Effects of preoperative virtual simulation planning on the treatment of acetabular fractures: a meta-analysis

Objectives: To investigate the impact of preoperative virtual simulation planning on intraoperative parameters, postoperative complications, and functional recovery in acetabular fracture surgery, thereby aiding in clinical decision-making regarding the most effective approach. Methods: We conducted a systematic search of articles in PubMed, Embase, Cochrane Library, and Web of Science databases up to July 14, 2023. All clinical studies comparing preoperative virtual simulation planning with conventional surgical treatment were included. Results: 16 studies involving 593 patients were included. Among these studies, 6 were randomised controlled trials (RCTs), 1 was a prospective study, and 9 were retrospective studies. Compared to conventional surgery, preoperative virtual simulation planning-assisted surgery significantly reduced intraoperative time (weighted mean differences [WMD] -48.87; 95% CI, -61.15–-36.59; p < 0.001), internal fixation time (WMD -29.83; 95% CI, -37.46–-22.20; p < 0.001), intraoperative blood loss (WMD -259.95; 95% CI, -354.15–-165.75; p < 0.001), and fluoroscopy frequency (WMD -4.56; 95% CI, -5.39–-3.73; p < 0.001), as well as the incidence of postoperative complications (OR 0.34; 95% CI, 0.18–0.65; p = 0.001). There was no significant difference in fracture reduction quality between the preoperative virtual simulation planning group and the conventional group (OR 0.98; 95% CI, 0.75–1.29; p = 0.900), but the former had a higher rate of anatomical reduction (OR 3.00; 95% CI, 1.90–4.72; p < 0.001). There was no significant difference in hip joint function scores between the 2 groups (OR 1.01; 95% CI, 0.72–1.41; p = 0.974). However, the preoperative virtual simulation planning group had a higher proportion of patients with excellent scores (OR 2.32; 95% CI, 1.35–3.99; p = 0.002) and a lower proportion of patients with poor scores (OR 0.52; 95% CI, 0.14–1.92; p = 0.327). Conclusions: Compared to conventional surgery, preoperative virtual simulation planning is more effective in the treatment of acetabular fractures, resulting in shorter intraoperative and internal fixation times, reduced intraoperative blood loss, and lower fluoroscopy frequency. Moreover, in the follow-up period, the preoperative virtual simulation planning group exhibits a lower incidence of postoperative complications and superior fracture site recovery, resulting in better overall prognostic outcomes. Prospero registration: https://www.crd.york.ac.uk/PROSPERO/ (registration number: RD42023447807).