Abstract
OBJECTIVE: To investigate the clinical efficacy and safety of 3D printing template in the fixation of distal tibial epiphyseal fractures in children. METHODS: A retrospective analysis was conducted on 57 cases of distal tibial epiphyseal fracture admitted to our hospital between January 2017 and January 2023. 27 patients underwent the conventional operative technique (conventional group), while the remaining 30 patients underwent the 3D printing template (3D printing template group). Exclusions comprised patients presenting with pathological fracture, neuromuscular disorder, metabolic disease, prior tibial fracture or instrumentation, and polytrauma. Additionally, individuals with a follow-up duration of less than 12 months or incomplete medical records were excluded. The reduction effect was evaluated using radiographs, and the times of fluoroscopy, operation time, time to union, and complications (such as infection or loss of reduction) were documented. Ankle joint function was assessed by the AOFAS score. RESULTS: A total of 57 patients were divided into two groups: the conventional group, comprising 27 patients (14 males, 13 females), and the 3D printing template group, consisting of 30 patients (19 males, 11 females). Patients in both groups were followed up for at least one year, with an average of 2.3 years (1-3 years). The two groups exhibited no statistically significant differences in terms of sex, age, body weight, mechanism of injury, time from injury to surgery, Salter-Harris classification, or concomitant injuries. There was no significant difference in length of hospital stay, time to union, and limb length discrepancy between the two groups (P > 0.05). However, there was significantly less operative time in the 3D template group compared with the conventional group (P < 0.05). Higher intraoperative fluoroscopy frequency was observed in the conventional group than in the 3D template group (P < 0.001). However, the hospitalization expenses were higher in the 3D template group (3784 ± 315.7 $) than in the conventional group (3449 ± 550.6 $). No infection, nonunion, delayed union, malunion, loss of reduction, or premature epiphyseal closure between the two groups. Tendon adhesions were observed in 10 cases in the conventional group, contrasting with 12 cases in the 3D template group. In the final follow-up, AOFAS scores reflected excellence in 26 cases and goodness in one in the conventional group, while excellence was noted in 28 cases and goodness in two in the 3D template group, culminating in an outstanding rate of 100% for both excellence and goodness. CONCLUSION: The conventional technique and 3D printing template technique both met the treatment requirements of distal tibial epiphyseal fractures. 3D printing guide plate provides a new method for distal tibial epiphyseal fractures with high accuracy and safety compared with traditional method by reducing the times of fluoroscopy and operating time. CLINICAL TRIAL NUMBER: Not applicable.