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Moorthy V, Chua ITH, Tan SE, Pillai A, Tan BY, Yam MGJ. Impact of introducing 3D printing-assisted surgery into clinical practice for traumatic pelvic and acetabular fractures. J Orthop 2024; 57:60-64. [PMID: 38994439 PMCID: PMC11233788 DOI: 10.1016/j.jor.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/09/2024] [Indexed: 07/13/2024] Open
Abstract
Background Given the novelty of three-dimensional (3D) printing-assisted fracture surgery in orthopaedics, surgeon familiarity is limited and learning curve is high. As such, it is unclear how the introduction of 3D printing into clinical practice for pelvic and acetabular fracture surgery would impact perioperative outcomes. The aim of this study was to determine the impact of introducing 3D printing-assisted surgery on perioperative outcomes for traumatic pelvic and acetabular fractures. Methods We retrospectively identified consecutive patients who underwent surgical fixation of traumatic pelvic and acetabular fractures from 2018 to 2022 at a single tertiary hospital. The patients included in the study were divided into two groups: (1) 3D printing-assisted surgery and (2) conventional surgery. Baseline demographics and perioperative outcomes of total surgical duration, estimated blood loss, blood transfusion, number fluoroscopy images, fluoroscopy duration and postoperative disposition were recorded and compared between the two groups. Results In total, 26 patients were included in the present study, with 3D printing-assisted surgery being used in 34.6 % (n = 9) of cases. There were no significant differences in baseline demographics or fracture type between the 3D printing group and conventional group. As compared to patients who underwent conventional surgery, those that underwent 3D printing-assisted surgery had, on average, shorter surgical duration (299.8 ± 88.2 vs 309.1 ± 143.1 min), lesser estimated blood loss (706.3 ± 330.0 vs 800.0 ± 584.2 ml), lower transfusion rates (50.0 % vs 52.9 %), lower number of intraoperative fluoroscopy images (62.8 ± 74.5 vs 71.6 ± 47.9 images) and shorter fluoroscopy duration (235.0 ± 79.2 vs 242.3 ± 83.5 min), although statistical significance was not achieved. None of the patients in the present study developed surgical complications postoperatively. Conclusion The introduction of 3D printing-assisted surgery in clinical practice for pelvic and acetabular fractures is a safe and viable adjunct in pelvic and acetabular surgery, achieving comparable perioperative outcomes in the initial phase.
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Affiliation(s)
- Vikaesh Moorthy
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Sze Ern Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Anand Pillai
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Bryan Yijia Tan
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore
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Chen F, Huang C, Ling C, Zhou J, Wang Y, Zhang P, Jiang X, Xu X, Jian J, Li J, Wang L, Yao Q. 3D PRINTING IN COMPLEX TIBIAL FRACTURE CLASSIFICATION & PLANNING. ACTA ORTOPEDICA BRASILEIRA 2024; 32:e269705. [PMID: 39119246 PMCID: PMC11308553 DOI: 10.1590/1413-785220243203e269705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/15/2024] [Indexed: 08/10/2024]
Abstract
Objective Tibial plateau fractures are common intra-articular fractures that pose classification and treatment challenges for orthopedic surgeons. Objective This study examines the value of 3D printing for classifying and planning surgery for complex tibial plateau fractures. Methods We reviewed 54 complex tibial plateau fractures treated at our hospital from January 2017 to January 2019. Patients underwent preoperative spiral CT scans, with DICOM data processed using Mimics software. 3D printing technology created accurate 1:1 scale models of the fractures. These models helped subdivide the fractures into seven types based on the tibial plateau's geometric planes. Surgical approaches and simulated operations, including fracture reduction and plate placement, were planned using these models. Results The 3D models accurately depicted the direction and extent of fracture displacement and plateau collapse. They facilitated the preoperative planning, allowing for precise reconstruction strategies and matching intraoperative details with the pre-printed models. Post-surgery, the anatomical structure of the tibial plateau was significantly improved in all 54 cases. Conclusion 3D printing effectively aids in the classification and preoperative planning of complex tibial plateau fractures, enhancing surgical outcomes and anatomical restoration. Level of Evidence IV, Prospective Study.
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Affiliation(s)
- Fuyang Chen
- Department of Orthopaedic Surgery, Pukou Hospital, Pukou branch of Jiangsu Province Hospital, Nanjing, China
| | - Chenyu Huang
- Nanjing Medical University, Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing, China
- Nanjing Medical University, Institute of digital medicine, Nanjing, China
- Nanjing Medical University, Institute of Digital Medicine, Key Lab of Additive Manufacturing Technology, Nanjing, China
- Univerisity of California, Department of Biomedical Engineering, Irvine, USA
| | - Chen Ling
- Nanjing Medical University, Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing, China
- Nanjing Medical University, Institute of digital medicine, Nanjing, China
- Nanjing Medical University, Institute of Digital Medicine, Key Lab of Additive Manufacturing Technology, Nanjing, China
| | - Jinming Zhou
- Department of Orthopaedic Surgery, Pukou Hospital, Pukou branch of Jiangsu Province Hospital, Nanjing, China
| | - Yufeng Wang
- Nanjing Medical University, Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing, China
- Nanjing Medical University, Institute of digital medicine, Nanjing, China
- Nanjing Medical University, Institute of Digital Medicine, Key Lab of Additive Manufacturing Technology, Nanjing, China
| | - Po Zhang
- Nanjing Medical University, Institute of digital medicine, Nanjing, China
- Nanjing Medical University, Institute of Digital Medicine, Key Lab of Additive Manufacturing Technology, Nanjing, China
| | - Xiao Jiang
- Nanjing Medical University, Institute of digital medicine, Nanjing, China
- Nanjing Medical University, Institute of Digital Medicine, Key Lab of Additive Manufacturing Technology, Nanjing, China
| | - Xiaoming Xu
- Department of Orthopaedic Surgery, Pukou Hospital, Pukou branch of Jiangsu Province Hospital, Nanjing, China
| | - Jian Jian
- Department of Orthopaedic Surgery, Pukou Hospital, Pukou branch of Jiangsu Province Hospital, Nanjing, China
| | - Jiayi Li
- Nanjing Medical University, Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing, China
- Nanjing Medical University, Institute of digital medicine, Nanjing, China
- Nanjing Medical University, Institute of Digital Medicine, Key Lab of Additive Manufacturing Technology, Nanjing, China
| | - Liming Wang
- Nanjing Medical University, Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing, China
- Nanjing Medical University, Institute of digital medicine, Nanjing, China
- Nanjing Medical University, Institute of Digital Medicine, Key Lab of Additive Manufacturing Technology, Nanjing, China
| | - Qingqiang Yao
- Nanjing Medical University, Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing, China
- Nanjing Medical University, Institute of digital medicine, Nanjing, China
- Nanjing Medical University, Institute of Digital Medicine, Key Lab of Additive Manufacturing Technology, Nanjing, China
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Pala E, Canapeti J, Trovarelli G, Angelini A, Ruggieri P. Is still effective massive allograft reconstruction in parosteal osteosarcoma of the distal femur? Review of the literature and advantages of newer technologies. J Orthop Surg Res 2024; 19:395. [PMID: 38978107 PMCID: PMC11232198 DOI: 10.1186/s13018-024-04880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
PURPOSE Parosteal Osteosarcoma is a well-differentiated, low-grade bone sarcoma. It most commonly occurs in the third decade of life, usually in the distal femur. This study aims to perform a literature review about the types of reconstructions reported and to analyze the results of an updated technique of resection using custom-made 3D-printed cutting guides. METHODS We perform a systematic literature review about parosteal osteosarcoma, evaluating treatments, margins, local recurrence, complications, and functional results when available. We also report a case treated in our Center with a revisited technique introducing custom-made 3D-printed cutting guides. RESULTS We analyzed 12 studies with a total of 151 patients. The distal femur was the most frequently reported site (81.5%). After distal femur resection, reconstruction was performed with graft in most cases (48%), followed by prosthetic reconstruction (40%). Margins were wide in 85.5% of cases. The total incidence of local recurrence was 11%. Functional results were excellent in all cases, with a mean MSTS score of 86%. In our case, with the help of the jigs, the surgical technique was relatively easy, graft fusion excellent and fast, margins wide, and functional results excellent. CONCLUSIONS In the literature, the most commonly used type of reconstruction after resection is biological with graft. Indeed, despite the increasing number of prosthetic reconstructions, the historical diaphysometaphyseal hemiresection and graft is still indicated in parosteal osteosarcoma of the distal femur. New technologies, such as the jigs we used, allow significant advantages during the procedure: reduce the resection and graft preparation time, allow a better match between components, and help to obtain safer margins, sparing as much bone as possible.
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Affiliation(s)
- Elisa Pala
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 3, 35128, Padua, Italy
| | - Joele Canapeti
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 3, 35128, Padua, Italy
| | - Giulia Trovarelli
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 3, 35128, Padua, Italy
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 3, 35128, Padua, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via Giustiniani 3, 35128, Padua, Italy.
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Solyom A, Moldovan F, Moldovan L, Strnad G, Fodor P. Clinical Workflow Algorithm for Preoperative Planning, Reduction and Stabilization of Complex Acetabular Fractures with the Support of Three-Dimensional Technologies. J Clin Med 2024; 13:3891. [PMID: 38999455 PMCID: PMC11242480 DOI: 10.3390/jcm13133891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Treatment of pelvic injuries poses serious problems for surgeons due to the difficulties of the associated injuries. The objective of this research is to create a clinical workflow that integrates three-dimensional technologies in preoperative planning and performing surgery for the reduction and stabilization of associated acetabular fractures. Methods: The research methodology consisted of integrating the stages of virtual preoperative planning, physical preoperative planning, and performing the surgical intervention in a newly developed clinical workflow. The proposed model was validated in practice in a pilot surgical intervention. Results: On a complex pelvic injury case of a patient with an associated both-column acetabular fracture (AO/OTA-62C1g), we presented the results obtained in the six stages of the clinical workflow: acquisition of three-dimensional (3D) images, creation of the virtual model of the pelvis, creation of the physical model of the pelvis, preoperative physical simulation, orthopedic surgery, and imaging validation of the intervention. The life-size 3D model was fabricated based on computed tomography imagistics. To create the virtual model, the images were imported into Invesalius (version 3.1.1, CTI, Brazil), after which they were processed with MeshLab (version 2023.12, ISTI-CNR, Italy) and FreeCAD (version 0.21.2, LGPL, FSF, Boston, MA, USA). The physical model was printed in 21 h and 37 min using Ultimaker Cura software (version 5.7.2), on an Ultimaker 2+ printing machine through a Fused Deposition Modeling process. Using the physical model, osteosynthesis plate dimensions and fixation screw trajectories were tested to reduce the risk of neurovascular injury, after which they were adjusted and resterilized, which enhanced preoperative decision-making. Conclusions: The life-size physical model improved anatomical appreciation and preoperative planning, enabling accurate surgical simulation. The tools created demonstrated remarkable accuracy and cost-effectiveness that support the advancement and efficiency of clinical practice.
