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Background <p>Accurate bone grafting is critical for tibial plateau fracture management, yet conventional empirical methods frequently result in imprecise graft volumes and suboptimal outcomes.</p> Methods <p>A total of 210 patients with tibial plateau fractures (Schatzker type III) admitted to Zhangjiagang First People’s Hospital from June 2023 to June 2025 were enrolled in this study. According to the intraoperative bone grafting method, patients were divided into 3D-BGC (3D-printed Bone Graft Container) group (57 cases) and Empirical group (153 cases). The 3D-BGC serves as a non-implantable external volumetric tool: bone graft material is pre-packed inside the container, then transferred into the bone defect, while the container itself is discarded. A comprehensive scoring method was used to evaluate rehabilitation outcomes, and patients were divided into good rehabilitation group and poor rehabilitation group based on the median of comprehensive scores. Univariate analysis and LASSO regression were used to screen predictive variables, multivariate Logistic regression was used to analyze the influencing factors of rehabilitation, and a nomogram prediction model was established with internal validation.</p> Results <p>Among 210 patients, 103 cases (49.05%) achieved good rehabilitation and 107 cases (50.95%) had poor rehabilitation. The good rehabilitation rate in the 3D-BGC group was 92.98% (53/57), significantly higher than that in the Empirical group (32.68%, 50/153, <i>P</i> &lt; 0.001). Logistic regression analysis showed that bone grafting method, time to first weight-bearing, and range of motion at 1 week postoperatively were independent influencing factors for postoperative rehabilitation of tibial plateau fractures (<i>P</i> &lt; 0.05). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of the nomogram model for predicting good rehabilitation was 0.848 (95%CI: 0.796, 0.900). The Hosmer-Lemeshow goodness-of-fit test showed χ²=6.159, <i>P</i> = 0.630, and the calibration curve indicated good consistency of the model. The decision curve showed that the model had positive net benefit within the threshold probability range of 0.44–0.93.</p> Conclusion <p>The 3D-BGC was significantly associated with better postoperative rehabilitation. The nomogram provides reliable guidance for individualized rehabilitation risk stratification.</p> Trial registration <p>This study is a retrospective observational study; prospective registration was not applicable. The study was approved by the Institutional Review Board of Zhangjiagang Hospital Affiliated to Soochow University (Approval No. ZJGYYLL-2023-05-038).</p> Graphical abstract <p></p>

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Efficacy of 3D-printed bone graft container in the treatment of tibial plateau fractures and postoperative rehabilitation prediction model

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月1日

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  • Xiaojun Zhao,
  • Linyan Cao,
  • Jiayu Qian,
  • Jianfei Ge,
  • Zhi Xu,
  • Xiaolei Sheng

摘要

Background

Accurate bone grafting is critical for tibial plateau fracture management, yet conventional empirical methods frequently result in imprecise graft volumes and suboptimal outcomes.

Methods

A total of 210 patients with tibial plateau fractures (Schatzker type III) admitted to Zhangjiagang First People’s Hospital from June 2023 to June 2025 were enrolled in this study. According to the intraoperative bone grafting method, patients were divided into 3D-BGC (3D-printed Bone Graft Container) group (57 cases) and Empirical group (153 cases). The 3D-BGC serves as a non-implantable external volumetric tool: bone graft material is pre-packed inside the container, then transferred into the bone defect, while the container itself is discarded. A comprehensive scoring method was used to evaluate rehabilitation outcomes, and patients were divided into good rehabilitation group and poor rehabilitation group based on the median of comprehensive scores. Univariate analysis and LASSO regression were used to screen predictive variables, multivariate Logistic regression was used to analyze the influencing factors of rehabilitation, and a nomogram prediction model was established with internal validation.

Results

Among 210 patients, 103 cases (49.05%) achieved good rehabilitation and 107 cases (50.95%) had poor rehabilitation. The good rehabilitation rate in the 3D-BGC group was 92.98% (53/57), significantly higher than that in the Empirical group (32.68%, 50/153, P < 0.001). Logistic regression analysis showed that bone grafting method, time to first weight-bearing, and range of motion at 1 week postoperatively were independent influencing factors for postoperative rehabilitation of tibial plateau fractures (P < 0.05). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of the nomogram model for predicting good rehabilitation was 0.848 (95%CI: 0.796, 0.900). The Hosmer-Lemeshow goodness-of-fit test showed χ²=6.159, P = 0.630, and the calibration curve indicated good consistency of the model. The decision curve showed that the model had positive net benefit within the threshold probability range of 0.44–0.93.

Conclusion

The 3D-BGC was significantly associated with better postoperative rehabilitation. The nomogram provides reliable guidance for individualized rehabilitation risk stratification.

Trial registration

This study is a retrospective observational study; prospective registration was not applicable. The study was approved by the Institutional Review Board of Zhangjiagang Hospital Affiliated to Soochow University (Approval No. ZJGYYLL-2023-05-038).

Graphical abstract