APRIL 2022 | The Surgical Technologist | 165 printed cutting and locking guides allow for extensive preoperative planning to maximize intraoperative success. Improvements in accuracy have been noted in medial closing wedge distal femoral osteotomy for valgus knee malalignment and lateral compartment disease.39 Patients with acetabular fractures, which are difficult to assess and treat because of the complex anatomy of the acetabulum, have more precise screw and plate placement because of 3D-printed guiding templates created from CT scans of the pelvis.40 The issues that can arise with PSI merit additional discussion. Three-dimensional printed PSI is designed to control the cutting and reduction according to the surgical plan, which in theory should improve the predictability of the procedure. Although the utility of these guides should not be understated, they remain technically demanding procedures. A small series of patients with uniplanar, biplanar, or triplanarmalunion of the long bones underwent corrective osteotomies with 3D-printed patient-specific guides. For malunions of the lower extremities, almost all clinical measurements of the femur and tibia demonstrated an undercorrection postoperatively. Patients with malunions of the humerus had axial and sagittal correction rates that differed substantially between planned and achieved measurements.41 Overall, the authors summarized their experience with 3D-printed PSI and concluded the following: careful examination of planned guide positioning is imperative for complete correction intraoperatively, use of predrilled screw holes does not guarantee accurate screw position, translation of bone fragments over osteotomy planes in the case of an oblique osteotomy warrants careful evaluation, and estimation of Table 1. Current Literature on the Applications of Three-dimensional Printing in Orthopaedic Surgery Factor Anatomic Models Noncustom Implants Patient-specific Instrumentation Custom Implants Prosthetics Education Kim et al22 Bizzotto et al16 Zhang et al72 Foot and ankle Hodsden30 Dekker et al45 Wojciechowski et al24 Xu et al25 Xu et al70 Joints Trauner28 Wan et al29 Kwon et al35 Stone et al36 Schwarzkopf et al33 Attard et al37 Leon-Munoz et al38 Culler et al58 Schwarzkopf et al59 Li et al10 Oncology Ren et al50 Xiao et al51 Zhang et al52 Papagelopoulos et al53 Papagelopoulos et al54 Imanishi55 Wei et al56 Spine Serra31 Mokawem et al32 Burnard et al60 Sports Trauma Tetsworth4 Michalski15 Bizzotto et al16 Kang et al17 Belien et al18 Jeong et al19 Kim et al21 Chung et al20 Nwankwo et al47 Tracey et al48 Journal of the AAOS Global Research & Reviews® ----- April 2021, Vol 5, No 4 ----- © American Academy of Orthopaedic Surgeons 5 Review Article Colleen M. Wixted, BS, et al
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