In this study, the 3D printing and framework fixation of the other fractured ribs were not involved since the approaches of the internal fixation in that region were relatively simple, which had little help on the surgical process. In addition, the increase in 3D printing led to increased medical costs, which would increase the financial burden to patients. High complex rib fractures mainly occur in 2nd to 4th ribs, and often have strong chest muscles coverage in front and multiple fracture segments, making it difficult to reveal visual field and shape locking plate according to the surgeon’s experience. Conventional locking plate fixation requires the incision and the exposure length to be as close as possible to the length of the locking plate, which is not suitable for high complex rib fractures. Therefore, it is of significant to explore minimally invasive surgical methods and adjust the shaping locking plate for high complex rib fractures.
3D printing technology has been widely used in the medical field. Studies have shown that, it is easier to understand the three-dimensional shape of complex fractures with the help of 3D printing models, which is beneficial for preoperative planning, and makes the operation safer and more effective [12, 13]. In this study, the results showed that the length and shape of the locking plate shaped by 3D printing technology fitted well within the ribs and sternum, and the position was accurate without intraoperative adjustment. It saved the steps of intraoperative fracture reduction, as well as visual and empirical repeated shaping of the locking plate that were routinely used at this stage, thereby reducing tissue damage and shortening the operation time. In addition, two small incisions in the chest and underarms were performed in the surgery, instead of the incision through the chest muscles or under breast folds which is currently commonly used , which made the surgical incision greatly reduced and more beautiful. Under the full protection of muscles and neurovasculature, the “frame” structure was successfully established with completed reduction and fixation of each middle fracture section, allowing to reduce the steps of routine surgery on rib fractures and insert and temporarily fix the locking plates. The application of 3D printing and internal fixation technology reduced the operation time and difficulty of the procedure, which were consistent with other studies . Therefore, the combination of 3D printing technology and framework fixation suggested the well-fixed rib fractures, well-fitted locking plate, and decreased probability of postoperative dislocation and screw shedding.
Chest wall pain is a strong and unpleasant subjective sensation in patients with rib fractures, which is related to the dislocation stimulation of rib fractures, release of pain factors, and compression of the intercostal nerves. Studies have shown that controlling of chest pain can not only reduce the patient’s own discomfort, but also prevent various complications such as pneumonia and respiratory limitation . After surgical treatment, the fractured end of the ribs was fixed to avoid the movement of dislocation, and thus relieving the stimulation of the intercostal nerves caused by the fracture. This can significantly reduce the patient’s chest pain, and improve the quality of their life [15, 16]. This study also showed that most patients stopped using analgesic drugs 7 days after surgery, and the patients with chest pain were gradually relieved with time after surgery, indicating a satisfactory analgesic effect of 3D printing combined with framework internal fixation technology.
In summary, pre-shaping locking plate and preoperative planning of high complex rib fractures using the 3D printed rib model and framework fixation technology were feasible and effective in the minimally invasive surgery. This finding has not only solved the difficulty and inaccuracy of shaping locking plate during the surgery, but also simplified the surgical procedures and restored the shape of the thoracic cage perfectly. All patients had significantly reduced the chest pain after the procedure. The limitation of this study is the small sample size, which made it difficult to conduct randomized controlled trials to improve the reliability of the conclusion. Therefore, it is needed to continuously accumulate patient data in the clinic setting to increase the sample size for further research.