconstruct the details of a Pilon fracture in a patient and evaluate its application in preoperative planning for fracture repair, as well as its potential role in postoperative communication and follow-up. This study aims to evaluate its application in preoperative planning and fracture repair, as well as its potential role in postoperative communication and follow-up.

Case Presentation: A 54-year-old female was admitted to the Accident & Emergency (A&E) department of ADAN Hospital following high-impact trauma. Non-enhanced Multi-Detector Computed Tomography (MDCT) images of the left foot, acquired using a GE Revolution GSI CT, provided detailed insight into the extent of the injury. The images were captured with a 120 kVp, Smart mA (312-370), slice thickness of 1.25 mm, a 50 cm SFOV, 0.984 pitch, and an exposure time of 500 ms. The images revealed a comminuted fracture involving the distal tibia and fibula, with intra-articular extension into the tibio-talar articulation.

Clinical Discussion: The pixelated quantitative color CT density map (QCTDM) display provided an effective platform to create a global 3D view of the fractured ankle, enabling the precise placement of fixation screws to prevent loosening post-internal fixation. A 3D computer model and prototype were designed, produced, and printed by the authors for preoperative planning. The 3D see-through, 360-degree cross-section of the ankle clearly depicted the embedded fractured pieces, allowing the surgeon to plan an efficient approach for the removal of the broken bone with minimal time. The operative time was reduced by 50% due to thorough preoperative planning and virtual reality practice, leading to faster postoperative recovery.

Conclusions: 3D computer modeling is a valuable tool in the preoperative management of broken ankles requiring internal fixation. It improves surgical precision, reduces operative time, and enhances patient outcomes.