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Affiliation(s)
- Arpad Solyom
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.S.); (P.F.)
| | - Flaviu Moldovan
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.S.); (P.F.)
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (L.M.); (G.S.)
| | - Gabriela Strnad
- Faculty of Engineering and Information Technology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (L.M.); (G.S.)
| | - Pal Fodor
- Orthopedics—Traumatology Department, Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.S.); (P.F.)
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Meesters AML, Assink N, IJpma FFA. Functional outcome of 2-D- and 3-D-guided corrective forearm osteotomies: a systematic review. J Hand Surg Eur Vol 2024; 49:843-851. [PMID: 37747738 PMCID: PMC11264531 DOI: 10.1177/17531934231201962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023]
Abstract
We performed a systematic review to compare conventional (2-D) versus 3-D-guided corrective osteotomies regarding intraoperative results, patient-reported outcome measures, range of motion, incidence of complications and pain score. PubMed (MEDLINE), Embase and Cochrane CENTRAL were searched, and 53 articles were included, reporting 1257 patients undergoing forearm corrective osteotomies between 2010 and 2022. 3-D-guided surgery resulted in a greater improvement in median Disabilities of the Arm, Shoulder and Hand (DASH) score (28, SD 7 vs. 35, SD 5) and fewer complications (12% vs. 6%). Pain scores and range of motion were similar between 3-D-guided and conventional surgery. 3-D-guided corrective osteotomy surgery appears to improve patient-reported outcomes and reduce complications compared to conventional methods. However, due to the limited number of comparative studies and the heterogeneity of the studies, a large randomized controlled trial is needed to draw definitive conclusions.Level of evidence: III.
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Affiliation(s)
- Anne M. L. Meesters
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- 3D Lab, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Nick Assink
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- 3D Lab, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Seo U, Choi YJ, Kim KJ. Cylindrical depth image based customized helical bone plate design. Med Eng Phys 2024; 129:104187. [PMID: 38906577 DOI: 10.1016/j.medengphy.2024.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/06/2024] [Accepted: 05/20/2024] [Indexed: 06/23/2024]
Abstract
Commercial straight metal plates have been generally used to fix fractured bones, but recently, the need for customized and helical metal plates has emerged. Customized metal plates are designed to fit the shape of the fracture area that is a 3D curved surface, making it more difficult than designing on a 2D plane. Helical plates are researched due to their advantage in avoiding blood vessel damage compared to commercially available straight metal plates. In this paper, we propose a novel algorithm to design a customized helical metal plate for the femur using cylindrical depth images and Boolean operations. We also present the results of 3D printing a metal plate designed using the proposed algorithm, and the shape matching is verified by calculating the minimum distance between the surface of the printed plate and the surface of the femur.
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Affiliation(s)
- Udeok Seo
- 3D Convergence Technology Center, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, South Korea; School of Computer Science and Engineering, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, South Korea
| | - Yoo-Joo Choi
- Dept. of AI Software Engineering, Seoul Media Institute of Technology, Seoul, 03925, South Korea
| | - Ku-Jin Kim
- School of Computer Science and Engineering, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, South Korea.
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Jain M, Sharma V, Sood C, Shyam A. Impact of 3D printing on Orthopedic Surgery in India: Has the Technology Really Arrived! J Orthop Case Rep 2024; 14:1-3. [PMID: 38911002 PMCID: PMC11189093 DOI: 10.13107/jocr.2024.v14.i06.4480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/20/2024] [Indexed: 06/25/2024] Open
Abstract
Surgical innovations have driven advancements in patient care, leading to improved surgical results and decreased patient morbidity. The integration of new technical advancements in orthopedic surgery is linked to the clinical advantages, ethical challenges, financial factors, and its broader influence on the global health-care sector [1]. 3D printing in orthopedic surgery is a developing technique that is rapidly gaining recognition and positively impacting patient results. The widespread influence and usefulness of 3D printing in orthopedics have been confirmed through reports detailing its application in complex trauma, complex hip revision surgeries, and various other areas such as complex spine deformity for pedicle screw trajectory guides, 3D printed implants, and bio-scaffolds [2-5]. The amount of scientific literature on the use of 3D printing in orthopedics has significantly increased in the past decade, both internationally and in India [6]. However, it has this quickly rising trend in the field of orthopedic surgery “really arrived in India.”
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Affiliation(s)
- Mantu Jain
- Department of Orthopaedics, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Vyom Sharma
- Department of Orthopaedics, Military Hospital Khadki and AFMC, Pune, Maharashtra, India
| | - Chetan Sood
- Department of Orthopaedics, Base Hospital Guwahati, Guwahati, Assam, India
| | - Ashok Shyam
- Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India
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Martinelli F, Rota C, Pederzini LA, Celli A. Three-dimensional printed models for surgery planning of post-traumatic stiff elbow: Current concepts. J ISAKOS 2024; 9:490-495. [PMID: 38582454 DOI: 10.1016/j.jisako.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024]
Abstract
The post-traumatic stiff elbow is a challenge for the surgeon, requiring expertise for the treatment choice and accurate planning. Stiffness can result from traumatic injury involving the periarticular soft tissues and the joint articular surfaces. In this article, we want to assess the impact of three-dimensional (3D) printed models in selecting the appropriate surgical strategy for this pathology. Six cases of increasing complexity regarding post-traumatic stiff elbow were submitted to four expert elbow surgeons who had the possibility to evaluate videos and reports of clinical examination, plain radiograms and CT with 3D reconstruction for each case. After a first treatment proposition given by the experts for each patient, a three-dimensional printed model of each elbow based on the CT was provided to the surgeons, asking them to evaluate again all the cases having the possibility to assess also the 3D models. In the four most complex cases all surgeons found more beneficial the use of three-dimensional representation for treatment planning and rate the risk of complications than the sole CT imaging with 3D reconstruction and many of them changed surgical strategy after analysing the model. 3D printing technology is a useful tool in surgery planning for treating complex cases of post traumatic elbow stiffness, especially in the presence of joint deformity. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
| | - Clelia Rota
- Hesperia Hospital, Via Arquà, 80, 41125, Modena, MO, Italy.
| | | | - Andrea Celli
- Hesperia Hospital, Via Arquà, 80, 41125, Modena, MO, Italy.
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Zhang Y, Guo Y, Li Z, Wang B, Li Z. 3D-printed Multifunctional Guide Plate for Fenestration and Screws Drill in Proximal Femoral Benign Tumor. Orthop Surg 2024; 16:1487-1492. [PMID: 38726583 PMCID: PMC11144502 DOI: 10.1111/os.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 06/04/2024] Open
Abstract
The accurate fenestration, screw implantation and assisting stabilizing-plate placement in surgery of benign tumors in the proximal femur needs be defined easily. The aim of this study was to investigate the value of 3D printed multifunctional guides plate (3D-MGP) based on computer aided design. Between January 2020 and June 2022, 17 patients (nine females and eight males) with benign proximal femoral tumor had lesion curettage and allograft combined with internal plate fixation using 3D-MGP. In this study, the patients had CT scans and a technician reconstructed the 3D images of tumor and the femur, a doctor designed the location and margin of the fenestration and screws, and integrated different functions into MGP for benign proximal femoral lesions, which assisted in precise localization, fenestration and screw drilling. Musculoskeletal Tumor Society (MSTS) scoring was used to evaluate lower extremity function. Bone healing and the screws location was assessed with the radiographs. All patients underwent successful surgery with complete resection of the tumor and internal fixation with using the 3D-MGP. The mean follow-up was 16.4 months. The operative time was 126.47 ± 18.44 min, intraoperative bleeding was 198.23 ± 67.94 mL, intraoperative fluoroscopy was 6.47 ± 0.62, postoperative drainage was 223.82 ± 119.51 mL, and MSTS score was 27.29 ± 1.31 points. There were no unplanned fenestration and improper screw fixation. The 3D-MGP enabled personalized and accurate location of tumor, fenestration, screw placement and assisted stabilizing-plate placement for the treatment of benign tumor of the proximal femur. This technique has the potential to shorten operative times, decrease intraoperative bleeding, and reduce radiation exposure to patients.
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Affiliation(s)
- Yuxuan Zhang
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Yi Guo
- Montefiore Medical CenterAlbert Einstein School of MedicineNew YorkNew YorkUSA
| | - Zonghao Li
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
| | - Bing Wang
- School of Mechanical EngineeringShandong UniversityJinanChina
| | - Zhenfeng Li
- Department of OrthopedicsQilu Hospital of Shandong UniversityJinanChina
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Lavoie-Turcotte T, Ménard AL, Begon M, Nault ML. Flatfoot arch correction with generic 3D-printed orthoses at different body weight percentages. Foot (Edinb) 2024; 59:102093. [PMID: 38520781 DOI: 10.1016/j.foot.2024.102093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Flatfoot can be associated with foot pathologies and treated conservatively with foot orthoses to correct arch collapse and alleviate painful symptoms. Recently, 3D printing has become more popular and is widely used for medical device manufacturing, such as orthoses. This study aims at quantifying the effect of generic 3D-printed foot orthoses on flatfoot arch correction under different static loading conditions. METHODS Participants with normal and flatfeet were recruited for this cross-sectional study. Clinical evaluation included arch height, foot posture index, and Beighton flexibility score. Surface imaging was performed in different loading conditions: 1) 0% when sitting, 2) 50% when standing on both feet, and 3) 125% when standing on one foot with a weighted vest. For flatfoot participants, three configurations were tested: without an orthosis, with a soft generic 3D printed orthosis, and with a rigid 3D printed orthosis. Arch heights and medial arch angles were calculated and compared for the different loading conditions and with or without orthoses. The differences between groups, with and without orthoses, were analyzed with Kruskal-Wallis tests, and a p < 0.05 was considered significant. RESULTS A total of 10 normal feet and 10 flatfeet were analyzed. The 3D printed orthosis significantly increased arch height in all loading conditions, compared to flatfeet without orthosis. Wearing an orthosis reduced the medial arch angle, although not significantly. Our technique was found to have good to excellent intra and interclass correlation coefficients. CONCLUSIONS Generic 3D printed orthoses corrected arch collapse in static loading conditions, including 125% body weight to simulate functional tasks like walking. Our protocol was found to be reliable and easier to implement in a clinical setting compared to previously reported methods. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Tommy Lavoie-Turcotte
- Faculty of Medicine, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada
| | - Anne-Laure Ménard
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada
| | - Mickael Begon
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada; CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5. Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1C5. Canada; University of Montreal, 2900 boul. Edouard-Montpetit, Montréal, QC H3T 1J4. Canada; CIUSSS Hôpital du Sacré-Cœur de Montréal (HSCM), Department of Orthopedic Surgery, 5400 boul. Gouin Ouest, Montreal, QC H4J 1C5, Canada.
