Virtual 3D Surgical Planning for Tibial Plateau Fractures: A Multicenter Prospective Randomized Controlled Trial

Patients with tibial plateau fractures are traditionally challenging to treat, especially the complex fracture patterns in which anatomic reconstruction of the articular surface can be very demanding. In a previous study, the researchteam showed that surgical decision-making should be guided by recognition of specific fracture characteristics, rather than the 'classic' classification of fractures by Schatzker. Recognition of these specific tibial plateau fracture patterns has been proven reliable and reproducible to guide surgeons plan their approach, reduction techniques and fixation.

Building on our improved understanding of (complex) tibial plateau fracture patterns, and how these specific fracture characteristics guide our surgical management, the next step includes meticulous pre-operative surgical planning to achieve the best functional results for our patients. A new state-of-the-art tool is currently available to aid surgeons in 3D virtual planning of approach, reduction strategy, and even application of hardware (i.e. size of plates and lengths of screws (https://sectra.com/medical/product/sectra-3d-trauma/).

Recent studies on virtual surgical planning for fracture care have shown variable results. One study concluded that there was a significant reduction in duration of surgery in about 75.0% of all cases. Another study showed improvement of the outcomes of acetabular fracture surgery by reduced duration of the surgery and improved quality of the reduction. However, a third study showed that 3D virtual reality is inferior compared to 3D printed models on acetabular fractures in terms of interobserver agreement. In conclusion, the added value of virtual preoperative planning has yet to be determined.

If virtual surgical planning is as promising as some of the previous results show, it could also have a significant impact on the surgical reduction in the treatment of tibial plateau fractures. This might lead to a reduction of duration of surgery, less complications and better patient related outcomes, such as postoperative pain and knee function.

Therefore, the investigators would like to compare the conventional preoperative planning with the preoperative planning with use of the virtual planning software of Sectra AB for tibial plateau fractures in terms of duration of surgery, surgical complications and patient related outcomes.