Simulation Software to Plan the Treatment of Acetabular Fractures: The Patient-Specific Biomechanical Model

Abstract

Objectives: The objective of this study was to assess the impact of using simulation software for preoperative planning: a patient-specific biomechanical model (PSBM) in acetabular surgery. The secondary objectives were to assess operating time, intraoperative bleeding, and peroperative complications. Design: This is a prospective control study. Setting: Level 1 trauma center. Patients/Participants: Between January 2019 and December 2022, patients with operative acetabular fracture treated by the first author were prospectively enrolled. Intervention: Patients were divided into 2 groups according to the use or not of PSBM for preoperative planning. When PSBM was used, data were extracted from the preoperative high-resolution computed tomography scans to build a biomechanical model implemented in a custom software [simulation (SIM group)]. When computed tomography scans were not performed in our hospital, PSBM was not feasible (non-SIM group). Main Outcome Measurements: Radiological results, surgery duration, blood loss, and peroperative complications were recorded. Results: Sixty-six patients were included; 26 in the PSBM group and 40 in the standard group. The 2 groups were comparable regarding fracture patterns and epidemiological data. After simulation, in the SIM group, a poor reduction (>3 mm) was found in 2 of 26 patients (7.7%) versus 11 of 40 patients (27.5%) in the non-SIM group, P = 0.048. The mean operative time was shorter after simulation (110 minutes vs. 155 minutes, P = 0.01), and the mean blood loss was reduced (420 vs. 670 mL, P = 0.01). Conclusions: By reducing the peroperative trials for reduction, PSBM allows better reduction in a shorter operative time and with less blood loss. Level of Evidence: Level II: prospective study.