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11
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Pulumati A, Algarin YA, Kim S, Latta S, Li JN, Nouri K. 3D bioprinting: a review and potential applications for Mohs micrographic surgery. Arch Dermatol Res 2024; 316:147. [PMID: 38698273 DOI: 10.1007/s00403-024-02893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/14/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
Mohs Micrographic Surgery (MMS) is effective for treating common cutaneous malignancies, but complex repairs may often present challenges for reconstruction. This paper explores the potential of three-dimensional (3D) bioprinting in MMS, offering superior outcomes compared to traditional methods. 3D printing technologies show promise in advancing skin regeneration and refining surgical techniques in dermatologic surgery. A PubMed search was conducted using the following keywords: "Three-dimensional bioprinting" OR "3-D printing" AND "Mohs" OR "Mohs surgery" OR "Surgery." Peer-reviewed English articles discussing medical applications of 3D bioprinting were included, while non-peer-reviewed and non-English articles were excluded. Patients using 3D MMS models had lower anxiety scores (3.00 to 1.7, p < 0.0001) and higher knowledge assessment scores (5.59 or 93.25% correct responses), indicating better understanding of their procedure. Surgical residents using 3D models demonstrated improved proficiency in flap reconstructions (p = 0.002) and knowledge assessment (p = 0.001). Additionally, 3D printing offers personalized patient care through tailored surgical guides and anatomical models, reducing intraoperative time while enhancing surgical. Concurrently, efforts in tissue engineering and regenerative medicine are being explored as potential alternatives to address organ donor shortages, eliminating autografting needs. However, challenges like limited training and technological constraints persist. Integrating optical coherence tomography with 3D bioprinting may expedite grafting, but challenges remain in pre-printing grafts for complex cases. Regulatory and ethical considerations are paramount for patient safety, and further research is needed to understand long-term effects and cost-effectiveness. While promising, significant advancements are necessary for full utilization in MMS.
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Affiliation(s)
- Anika Pulumati
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA.
| | - Yanci A Algarin
- Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA
| | - Sarah Kim
- University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Steven Latta
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Jeffrey N Li
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, 455 NE 24th St. Apt 615, Miami, FL, 33137, USA
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12
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Calderon C, Golzar A, Marcott S, Gifford K, Napel S, Fleischmann D, Baik FM, Osborne TF, Finegersh A, Sirjani D. 3D Printing for the Development of Palatal Defect Prosthetics. Fed Pract 2024; 41:S3-S7. [PMID: 38813248 PMCID: PMC11132111 DOI: 10.12788/fp.0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Background Three-dimensional (3D) printing has emerged as a promising new technology for the development of surgical prosthetics. Research in orthopedic surgery has demonstrated that using 3D printed customized prosthetics results in more precise implant placements and better patient outcomes. However, there has been little research on implementing customized 3D printed prosthetics in otolaryngology. The program sought to determine whether computed tomography (CT) serves as feasible templates to construct 3D printed palatal obturator prosthetics for defects in patients who have been treated for head and neck cancers. Observations A retrospective review of patients with palatal defects was conducted and identified 1 patient with high quality CTs compatible with 3D modeling. CTs of the patient's craniofacial anatomy were used to develop a 3D model and a Formlabs 3B+ printer printed the palatal prosthetic. We successfully developed and produced an individualized prosthetic using CTs from a veteran with head and neck deformities caused by cancer treatment who was previously treated at the Veterans Affairs Palo Alto Health Care System. This project was successful in printing patient-specific implants using CT reproductions of the patient's craniofacial anatomy, particularly of the palate. The program was a proof of concept and the implant we created was not used on the patient. Conclusions Customized 3D printed implants may allow otolaryngologists to enhance the performance and efficiency of surgeries and better rehabilitate and reconstruct craniofacial deformities to restore appearance and function to patients. Additional research will strive to enhance the therapeutic potential of these prosthetics to serve as low-cost, patient-specific implants.
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Affiliation(s)
- Christian Calderon
- Stanford University School of Medicine, California
- Veterans Affairs Palo Alto Health Care System, California
| | - Autreen Golzar
- Stanford University School of Medicine, California
- Veterans Affairs Palo Alto Health Care System, California
| | - Stephen Marcott
- Stanford University School of Medicine, California
- Veterans Affairs Palo Alto Health Care System, California
| | - Kyle Gifford
- 3D and Quantitative Imaging Laboratory, Stanford, California
| | - Sandy Napel
- 3D and Quantitative Imaging Laboratory, Stanford, California
| | | | - Fred M. Baik
- Stanford University School of Medicine, California
- Veterans Affairs Palo Alto Health Care System, California
| | - Thomas F. Osborne
- Stanford University School of Medicine, California
- Veterans Affairs Palo Alto Health Care System, California
| | - Andrey Finegersh
- Stanford University School of Medicine, California
- Veterans Affairs Palo Alto Health Care System, California
| | - Davud Sirjani
- Stanford University School of Medicine, California
- Veterans Affairs Palo Alto Health Care System, California
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13
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Guevara F, Foss KD, Harper TAM, Moran CA, Hague DW, Hamel PES, Schaeffer DJ, McCoy AM. Ex vivo comparison of pin placement with patient-specific drill guides or freehand technique in canine cadaveric spines. Vet Surg 2024; 53:254-263. [PMID: 37822110 DOI: 10.1111/vsu.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To compare vertebral implant placement in the canine thoracolumbar spine between 3D-printed patient-specific drill guides (3DPG) and the conventional freehand technique (FH). STUDY DESIGN Ex vivo study. ANIMALS Cadaveric canine spines (n = 24). METHODS Implant trajectories were established for the left and right sides of the T10 through L6 vertebrae based on computed tomography (CT) imaging. Customized drill guides were created for each vertebra of interest. Each cadaver was randomly assigned to one of six veterinarians with varying levels of experience placing vertebral implants. Vertebrae were randomly assigned a surgical order and technique (3DPG or FH) for both sides. Postoperative CT images were acquired. A single, blinded observer assessed pin placement using a modified Zdichavsky classification. RESULTS A total of 480 implants were placed in 240 vertebrae. Three sites were excluded from the analysis; therefore, a total of 238 implants were evaluated using the FH technique and 239 implants using 3DPG. When evaluating implant placement, 152/239 (63.6%) of 3DPG implants were considered to have an acceptable placement in comparison with 115/248 (48.32%) with FH. Overall, pin placement using 3DPG was more likely to provide acceptable pin placement (p < .001) in comparison with the FH technique for surgeons at all levels of experience. CONCLUSION The use of 3DPG was shown to be better than the conventional freehand technique regarding acceptable placement of implants in the thoracolumbar spine of canine cadavers. CLINICAL SIGNIFICANCE Utilizing 3DPG can be considered better than the traditional FH technique when placing implants in the canine thoracolumbar spine.
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Affiliation(s)
- Francisco Guevara
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Kari D Foss
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Tisha A M Harper
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Clara A Moran
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Devon W Hague
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Philip E S Hamel
- Boundary Bay Veterinary Specialty Hospital, Langley, British Columbia, Canada
| | - David J Schaeffer
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Annette M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
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14
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Assink N, ten Duis K, de Vries JPPM, Witjes MJH, Kraeima J, Doornberg JN, IJpma FFA. 3D surgical planning including patient-specific drilling guides for tibial plateau fractures. Bone Jt Open 2024; 5:46-52. [PMID: 38240277 PMCID: PMC10797644 DOI: 10.1302/2633-1462.51.bjo-2023-0130.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Aims Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026). Conclusion The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kaj ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Max J. H. Witjes
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joep Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Job N. Doornberg
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Flinders University, Adelaide, Australia
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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15
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Kadiri S, Jakupi K, Dukovski V, Hodolli G. Optimizing 3D-printed workpieces for radiotherapy application: modelling the CT number and print time. Biomed Phys Eng Express 2024; 10:025009. [PMID: 38198717 DOI: 10.1088/2057-1976/ad1d0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024]
Abstract
This study aims to analyze the influence of specific printing parameters, including infilling, print speed, and layer height, on the CT numbers and printing time of 3D-printed workpieces fabricated from Polylactic Acid (PLA). The primary objective is to optimize these parameters to attain desired CT numbers and print time for radiotherapy applications. To achieve this objective, we employed the Taguchi experimental design and regression analysis methodologies. A series of experiments were conducted to systematically assess the effects of varying infilling, print speed, and layer height values on the CT numbers and printing time of the PLA workpieces. The resulting data were then used to create mathematical models for predicting optimal parameter settings. Our investigations revealed that specific adjustments to infilling and layer height significantly influence the CT numbers and printing time of 3D-printed workpieces. By leveraging the developed mathematical models, precise predictions can be made to optimize independent parameters for the desired CT numbers and printing times, enhancing the efficacy of 3D-printed workpieces for radiotherapy applications. This research contributes to the advancement of 3D-printed workpieces utilized in radiotherapy, offering a pathway to enhance the accuracy and efficiency of treatment delivery. The optimization of printing parameters outlined in this study provides a valuable tool for clinicians and researchers in the field, ultimately benefiting patients undergoing radiotherapy treatments.
