Skip to main content

3D Printing in Pre-surgical Planning

Three dimensional printing becomes promising fast prototyping technology utilised on different fields of medicine. The latest achievements of 3D printing may revolutionize existing methods of pre-surgery planning, manufacture of surgical instruments, and creation of patient specific orthopaedic implants. Thanks to additive fabrication techniques CT and MRI images can be transformed into physical models of patient anatomical structures.

Fig. 1 (a) 2D CT scan. (b) 3D Volume rendering. (c) 3D printed replica of an ankle fracture with sterile model on the surgical table for plate testing. Reference  [2].
Fig. 1 (a) CT scan. (b) 3D Volume rendering. (c) 3D printed replica of an ankle fracture with sterile model on the surgical table for plate testing. Reference [2]

Application of 3D models in pre-surgery planning

In old-fashioned pre-surgery planning way surgeon basis on CT or MRI images, i.e. on 2D or 3D imaging. That way may be insufficient to get acquainted with a given pathology or simulate complex surgery.

Owing to utilization of 3D printing technology it is possible to create a three-dimensional model of the anatomical structures of the patient in the real scale. Printed model allows the surgeon to become better acquainted with the anatomy of the patient, and thus a better understanding of the pathology. The graspable model allows to carry out the test surgery, during which the physician can accurately train all cuts on the model, try surgical instruments and plan in details subsequent procedures. It can even more precisely plan complex reconstruction surgery with a help of printed bone models, where the shape or body symmetry may be difficult to maintain.

In details surgery planning enables to avoid any improper decisions results in further health complications that may even put on risk patient’s life. Any procedure performed during a real surgery becomes more reliable, because physicians can use a 3D printed model to improve understanding of fracture by means of tactile and visual experience. Also surgical time may be reduced thanks to use of 3D printed bone’s models. Furthermore a physician can easily explain the patient the surgical procedure and show the result on the model.

Fig. 2 (a) Plate and screw testing on a distal radius fracture. (b) Radial head fracture with sterile model. Reference [2].
Fig. 2 (a) Plate and screw testing on a distal radius fracture. (b) Radial head fracture with sterile model. Reference [2]


Scientific reports confirm[1] that the use of printed models obtained from CT screening on the stage of pre-surgery planning significantly improve the understanding of the pathology. 3D models usage allows to perform more precise pre-surgery planning, template and surgical instruments testing and titan’s plate positioning.

Surgeons from Swiss and several Italy clinics specialised in orthopaedic and traumatology in [2] present their 2 years’ experience with 3D printed models. Anatomical models were used to plan among others a reconstruction of articular fractures of 102 patients of orthopaedic and traumatology wards. Physicians have agreed that the application of the 3D printings illustrating the traumas allows them to more precisely evaluate and plan procedure and consequently shorten its duration. Patients responded enthusiastically to usage of the 3D printing technology to illustrate their trauma. There was a substantial improvement in comprehension of the fracture after seeing the 3D printed models. Besides the models were used as didactic resources in a clinic to improve young residents awareness of a trauma and surgical techniques. Many times models were used to test the appropriate screw length and orientation or plate positioning. During surgery the sterilized models were put in the operating theatre, to enable a physician to have an improved sense of spatial orientation. Surgeon’s experience confirmed proper use of 3D printings to illustrate the fractures of a type B and C of the AO classification.

The application of 3D printing to plan orthopaedic and trauma surgery is not as common, which is due to the difficulties in organizing all the steps of the workflow. However work is under way to introduce this stage as a mandatory step.

The 3D printing usage in the pre-surgery planning is a small step in the future of the personalized medicine and contribute to the quality improvement of the health system.[2]

[1] Eltorai A., Nguyen E., Daniels A. Three-Dimensional Printing in Orthopedic Surgery. 2015; doi: 10.3928/01477447-20151016-05
[2] Bizzoto N., Tami I., Santucci A., Adani R., Poggi P., Romani D., Carpeggiani G., Ferraro F., Festa S., Magnan B. 3D Printed replica of articular fractures for sugical planning and patient consent: A two year multi-centric experience. 2016; doi: 10.1186/s41205-016-0006-8