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Clinical efficacy and biomechanical analysis of 3D-printed guide plate-assisted cannulated screw fixation compared
Chaoqiang Wang1,2, Xiaoyu He2, Zhongyu Zhang2
1Department of Sports Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Background:
Optimal fixation for pelvic and acetabular fractures remains challenging due to competing demands for stability and minimally invasive surgery. This study combined finite element (FE) modeling and a retrospective clinical analysis to compare three fixation strategies.
Methods:
A three-dimensional FE model of a representative both-column acetabular fracture was constructed to compare cannulated screw-only, plate-only, and combined cannulated screw-plate fixation under simulated standing and sitting conditions. Clinically, patients with acetabular fractures treated between November 2021 and May 2023 were retrospectively grouped into 3D-printed guide plate-assisted cannulated screw plus plate (n = 8), conventional cannulated screw plus plate (n = 14), and plate-only fixation (n = 12). Perioperative outcomes, postoperative complications, and 3-month hip function were analyzed with multivariable adjustment.
Results:
FE analysis showed higher stress and displacement under sitting than standing across all constructs, with combined cannulated screw-plate fixation providing better fracture-line displacement control than screw-only fixation, particularly under sitting conditions. Clinically, after multivariable adjustment, the 3D-printed guide group had significantly shorter operative time than the plate-only group and the conventional screw plus plate group (-56.15 min, P = 0.048; -68.46 min, P = 0.031, respectively), lower intraoperative blood loss than the plate-only group (-575.48 mL, P = 0.001), and shorter incision length than the plate-only group (-7.94 cm, P = 0.004). Both the 3D-printed guide group and the conventional screw plus plate group showed significantly lower total hospitalization costs than the plate-only group (-39,944.29 RMB, P = 0.040; -32,527.55 RMB, P = 0.048, respectively). No significant adjusted differences were observed in complication risk, 3-month hip function, or hospital length of stay.
Conclusions:
Combined cannulated screw-plate fixation provides superior biomechanical stability for complex acetabular fractures, while patient-specific 3D-printed guide plate significantly improve perioperative efficiency without compromising short-term safety or functional recovery.