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Affiliation(s)
- Sehad Kadiri
- Faculty of Radiology, AAB College, 10000 Pristina, Kosovo
| | - Kaltrine Jakupi
- Faculty of Mechanical Engineering, University of Pristina 'Hasan Prishtina', 10000 Pristina, Kosovo
- Faculty of Mechanical Engineering, 'Ss. Cyril and Methodius' University in Skopje, 1001 Skopje, North Macedonia
| | - Vladimir Dukovski
- Faculty of Mechanical Engineering, 'Ss. Cyril and Methodius' University in Skopje, 1001 Skopje, North Macedonia
| | - Gezim Hodolli
- Faculty of Veterinary and Agriculture, University of Pristina 'Hasan Prishtina', 10000 Pristina, Kosovo
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16
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Fernandes da Silva JLG, Barroso Gonçalves SM, Plácido da Silva HH, Tavares da Silva MP. Three-dimensional printed exoskeletons and orthoses for the upper limb-A systematic review. Prosthet Orthot Int 2024:00006479-990000000-00211. [PMID: 38175034 DOI: 10.1097/pxr.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 11/17/2023] [Indexed: 01/05/2024]
Abstract
This systematic review aims to assess and summarize the current landscape in exoskeletons and orthotic solutions developed for upper limb medical assistance, which are partly or fully produced using 3-dimensional printing technologies and contain at least the elbow or the shoulder joints. The initial search was conducted on Web of Science, PubMed, and IEEEXplore, resulting in 92 papers, which were reduced to 72 after removal of duplicates. From the application of the inclusion and exclusion criteria and selection questionnaire, 33 papers were included in the review, being divided according to the analyzed joints. The analysis of the selected papers allowed for the identification of different solutions that vary in terms of their target application, actuation type, 3-dimensional printing techniques, and material selection, among others. The results show that there has been far more research on the elbow joint than on the shoulder joint, which can be explained by the relative complexity of the latter. Moreover, the findings of this study also indicate that there is still a gap between the research conducted on these devices and their practical use in real-world conditions. Based on current trends, it is anticipated that the future of 3-dimensional printed exoskeletons will revolve around the use of flexible and high-performance materials, coupled with actuated devices. These advances have the potential to replace the conventional fabrication methods of exoskeletons with technologies based on additive manufacturing.
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17
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Yasen Z, Robinson AP, Woffenden H. Advanced Preoperative Planning Techniques in the Management of Complex Proximal Humerus Fractures. Cureus 2024; 16:e51551. [PMID: 38313919 PMCID: PMC10835086 DOI: 10.7759/cureus.51551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
This review evaluates the current literature on the recent advances of preoperative planning in the management of complex proximal humerus fractures (PHF). PHFs can pose a considerable challenge for orthopaedic surgeons due to their diversity in presentation and complexity. Poor preoperative planning can lead to prolonged operations, increased blood loss, higher risk of complications, and increased stress on the surgical team. Recent advances have seen the evolution of preoperative planning from conventional methods to computer-assisted virtual surgical technology (CAVST) and three-dimensional (3D) printing, which have been highlighted as transformative tools for improving preoperative planning and postoperative outcomes. CAVST allows the creation of 3D renderings of patient-specific anatomy, clearly demonstrating fracture patterns and facilitating detailed planning for arthroplasty or surgical fixation. The early studies show promising outcomes however the literature calls for more high-quality randomised controlled trials. Using 3D printing for high-fidelity simulation involving patient-specific physical models offers an immersive experience for surgical planning. Preoperative planning with 3D printing reduces operative time, blood loss and use of fluoroscopy. The technology's potential to produce customisable surgical implants further improves its versatility. There is a need for a cost analysis for the use of these technologies within the orthopaedic field, particularly considering the high expense of 3D printing materials and extended hospital stays until the printed models are available. CAVST and 3D printing also show promising applications within high-fidelity simulation surgical training, with CAVST offering possibilities in virtual reality and haptic-enhanced simulations and 3D printing providing physical models for trainee surgeons to hone their skills. Moving forward, a reduction in the cost of 3D printing and the advancement of CAVST using artificial intelligence would lead to future improvement. In conclusion, preoperative planning supported by these innovative technologies will play a pivotal role in improving surgical outcomes and training for complex PHF cases.
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Affiliation(s)
- Zaid Yasen
- Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, London, GBR
| | - Andrew P Robinson
- Trauma and Orthopaedics, Lewisham and Greenwich NHS Trust, London, GBR
| | - Hugo Woffenden
- General Surgery, HMS Nelson Medical Centre, Ministry of Defence, London, GBR
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18
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Awuah WA, Tenkorang PO, Adebusoye FT, Ng JC, Wellington J, Abdul-Rahman T, Nazir A, Mustapha MJ, Bulut H, Papadakis M. 3D printing in surgery: revolutionizing trauma and fracture care in low and middle-income countries. Postgrad Med J 2023; 100:1-3. [PMID: 37857514 DOI: 10.1093/postmj/qgad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/27/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Affiliation(s)
| | | | | | - Jyi Cheng Ng
- Faculty of Medicine and Health Sciences, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia
| | - Jack Wellington
- Cardiff University School of Medicine, Cardiff University, Cardiff CF14 4XN, Wales, United Kingdom
| | | | - Abubakar Nazir
- Faculty of Medicine, King Edward Medical University, Nelagumbad, Anarkali, Lahore 54000, Pakistan
| | | | - Halil Bulut
- Cerrahpasa School of Medicine, Istanbul University Cerrahpasa, Istanbul 34320, Turkey
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Wuppertal 42283, Germany
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19
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Calero Castro FJ, Padillo Eguía A, Durán Muñoz‐Cruzado V, Tallón Aguilar L, Tinoco González J, Laga I, de la Portilla de Juan F, Pareja Ciuró F, Padillo Ruiz J. Personalized additive manufacturing of devices for the management of enteroatmospheric fistulas. Bioeng Transl Med 2023; 8:e10583. [PMID: 38023715 PMCID: PMC10658531 DOI: 10.1002/btm2.10583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 12/01/2023] Open
Abstract
Additive manufacturing techniques allow the customized design of medical devices according to the patient's requirements. Enteroatmospheric fistula is a pathology that benefits from this personalization due to its extensive clinical variability since the size and morphology of the wound differ extensively among patients. Standard prosthetics do not achieve proper isolation of the wound, leading to a higher risk of infections. Currently, no effective personalized technique to isolate it has been described. In this work, we present the workflow for the design and manufacture of customized devices adapted to the fistula characteristics as it evolves and changes during the treatment with Negative Pressure Wound Therapy (NPWT). For each case, a device was designed with dimensions and morphology depending on each patient's requirements using white light scanning, CAD design, and additive manufacturing. The design and manufacture of the devices were performed in 230.50 min (184.00-304.75). After the placement of the device, the wound was successfully isolated from the intestinal content for 48-72 h. The therapy was applied for 27.71 ± 13.74 days, and the device was redesigned to adapt to the wound when geometrical evolutionary changes occur during the therapy. It was observed a decrease in weekly cures from 23.63 ± 10.54 to 2.69 ± 0.65 (p = 0.001). The fistulose size was reduced longitudinal and transversally by 3.25 ± 2.56 cm and 6.06 ± 3.14 cm, respectively. The wound depth also decreased by 1.94 ± 1.08 cm. In conclusion, customization through additive manufacturing is feasible and offers promising results in the generation of personalized devices for the treatment of enteroatmospheric fistula.
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Affiliation(s)
- Francisco José Calero Castro
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
| | | | - Virginia Durán Muñoz‐Cruzado
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - Luis Tallón Aguilar
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - José Tinoco González
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - Imán Laga
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
| | - Fernando de la Portilla de Juan
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - Felipe Pareja Ciuró
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
| | - Javier Padillo Ruiz
- Oncology Surgery, Cell Therapy, and Organ Transplantation Group, Instituto de Biomedicina de Sevilla (IBiS)Hospital Universitario Virgen del Rocío, CSIC, Universidad de SevillaSevilleSpain
- Department of General SurgeryIBiS, Hospital University Virgen del Rocío, CSIC, University of SevilleSevilleSpain
- University of SevilleSevilleSpain
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20
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Richard RD, Heare A, Mauffrey C, McGinley B, Lencioni A, Chandra A, Nasib V, Chaiken BL, Trompeter A. Use of 3D Printing Technology in Fracture Management: A Review and Case Series. J Orthop Trauma 2023; 37:S40-S48. [PMID: 37828701 DOI: 10.1097/bot.0000000000002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/14/2023]
Abstract
SUMMARY Three-dimensional (3D) offers exciting opportunities in medicine, particularly in orthopaedics. The boundaries of 3D printing are continuously being re-established and have paved the way for further innovations, including 3D bioprinting, custom printing refined methods, 4D bioprinting, and 5D printing potential. The quality of these applications have been steadily improving, increasing their widespread use among clinicians. This article provides a review of the current literature with a brief introduction to the process of additive manufacturing, 3D printing, and its applications in fracture care. We illustrate this technology with a case series of 3D printing used for correction of complex fractures/nonunion. Factors limiting the use of this technology, including cost, and potential solutions are discussed. Finally, we discuss 4D bioprinting and 5D printing and their potential role in fracture surgery.
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Affiliation(s)
- Raveesh D Richard
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Austin Heare
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Cyril Mauffrey
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Beau McGinley
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Alex Lencioni
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Arjun Chandra
- Trauma and Orthopaedic Department, St. Georges University Hospital, London, England
| | - Vareesha Nasib
- Trauma and Orthopaedic Department, St. Georges University Hospital, London, England
| | - Brian L Chaiken
- Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO; and
| | - Alex Trompeter
- Trauma and Orthopaedic Department, St. Georges University Hospital, London, England
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21
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Lu S, Yang Y, Li S, Zhang L, Shi B, Zhang D, Li B, Hu Y. Preoperative Virtual Reduction Planning Algorithm of Fractured Pelvis Based on Adaptive Templates. IEEE Trans Biomed Eng 2023; 70:2943-2954. [PMID: 37126611 DOI: 10.1109/tbme.2023.3272007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The minimally invasive treatment of pelvic fractures is one of the most challenging trauma orthopedics surgeries, where preoperative planning is crucial for the performance and outcome of the surgery. However, planning the ideal position of fragments currently relies heavily on the experience of the surgeon. METHODS A pelvic fracture virtual reduction algorithm for target position is provided based on statistical shape models (SSM). First, according to sexual dimorphism, pelvic SSM based on point cloud curvature down-sampling are constructed as adaptive templates. Then, an optimization algorithm is designed to iteratively adjust the target pose of the fragments and the adaptive matching of the templates. Finally, the feasibility of the method is verified by simulating fractures and clinical data. RESULTS The pelvis has complex shape characteristics, which can be analyzed by SSM to clearly understand the pattern of change. Experiments showed that the SSM-based pelvic fracture reduction method had translation and rotation errors of 2.20±1.09 mm and 3.16±1.26° in simulated cases, and 2.78±0.95 mm and 3.10±0.53° in clinical cases, which has higher accuracy than methods based on mean shape models, and wider applicability than methods based on pelvic symmetry. CONCLUSION The pelvic digital model created by SSM has good generalization properties, and the SSM-based virtual reduction algorithm can effectively reconstruct the target position of the fractured pelvis in preoperative planning. SIGNIFICANCE The proposed reduction method has the characteristics of high precision and wide application range, which provides a powerful tool for the surgeon's virtual preoperative planning.
