The Use of a Personalized 3D Printed Model for Pre-Operative Education in Patients with Severe Periarticular Foot and Ankle Fractures

Abstract

Category: Trauma; Other Introduction/Purpose: Complex periarticular foot and ankle fractures have shown to have significant psychosocial effects on patients such as developing catastrophizing behaviours and poor pain coping strategies. These factors have shown to influence patient satisfaction. Interestingly, a positive association exists between patient satisfaction and preoperative expectations being met. For patient expectations to be met, clear comprehensive preoperative education is required. 3D printing has gained popularity due to its benefits in preoperative planning as well as patient education. Our aims were to 1) investigate the impact of a personalized 3D printed model for patient education on pre- and post-operative expectations and overall satisfaction and 2) investigate the impact of this teaching modality on PROMS and their correlation to patient expectation and satisfaction. Methods: Twenty-eight patients presenting complex periarticular foot and ankle fractures (pilon, talus and calcaneus) were randomized to either control or intervention (3D). All patients underwent a preoperative standardized education session with or without a personalized 3D printed model. Patient expectation and satisfaction were quantified pre- and postoperatively using the MODEMS questionnaires while the following PROMs (VAS and SF-12) were assessed at 2 weeks, 3 months, 6 months and 12 months post-operatively. Results: No significant differences were found between groups for MODEMS pre- (p=0.329) and postoperative expectation (p=0.654), and satisfaction (p=0.411). While not statistically significant, there was a trend towards expectations being better met in the intervention group when compared to the control group (31.2% vs 43.5% respectively). Also, there were no significant differences between groups for VAS and SF-12 at different time points, expect for SF-12 at 3 months for physical component only. A strong positive correlation (0.905, p=0.013) was found between MODEMS preoperative expectation and VAS scores at 12 months in the intervention group. Conclusion: Although there were no significant differences found between groups for pre- and postoperative patient expectation and overall satisfaction at 12 months, there is a trend towards expectations being better met in the intervention group. This could indicate that lower and more realistic expectations are set preoperatively when educating patients using a 3D model. Expectations preoperatively are strongly correlated with pain scores at 12 months in the intervention group demonstrating an association with realistic expectations and improved pain scores when a 3D model was used. Thus, personalized 3D printed education is a non- invasive tool that may impact pain coping strategies post-operatively.