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Westrick ER, Bernstein M, Little MT, Marecek GS, Scolaro JA. Orthopaedic Advances: Use of Three-Dimensional Metallic Implants for Reconstruction of Critical Bone Defects After Trauma. J Am Acad Orthop Surg 2023; 31:e685-e693. [PMID: 37384878 DOI: 10.5435/jaaos-d-22-00676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/26/2023] [Indexed: 07/01/2023] Open
Abstract
Multiple successful strategies exist for the management of critical-sized bone defects. Depending on the location and etiology of an osseous defect, there are nuances that must be considered by the treating surgeon. The induced membrane technique and various modifications of the Ilizarov method (bone transport by distraction osteogenesis) have been the most common methods for biologic reconstruction. Despite the versatility and high union rates reported, they may not be practical for every patient. The rapid expansion of three-dimensional printing of medical devices has led to an increase in their use within orthopaedic surgery, specifically in the definitive treatment of critical bone defects. This article proposes indications and contraindications for implementation of this technology and reviews the available clinical evidence on the use of custom nonresorbable implants for the treatment of traumatic bone loss. Clinical cases are presented to illustrate the scenarios in which this approach is viable.
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Affiliation(s)
- Edward R Westrick
- From the Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA (Westrick), the Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada (Bernstein), the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Little), the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Marecek), and the Department of Orthopaedic Surgery, University of California Irvine, Orange, CA (Scolaro)
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Cattaneo S, Domenicucci M, Galante C, Biancardi E, Casiraghi A, Milano G. Use of patient-specific guides and 3D model in scapula osteotomy for symptomatic malunion. 3D Print Med 2023; 9:24. [PMID: 37672114 PMCID: PMC10481603 DOI: 10.1186/s41205-023-00184-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/01/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Scapular osteotomy for malunion can lead to resolution of pain and functional improvement in scapula fracture sequelae. Understanding three-dimensional bone morphology and analysing post-traumatic deformity is the main step of planning and the key to success of the procedure. 3D models and patient-specific guides are a growing technology to enhance accuracy of planning and to assist during surgery. CASE PRESENTATION We report the case of a 50 years old male, complaining of pain and limited function after a malunited scapular body fracture. Clinical assessment showed a severe impairment of shoulder function with active and passive forward flexion limited to 80°, absent external rotation, and internal rotation limited to the buttock. X-rays and CT scan showed an excessive lateral border offset of 53 mm and complete displacement of the glenoid segment anteriorly and medially to the scapular body, with impingement between the lateral most prominent scapular bone spur and humeral shaft. Glenopolar angle was 19°, scapular body angulation on the sagittal plane was 12°. Corrective osteotomy was planned on a virtual interactive rendering and on 3D printed models. Patient-specific guides were developed to perform a body-spine osteotomy with removal of a bone wedge, and a glenoid-spine osteotomy; a patient-specific wedge spacer was used to hold the reduction during plate fixation. Follow-up up to 12 months after surgery demonstrated improvement in scapula anatomy, shoulder girdle function, and patient-reported outcomes. CONCLUSIONS For the first time in scapula malunion surgery, patient-specific osteotomy guides were succesfully used during surgery to perform osteotomies and to assist in reduction maneuvers.
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Affiliation(s)
- Stefano Cattaneo
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia (BS), 25123, Italy.
| | - Marco Domenicucci
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia (BS), 25123, Italy
| | - Claudio Galante
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia (BS), 25123, Italy
| | - Elena Biancardi
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia (BS), 25123, Italy
| | - Alessandro Casiraghi
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia (BS), 25123, Italy
| | - Giuseppe Milano
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia (BS), 25123, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Viale Europa 11, Brescia, 25123, BS, Italy
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Hendea RE, Raducanu D, Claver A, García JA, Cojocaru VD, Nocivin A, Stanciu D, Serban N, Ivanescu S, Trisca-Rusu C, Campian RS. Biodegradable Magnesium Alloys for Personalised Temporary Implants. J Funct Biomater 2023; 14:400. [PMID: 37623645 PMCID: PMC10455490 DOI: 10.3390/jfb14080400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
The objective of this experimental work was to examine and characterise the route for obtaining demonstrative temporary biodegradable personalised implants from the Mg alloy Mg-10Zn-0.5Zr-0.8Ca (wt.%). This studied Mg alloy was obtained in its powder state using the mechanical alloying method, with shape and size characteristics suitable for ensuing 3D additive manufacturing using the SLM (selective laser melting) procedure. The SLM procedure was applied to various processing parameters. All obtained samples were characterised microstructurally (using XRD-X-ray diffraction, and SEM-scanning electron microscopy); mechanically, by applying a compression test; and, finally, from a corrosion resistance viewpoint. Using the optimal test processing parameters, a few demonstrative temporary implants of small dimensions were made via the SLM method. Our conclusion is that mechanical alloying combined with SLM processing has good potential to manage 3D additive manufacturing for personalised temporary biodegradable implants of magnesium alloys. The compression tests show results closer to those of human bones compared to other potential metallic alloys. The applied corrosion test shows result comparable with that of the commercial magnesium alloy ZK60.
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Affiliation(s)
- Radu Emil Hendea
- Department of Oral Rehabilitation, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (R.E.H.); (R.S.C.)
| | - Doina Raducanu
- Department of Metallic Materials Processing and Ecometallurgy, University Politehnica of Bucharest, 060042 Bucharest, Romania; (V.D.C.); (N.S.)
| | - Adrián Claver
- Institute for Advanced Materials and Mathematics (INAMAT2), Universidad Pública de Navarra (UPNA), 31006 Pamplona, Spain; (A.C.); (J.A.G.)
| | - José Antonio García
- Institute for Advanced Materials and Mathematics (INAMAT2), Universidad Pública de Navarra (UPNA), 31006 Pamplona, Spain; (A.C.); (J.A.G.)
| | - Vasile Danut Cojocaru
- Department of Metallic Materials Processing and Ecometallurgy, University Politehnica of Bucharest, 060042 Bucharest, Romania; (V.D.C.); (N.S.)
| | - Anna Nocivin
- Faculty of Mechanical, Industrial and Maritime Engineering, OVIDIUS University of Constanta, 900527 Constanța, Romania;
| | - Doina Stanciu
- Zircon Dent SRL, 400690 Cluj-Napoca, Romania; (D.S.); (S.I.)
| | - Nicolae Serban
- Department of Metallic Materials Processing and Ecometallurgy, University Politehnica of Bucharest, 060042 Bucharest, Romania; (V.D.C.); (N.S.)
| | | | - Corneliu Trisca-Rusu
- National Institute for Research and Development in Micro-Technologies, 077190 Bucharest, Romania;
| | - Radu Septimiu Campian
- Department of Oral Rehabilitation, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (R.E.H.); (R.S.C.)
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Masada KM, Cristino DM, Dear KA, Hast MW, Mehta S. 3-D Printed Fracture Models Improve Resident Performance and Clinical Outcomes in Operative Fracture Management. JOURNAL OF SURGICAL EDUCATION 2023; 80:1020-1027. [PMID: 37198080 DOI: 10.1016/j.jsurg.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/30/2022] [Accepted: 04/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To determine if preoperative examination of patient additive manufactured (AM) fracture models can be used to improve resident operative competency and patient outcomes. DESIGN Prospective cohort study. Seventeen matched pairs of fracture fixation surgeries (for a total of 34 surgeries) were performed. Residents first performed a set of baseline surgeries (n = 17) without AM fracture models. The residents then performed a second set of surgeries randomly assigned to include an AM model (n = 11) or to omit it (n = 6). Following each surgery, the attending surgeon evaluated the resident using an Ottawa Surgical Competency Operating Room Evaluation (O-Score). The authors also recorded clinical outcomes including operative time, blood loss, fluoroscopy duration, and patient reported outcome measurement information system (PROMIS) scores of pain and function at 6 months. SETTING Single-center academic level one trauma center. PARTICIPANTS Twelve orthopaedic residents, between postgraduate year (PGY) 2 and 5, participated in this study. RESULTS Residents significantly improved their O-Scores between the first and second surgery when they trained with AM models for the second surgery (p = 0.004, 2.43 ± 0.79 versus 3.73 ± 0.64). Similar improvements were not observed in the control group (p = 0.916, 2.69 ± 0.69 versus 2.77 ± 0.36). AM model training also significantly improved clinical outcomes, including surgery time (p = 0.006), fluoroscopy exposure time (p = 0.002), and patient reported functional outcomes (p = 0.0006). CONCLUSIONS Conclusions: Training with AM fracture models improves the performance of orthopaedic surgery residents during fracture surgery.
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Affiliation(s)
- Kendall M Masada
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Danielle M Cristino
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kayley A Dear
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael W Hast
- Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samir Mehta
- McKay Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Le C, Kolasangiani K, Nayyeri P, Bougherara H. Experimental and numerical investigation of 3D-Printed bone plates under four-point bending load utilizing machine learning techniques. J Mech Behav Biomed Mater 2023; 143:105885. [PMID: 37192565 DOI: 10.1016/j.jmbbm.2023.105885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
The fused deposition modeling (FDM) technique is widely used to produce components for various applications and has the potential to revolutionize orthopedic research through the production of custom-fit and readily available biomedical implants. The properties of FDM-produced implants are significantly influenced by processing parameters, with layer thickness being a crucial parameter. This study investigated the effect of layer thickness on the flexural properties of Polylactic Acid (PLA) bone plate implants produced by the FDM technique. Experimental results showed that the flexural strength is inversely proportional to the layer thickness due to the variation of voids in the specimens. A 3D finite element (FE) model was developed using Abaqus/Explicit software by incorporating the Gurson-Tvergaard (GT) porous plasticity model to predict the elastoplastic and damage behavior of specimens with different layer thicknesses. The characterization of the elastoplastic and GT parameters was done using a tensile test and by the calibration of a machine learning algorithm. It was shown that the FE model was able to predict the flexural behavior of 3D-printed solid plates with a maximum error of 6.13% in the maximum load. The optimal layer height was found to be 0.1 mm, providing both high flexural strength and adequate bending stiffness.
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Affiliation(s)
- Christine Le
- Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B2K3, Canada
| | - Kamal Kolasangiani
- Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B2K3, Canada
| | - Pooyan Nayyeri
- Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B2K3, Canada
| | - Habiba Bougherara
- Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B2K3, Canada.
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27
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Zheng H, Xia Y, Ni X, Wu J, Li Y, Zhang P, Wu X, Lu K, Zhao Q. Clinical effects of 3D printing-assisted posterolateral incision in the treatment of ankle fractures involving the posterior malleolus. Front Surg 2023; 10:1176254. [PMID: 37292486 PMCID: PMC10244554 DOI: 10.3389/fsurg.2023.1176254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
Objective To explore the clinical outcomes of a 3D printing-assisted posterolateral approach for the treatment of ankle fractures involving the posterior malleolus. Methods A total of 51 patients with ankle fractures involving the posterior malleolus admitted to our hospital from January 2018 to December 2019 were selected. The patients were divided into 3D printing group (28 cases) and control group (23 cases). 3D printing was performed for ankle fractures, followed by printing of a solid model and simulation of the operation on the 3D model. The operation was then performed according to the preoperative plan, including open reduction and internal fixation via the posterolateral approach with the patient in the prone position. Routine x-ray and CT examinations of the ankle joint were performed, and ankle function was evaluated using the American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score. Results All patients underwent x-ray and CT examinations. All fractures healed clinically, without loss of reduction or failure of internal fixation. Good clinical effects were achieved in both groups of patients. The operation time, intraoperative blood loss and intraoperative fluoroscopy frequency in the 3D printing group were significantly less than those in the control group (p < 0.05). There was no significant difference between the two groups in the anatomical reduction rate of fractures or the incidence of surgical complications (p > 0.05). Conclusion The 3D printing-assisted posterolateral approach is effective in the treatment of ankle fractures involving the posterior malleolus. The approach can be well planned before the operation, is simple to perform, yields good fracture reduction and fixation, and has good prospects for clinical application.
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Affiliation(s)
- Hongming Zheng
- Department of Orthopedic Surgery, Affiliated Danyang Hospital of Nantong University, Danyang, China
| | - Yan Xia
- Department of Orthopedic Surgery, Affiliated Danyang Hospital of Nantong University, Danyang, China
| | - Xiaohui Ni
- Department of Orthopedics, Dafeng People’s Hospital, Yancheng, China
| | - Jieshi Wu
- Department of Orthopaedics, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yankun Li
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Pengpeng Zhang
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xinglin Wu
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Kaihang Lu
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Quanming Zhao
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
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Niculescu M, Honțaru OS, Popescu G, Sterian AG, Dobra M. Challenges of Integrating New Technologies for Orthopedic Doctors to Face up to Difficulties during the Pandemic Era. Healthcare (Basel) 2023; 11:1524. [PMID: 37297666 PMCID: PMC10288938 DOI: 10.3390/healthcare11111524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
In the field of orthopedics, competitive progress is growing faster because new technologies used to facilitate the work of physicians are continuously developing. Based on the issues generated in the pandemic era in this field, a research study was developed to identify the intention of orthopedic doctors to integrate new medical technologies. The survey was based on a questionnaire that was used for data collection. The quantitative study registered a sample of 145 orthopedic doctors. The data analysis was performed based on the IBM SPSS program. A multiple linear regression model was applied, which analyzed how the independent variables can influence the dependent variables. After analyzing the data, it was observed that the intention of orthopedic doctors to use new medical technologies is influenced by the advantages and disadvantages perceived by them, the perceived risks, the quality of the medical technologies, the experience of physicians in their use, and their receptivity to other digital tools. The obtained results are highly important both for hospital managers and authorities, illustrating the main factors that influence doctors to use emergent technologies in their clinical work.
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Affiliation(s)
- Marius Niculescu
- Faculty of Medicine, “Titu Maiorescu” University of Bucharest, 031593 Bucharest, Romania;
- Colentina Hospital, Șoseaua Ștefan cel Mare 19-21, 020125 Bucharest, Romania
| | - Octavia-Sorina Honțaru
- Faculty of Sciences, Physical Education and Informatics, University of Pitesti, Târgul din Vale 1, 110040 Arges, Romania
- Department of Public Health Arges, Exercitiu 39 bis, 110438 Arges, Romania
| | - George Popescu
- Emergency Clinical Hospital Dr. Bagdasar-Arseni, Șoseaua Berceni 12, 041915 Bucharest, Romania
| | - Alin Gabriel Sterian
- Emergency Hospital for Children Grigore Alexandrescu, 30-32 Iancu de Hunedoara Boulevard, 011743 Bucharest, Romania;
- Department of Pediatric Surgery and Orthopedics, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania
| | - Mihai Dobra
- Center of Uronephrology and Renal Transplant Fundeni, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
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Grinčuk A, Petryla G, Masionis P, Sveikata T, Uvarovas V, Makulavičius A. Short-term results and complications of the operative treatment of the distal radius fracture AO2R3 C type, planned by using 3D-printed models. Prospective randomized control study. J Orthop Surg (Hong Kong) 2023; 31:10225536231195127. [PMID: 37620284 DOI: 10.1177/10225536231195127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
PURPOSE 3D-printed models rapidly evolving in orthopaedic. Studies show that 3D-printed models used for preoperative planning improve a better understanding of fracture morphology and reduce operative time, blood loss and frequency of fluoroscopy, but there are no studies that investigated possible advantages in the outcomes and complications for the treatment of distal radius fracture (DRF). Our study aims to evaluate short-term functional results and complications between two groups treated DRF using 3D-printed models for preoperative planning and without. We hypothesize that the addition of 3D-printed models would improve functional outcomes and reduce complication rates. METHODS 66 randomized cases of DRF AO/OTA C type were enrolled and divided into "Control group" (n = 33) and "3D-printed model group" (n = 33). Personalized 3D-printed models were created. The primary outcomes were: Patient-Rated Wrist Evaluation questionnaire, Quick Disabilities of the Arm, Shoulder and Hand Score questionnaire, and complications. The secondary outcomes were: measurement of the range of motions, grip strength, radiological evaluation, and the visual analogue scale. Assessments were measured at 6 weeks, 3 months, and 6 months intervals. RESULTS We found that the integration of the 3D-printed model in preoperative planning decreased complication incidence significantly - from 30.3% in the "Control group" to 6.1% in the "3D-printed model group", p = .022. But we did not find a difference in functional and radiological outcomes. CONCLUSION The 3D-printed models for preoperative planning surgically treating DRF AO/OTA C type can help minimize the complication rate, however, they can't improve functional outcomes in the short-term results. LEVEL OF EVIDENCE Level I randomized controlled study.
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Affiliation(s)
- Aleksandr Grinčuk
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedrius Petryla
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Povilas Masionis
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Sveikata
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Valentinas Uvarovas
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aleksas Makulavičius
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Ramos CH, Wild PM, Martins EDC. Effectiveness in Sterilization of Objects Produced by 3D Printing with Polylactic Acid Material: Comparison Between Autoclave and Ethylene Oxide Methods. Rev Bras Ortop 2023; 58:284-289. [PMID: 37252310 PMCID: PMC10212635 DOI: 10.1055/s-0042-1750751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/17/2022] [Indexed: 10/17/2022] Open
Abstract
Objective Due to the popularity of 3D technology, surgeons can create specific surgical guides and sterilize them in their institutions. The aim of the present study is to compare the efficacy of the autoclave and ethylene oxide (EO) sterilization methods for objects produced by 3D printing with polylactic acid (PLA) material. Methods Forty cubic-shaped objects were printed with PLA material. Twenty were solid and 20 were hollow (printed with little internal filling). Twenty objects (10 solid and 10 hollow) were sterilized in autoclave, forming Group 1. The others (10 solid and 10 hollow) were sterilized in EO, composing Group 2. After sterilization, they were stored and referred to culture. Hollow objects of both groups were broken during sowing, communicating the dead space with the culture medium. The results obtained were statistically analyzed (Fisher exact test and residue analysis). Results In group 1 (autoclave), there was bacterial growth in 50% of solid objects and in 30% of hollow objects. In group 2 (EO), growth occurred in 20% of hollow objects, with no bacterial growth in solid objects (100% of negative samples). The bacteria isolated in the positive cases was non-coagulase-producing Staphylococcus Gram positive. Conclusions Sterilization by both autoclave and EO was not effective for hollow printed objects. Solid objects sterilized by autoclave did not demonstrate 100% of negative samples and were not safe in the present assay. Complete absence of contamination occurred only with solid objects sterilized by EO, which is the combination recommended by the authors.
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Affiliation(s)
| | - Pedro Minuzzi Wild
- Departamento de Ortopedia e Traumatologia do Hospital XV, Curitiba, PR, Brasil
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M’Bengue MS, Mesnard T, Chai F, Maton M, Gaucher V, Tabary N, García-Fernandez MJ, Sobocinski J, Martel B, Blanchemain N. Evaluation of a Medical Grade Thermoplastic Polyurethane for the Manufacture of an Implantable Medical Device: The Impact of FDM 3D-Printing and Gamma Sterilization. Pharmaceutics 2023; 15:pharmaceutics15020456. [PMID: 36839778 PMCID: PMC9960613 DOI: 10.3390/pharmaceutics15020456] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
Three-dimensional printing (3DP) of thermoplastic polyurethane (TPU) is gaining interest in the medical industry thanks to the combination of tunable properties that TPU exhibits and the possibilities that 3DP processes offer concerning precision, time, and cost of fabrication. We investigated the implementation of a medical grade TPU by fused deposition modelling (FDM) for the manufacturing of an implantable medical device from the raw pellets to the gamma (γ) sterilized 3DP constructs. To the authors' knowledge, there is no such guide/study implicating TPU, FDM 3D-printing and gamma sterilization. Thermal properties analyzed by differential scanning calorimetry (DSC) and molecular weights measured by size exclusion chromatography (SEC) were used as monitoring indicators through the fabrication process. After gamma sterilization, surface chemistry was assessed by water contact angle (WCA) measurement and infrared spectroscopy (ATR-FTIR). Mechanical properties were investigated by tensile testing. Biocompatibility was assessed by means of cytotoxicity (ISO 10993-5) and hemocompatibility assays (ISO 10993-4). Results showed that TPU underwent degradation through the fabrication process as both the number-averaged (Mn) and weight-averaged (Mw) molecular weights decreased (7% Mn loss, 30% Mw loss, p < 0.05). After gamma sterilization, Mw increased by 8% (p < 0.05) indicating that crosslinking may have occurred. However, tensile properties were not impacted by irradiation. Cytotoxicity (ISO 10993-5) and hemocompatibility (ISO 10993-4) assessments after sterilization showed vitality of cells (132% ± 3%, p < 0.05) and no red blood cell lysis. We concluded that gamma sterilization does not highly impact TPU regarding our application. Our study demonstrates the processability of TPU by FDM followed by gamma sterilization and can be used as a guide for the preliminary evaluation of a polymeric raw material in the manufacturing of a blood contacting implantable medical device.
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Affiliation(s)
- Marie-Stella M’Bengue
- Univ. Lille, INSERM, CHU Lille, U1008—Advanced Drug Delivery Systems and Biomaterials, F-59000 Lille, France
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207—UMET—Unité Matériaux et Transformations, F-59000 Lille, France
| | - Thomas Mesnard
- Univ. Lille, INSERM, CHU Lille, U1008—Advanced Drug Delivery Systems and Biomaterials, F-59000 Lille, France
- Institut Coeur Poumon, Regional Hospital Center University of Lille (CHRU Lille), 2 Avenue Oscar Lambret, F-59000 Lille, France
| | - Feng Chai
- Univ. Lille, INSERM, CHU Lille, U1008—Advanced Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Mickaël Maton
- Univ. Lille, INSERM, CHU Lille, U1008—Advanced Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Valérie Gaucher
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207—UMET—Unité Matériaux et Transformations, F-59000 Lille, France
| | - Nicolas Tabary
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207—UMET—Unité Matériaux et Transformations, F-59000 Lille, France
| | - Maria-José García-Fernandez
- Univ. Lille, INSERM, CHU Lille, U1008—Advanced Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Jonathan Sobocinski
- Univ. Lille, INSERM, CHU Lille, U1008—Advanced Drug Delivery Systems and Biomaterials, F-59000 Lille, France
- Institut Coeur Poumon, Regional Hospital Center University of Lille (CHRU Lille), 2 Avenue Oscar Lambret, F-59000 Lille, France
| | - Bernard Martel
- Univ. Lille, CNRS, INRAE, Centrale Lille, UMR 8207—UMET—Unité Matériaux et Transformations, F-59000 Lille, France
| | - Nicolas Blanchemain
- Univ. Lille, INSERM, CHU Lille, U1008—Advanced Drug Delivery Systems and Biomaterials, F-59000 Lille, France
- Correspondence: ; Tel.: +33-320-626-975
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Safali S, Berk T, Makelov B, Acar MA, Gueorguiev B, Pape HC. The Possibilities of Personalized 3D Printed Implants-A Case Series Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020249. [PMID: 36837451 PMCID: PMC9959288 DOI: 10.3390/medicina59020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
Background and Objectives: Following the most recent software and 3D printing developments, the use of personalized 3D printed orthopedic implants for treatment of complicated surgical cases has gained more popularity. Today, orthopedic problems that cannot be solved with standard implants may be effectively addressed using personalized prostheses. The aim of this study is to present the designing, modeling and production stages of four different personalized 3D printed prostheses and their application in clinical cases of patients who underwent treatment in various anatomical locations with a precisely specified indication for implantation. Materials and Methods: Based on computed tomography scanning, personalized 3D printed prostheses were designed, produced and used in four patients within a period of three to five days after injury or admission. Results: Early term follow-ups demonstrated good to excellent results. Conclusions: Personalized 3D printed prostheses offer an opportunity for a treatment of choice and provide good anatomical and functional results, shortened surgical time, less complications, and high satisfaction in patients with appropriate indications. The method should be considered primarily for patients with large bone defects, or such indicated for resection. Personalized 3D printed prostheses have the potential to become more common and beneficial in the future.
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Affiliation(s)
- Selim Safali
- Orthopaedics and Traumatology Department, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Till Berk
- AO Research Institute Davos, 7270 Davos, Switzerland
- Department of Trauma, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Biser Makelov
- University Multiprofile Hospital for Active Treatment ‘Prof. Stoyan Kirkovitch’, Trakia University, 6003 Stara Zagora, Bulgaria
| | - Mehmet Ali Acar
- Orthopaedics and Traumatology Department, Medical Faculty, Selçuk University, Konya 42250, Turkey
| | - Boyko Gueorguiev
- AO Research Institute Davos, 7270 Davos, Switzerland
- Correspondence:
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Muacevic A, Adler JR, Tarpada S, Kahn MD. Treatment of an Infected Tibial Shaft Non-Union Using a Novel 3D-Printed Titanium Mesh Cage: A Case Report. Cureus 2023; 15:e34212. [PMID: 36852371 PMCID: PMC9957684 DOI: 10.7759/cureus.34212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/27/2023] Open
Abstract
Treating large bone defects resulting from trauma, tumors, or infection can be challenging, as current methods such as external fixation with bone transport, bone grafting, or amputation often come with high costs, high failure rates, high requirements for follow-up, and potential complications. In this case report, we present the successful treatment of a complicated, infected tibial shaft non-union by using a personalized three-dimensional (3D)-printed titanium mesh cage. This case adds to the existing body of literature by demonstrating successful integration of bone into a titanium implant and a demonstration of immediate postoperative weight bearing in the setting of suboptimal operative and psychosocial conditions. Futhermore, this report highlights the flexibility of 3D-printing technology and its ability to allow for continued limb salvage, even after a planned bone transport procedure has been interrupted. The use of 3D-printed implants customized to the patient's specific needs offers a promising new avenue for treating complex tibial pathologies, and the technology's versatility and ability to be tailored to individual patients makes it a promising tool for addressing a wide range of bone defects.
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Tredan DAM, Mobbs RJ, Maharaj M, Parr WCH. Combining Virtual Surgical Planning and Patient-Specific 3D-Printing as a Solution to Complex Spinal Revision Surgery. J Pers Med 2022; 13:jpm13010019. [PMID: 36675680 PMCID: PMC9866145 DOI: 10.3390/jpm13010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/03/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
With the advent of three-dimensional printing, rapid growth in the field and application in spinal and orthopedic surgery has been seen. This technology is now being applied in creating patient-specific implants, as it offers benefits over the generic alternative, with growing literature supporting this. This report details a unique application of virtual surgical planning and manufacture of a personalized implant in a case of cervical disc replacement failure with severe osteolysis and resultant hypermobility. Where this degree of degenerative bone loss would often necessitate a vertebrectomy to be performed, this case highlights the considerable customizability of 3D-printed patient-specific implants to contour to the bony defects, allowing for a smaller and safer operation, with the achievement of stability as early as 3 months after the procedure, by the presence of osseointegration. With increasing developments in virtual planning technology and 3D printing ability, the future of complex spinal revision surgery may adopt these technologies as it affords the patient a faster, safer, and less invasive and destructive procedure.
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Affiliation(s)
- David A. M. Tredan
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW 2031, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
- Correspondence: ; Tel.: +61-(0)2-9382-2222
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW 2031, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, University of New South Wales, Randwick, NSW 2031, Australia
- 3DMorphic Pty. Ltd., Matraville, NSW 2036, Australia
| | - Monish Maharaj
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW 2031, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, NSW 2031, Australia
| | - William C. H. Parr
- NeuroSpine Surgery Research Group (NSURG), Sydney, NSW 2031, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, University of New South Wales, Randwick, NSW 2031, Australia
- 3DMorphic Pty. Ltd., Matraville, NSW 2036, Australia
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Pankratov AS, Lartsev YV, Rubtsov AA, Ogurtsov DA, Kim YD, Shmel'kov AV, Knyazev NA. Application of 3D modeling in a personalized approach to bone osteosynthesis (A literature review). BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2023.1.ictm.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Three-dimensional printing opens up many opportunities for use in traumatology and orthopedics, because it takes into account personal characteristics of the patients. Modern methods of high-resolution medical imaging can process data to create threedimensional images for printing physical objects. Today, three-dimensional printers are able to create a model of any complexity of shape and geometry. The article provides a review of the literature about three-dimensional digital modeling in shaping implants for osteosynthesis. Data search was carried out on the Scopus, Web of Scince, Pubmed, RSCI databases for the period 2012–2022. The effectiveness of three-dimensional printing for preoperative modeling of bone plates has been confirmed: implants perfectly corresponds with the unique anatomy of the patient, since the template for it is based on the materials of computed tomography. Individual templates can be useful when the geometry of patients' bones goes beyond the standard, and when improved results of surgery are expected due to better matching of implants to the anatomical needs of patients.
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Management of Complex Acetabular Fractures by Using 3D Printed Models. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121854. [PMID: 36557056 PMCID: PMC9785751 DOI: 10.3390/medicina58121854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Using 3D printed models in orthopaedics and traumatology contributes to a better understanding of injury patterns regarding surgical approaches, reduction techniques, and fracture fixation methods. The aim of this study is to evaluate the effectiveness of a novel technique implementing 3D printed models to facilitate the optimal preoperative planning of the surgical treatment of complex acetabular fractures. Materials and Methods: Patients with complex acetabular fractures were assigned to two groups: (1) conventional group (n = 12) and (2) 3D printed group (n = 10). Both groups included participants with either a posterior column plus posterior wall fracture, a transverse plus posterior wall fracture, or a both-column acetabular fracture. Datasets from CT scanning were segmented and converted to STL format, with separated bones and fragments for 3D printing in different colors. Comparison between the two groups was performed in terms of quality of fracture reduction (good: equal to, or less than 2 mm displacement, and fair: larger than 2 mm displacement), functional assessment, operative time, blood loss, and number of intraoperative x-rays. Results: A significant decrease in operative time, blood loss, and number of intraoperative x-rays was registered in the 3D printed group versus the conventional one (p < 0.01), with 80% of the patients in the former having good fracture reduction and 20% having fair reduction. In contrast, 50% of the patients in the conventional group had good reduction and 50% had fair reduction. The functional score at 18-month follow-up was better for patients in the 3D printed group. Conclusions: The 3D printing technique can be considered a highly efficient and patient-specific approach for management of complex acetabular fractures, helping to restore patient′s individual anatomy after surgery.
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Fang C, Cai L, Chu G, Jarayabhand R, Kim JW, O'Neill G. 3D printing in fracture treatment : Current practice and best practice consensus. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:1-7. [PMID: 35817874 PMCID: PMC9722822 DOI: 10.1007/s00113-022-01159-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 06/10/2023]
Abstract
The use of 3D printing in orthopedic trauma is supported by clinical evidence. Existing computed tomography (CT) data are exploited for better stereotactic identification of morphological features of the fracture and enhanced surgical planning. Due to complex logistic, technical and resource constraints, deployment of 3D printing is not straightforward from the hospital management perspective. As a result not all trauma surgeons are able to confidently integrate 3D printing into the daily practice. We carried out an expert panel survey on six trauma units which utilized 3D printing routinely. The most frequent indications are acetabular and articular fractures and malalignments. Infrastructure and manpower structure varied between units. The installation of industrial grade machines and dedicated software as well as the use of trained personnel can enhance the capacity and reliability of fracture treatment. Setting up interdisciplinary jointly used 3d printing departments with sound financial and management structures may improve sustainability. The sometimes substantial logistic and technical barriers which impede the rapid delivery of 3D printed models are discussed.
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Affiliation(s)
- Christian Fang
- Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
| | - Leyi Cai
- First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Gabriel Chu
- United Christian Hospital, Hong Kong SAR, China
| | | | - Ji Wan Kim
- Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
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Xuan Z, Zachar V, Pennisi CP. Sources, Selection, and Microenvironmental Preconditioning of Cells for Urethral Tissue Engineering. Int J Mol Sci 2022; 23:ijms232214074. [PMID: 36430557 PMCID: PMC9697333 DOI: 10.3390/ijms232214074] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022] Open
Abstract
Urethral stricture is a common urinary tract disorder in men that can be caused by iatrogenic causes, trauma, inflammation, or infection and often requires reconstructive surgery. The current therapeutic approach for complex urethral strictures usually involves reconstruction with autologous tissue from the oral mucosa. With the goal of overcoming the lack of sufficient autologous tissue and donor site morbidity, research over the past two decades has focused on cell-based tissue-engineered substitutes. While the main focus has been on autologous cells from the penile tissue, bladder, and oral cavity, stem cells from sources such as adipose tissue and urine are competing candidates for future urethral regeneration due to their ease of collection, high proliferative capacity, maturation potential, and paracrine function. This review addresses the sources, advantages, and limitations of cells for tissue engineering in the urethra and discusses recent approaches to improve cell survival, growth, and differentiation by mimicking the mechanical and biophysical properties of the extracellular environment.
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Rodham P, Giannoudis PV. Innovations in orthopaedic trauma: Top advancements of the past two decades and predictions for the next two. Injury 2022; 53 Suppl 3:S2-S7. [PMID: 36180258 DOI: 10.1016/j.injury.2022.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/22/2022] [Accepted: 09/02/2022] [Indexed: 02/02/2023]
Abstract
The first Trauma and Orthopaedic unit dates back to 1780, originally dedicated to the treatment of children's deformities. The specialty has subsequently become multifaceted, with a plethora of subspecialty areas of which orthopaedic trauma is the most commonly practiced. Recently there has been a significant demand for an evidence base with more than 130,000 of the 162,000 publications in the last century occurring within the past 20 years. This narrative review will summarise some of the more landmark changes within orthopaedic trauma that have been made within the past 20 years, whilst also attempting to predict where the specialty will continue to develop as we move forward.
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Affiliation(s)
- Paul Rodham
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom.
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Oraa J, Fiz N, González S, M B, Sánchez X, Delgado D, Sánchez M. Derotation tibial osteotomy with custom cutting guides and custom osteosynthesis plate printed with 3D technology: case and technical note. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Zhu C, Zhang C, Zhao Y, Yu G, Yu L. Modified Masquelet Technique Assisting 3D Printed Elbow Prosthesis for Open Elbow Fracture with Severe Bone Defect: A Case Report and Technique Note. Orthop Surg 2022; 14:3423-3430. [PMID: 36263967 PMCID: PMC9732626 DOI: 10.1111/os.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 05/28/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Internal fixation for severe open articular bone defects is sometimes ineffective or dangerous. In the emergency stage, radical debridement and infection prevention are demanded to provide a good tissue base and the space-occupying effect to provide enough necessary space to avoid soft-tissue contraction for the reconstruction. In addition, the 3D printing technology makes individual limb reconstruction a reality. CASE PRESENTATION Here, we present a 31-year-old patient with an open fracture and severe bone defect of his left elbow caused by traffic accident, classified as Gustilo-Anderson IIIB. We adopted aggressive debridement and insertion of polymethyl methacrylate (PMMA) to prevent the infection and temporarily construct the bone defect in the emergency stage. Secondly, the total elbow arthroplasty was performed using a unique three-dimensional (3D) printed prosthesis to reconstruct the elbow joint. During the follow-up, the elbow movement function was satisfactory. CONCLUSIONS The modified Masquelet technique assisting 3D printing of personalized elbow joint makes the satisfactory functional reconstruction for open high-energy injuries come true. It could be promoted for the similar surgery of other open joints fractures with severe bone defects.
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Affiliation(s)
- Chunquan Zhu
- Department of Trauma and Microsurgery OrthopedicsZhongnan Hospital of Wuhan UniversityWuhanChina,Department of OrthopedicsWuhan Fourth HospitalPuai HospitalWuhanChina
| | - Chong Zhang
- Department of Trauma and Microsurgery OrthopedicsZhongnan Hospital of Wuhan UniversityWuhanChina
| | - Yong Zhao
- Department of Trauma and Microsurgery OrthopedicsZhongnan Hospital of Wuhan UniversityWuhanChina
| | - Guorong Yu
- Department of Trauma and Microsurgery OrthopedicsZhongnan Hospital of Wuhan UniversityWuhanChina
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De Franco C, Colò G, Melato M, Battini A, Cambursano S, Logrieco GP, Balato G, Zoccola K. Fracture-Related Infection in Bicolumnar Acetabular Fracture: A Case Report. Diagnostics (Basel) 2022; 12:diagnostics12102476. [PMID: 36292165 PMCID: PMC9601166 DOI: 10.3390/diagnostics12102476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Case: A 51-year-old man was affected by a fracture-related infection after a bicolumnar acetabular fracture. A significant alteration of the anatomy was present; thus, a 3D-printed model was useful for planning. A two-stage treatment was planned: in the first stage, implant removal with irrigation and debridement was performed, while in the second stage, a new osteosynthesis and implant of a THA were planned. During the second stage, the patient suffered a cardiogenic shock, so a third surgical procedure was necessary to implant THA. Targeted antibiotic therapy was administered eight weeks after the first stage, with the resolution of the infection. Conclusions: The infection was resolved following the recent guidelines and treating it like a periprosthetic infection with a two-stage revision. A collaboration between specialists in orthopaedics and infectious disease, respectively, and using multidisciplinary approach, were mandatory.
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Affiliation(s)
- Cristiano De Franco
- Orthopaedics and Traumatology Unit, SS Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
- Correspondence: ; Tel.:+39-3349133871
| | - Gabriele Colò
- Orthopaedics and Traumatology Unit, SS Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Marco Melato
- Orthopaedics and Traumatology Unit, SS Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Alberto Battini
- Orthopaedics and Traumatology Unit, SS Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Simone Cambursano
- Orthopaedics and Traumatology Unit, SS Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Giuseppe Pietro Logrieco
- Orthopaedics and Traumatology Unit, SS Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Giovani Balato
- Orthopaedic Unit, Department of Public Health, Federico II University, 80138 Naples, Italy
| | - Kristijan Zoccola
- Orthopaedics and Traumatology Unit, SS Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
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Aili A, Ma Y, Sui J, Dai J, Zhu X, Muheremu A. Application of 3D printed models in the surgical treatment of spinal deformity. Am J Transl Res 2022; 14:6341-6348. [PMID: 36247257 PMCID: PMC9556452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To test if preoperative planning with 3 dimensional (3D)-printed spine models can increase the effectiveness and safety of spinal deformity surgery. METHODS A total of 53 patients who were treated in our center for spinal deformities from January 2010 to January 2018 were included in the current study. They were divided into two groups based on whether 3D-printed models were used in the surgical planning. A total of 28 patients who were treated with 3D-printed models were assigned to the experimental group, and 25 patients who were treated with conventional methods were assigned to the control group. Duration of surgery, intraoperative hemorrhage, incidence of surgery related complications, Oswestry disability index (ODI), visual analogue scale (VAS), and Cobb's angle were compared between the two groups before and after surgery. RESULTS There were significant differences in the duration of surgery, intraoperative hemorrhage and intraoperative x-ray exposure between the two groups (P<0.01). Cobb's angle was smaller in the experimental group than in the control group when measured three days and a year after surgery (P<0.01). Although there was no significant difference between the experimental and control groups (P>0.05), Oswestry disability index and VAS pain scores were lower a month and a year after the surgery than before the surgery (P<0.01). CONCLUSION Surgical planning using 3D-printed spine models can decrease the operation time, intraoperative hemorrhage, and x-ray exposure, and help achieve satisfactory structural restoration in patients with severe spinal deformity.
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Affiliation(s)
- Abudunaibi Aili
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Yuan Ma
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Jiangtao Sui
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Jie Dai
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Xu Zhu
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Aikeremujiang Muheremu
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
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Lee AKX, Lin TL, Hsu CJ, Fong YC, Chen HT, Tsai CH. Three-Dimensional Printing and Fracture Mapping in Pelvic and Acetabular Fractures: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11185258. [PMID: 36142905 PMCID: PMC9506009 DOI: 10.3390/jcm11185258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 02/06/2023] Open
Abstract
Three-dimensional printing and fracture mapping technology is gaining popularity for preoperative planning of fractures. The aim of this meta-analysis is to further understand for the effects of 3D printing and fracture mapping on intraoperative parameters, postoperative complications, and functional recovery on pelvic and acetabular fractures. The PubMed, Embase, Cochrane and Web of Science databases were systematically searched for articles according to established criteria. A total of 17 studies were included in this study, of which 3 were RCTs, with a total of 889 patients, including 458 patients treated by traditional open reduction and internal fixation methods and 431 patients treated using 3D printing strategies. It was revealed that three-dimensional printing and fracture mapping reduced intraoperative surgical duration (RoM 0.74; 95% CI; 0.66–0.83; I2 = 93%), and blood loss (RoM 0.71; 95% CI; 0.63–0.81; I2 = 71%). as compared to traditional surgical approaches. In addition, there was significantly lower exposure to intraoperative imaging (RoM 0.36; 95% CI; 0.17–0.76; I2 = 99%), significantly lower postoperative complications (OR 0.42; 95% CI; 0.22–0.78; I2 = 9%) and significantly higher excellent/good reduction (OR 1.53; 95% CI; 1.08–2.17; I2 = 0%) in the three-dimensional printing and fracture mapping group. Further stratification results with only prospective studies showed similar trends. Three-dimensional printing and fracture mapping technology has potential in enhancing treatment of complex fractures by improving surgical related factors and functional outcomes and therefore could be considered as a viable tool for future clinical applications.
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Affiliation(s)
- Alvin Kai-Xing Lee
- Department of Education, China Medical University Hospital, Taichung 404, Taiwan
| | - Tsung-Li Lin
- Department of Orthopedics Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Department of Sports Medicine, China Medical University, Taichung 404, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan
| | - Chin-Jung Hsu
- Department of Orthopedics Surgery, China Medical University Hospital, Taichung 404, Taiwan
- School of Chinese Medicine, China Medical University, Taichung 404, Taiwan
| | - Yi-Chin Fong
- Department of Orthopedics Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Department of Sports Medicine, China Medical University, Taichung 404, Taiwan
- Department of Orthopedics Surgery, China Medical University Hospital Beigang Branch, Yunlin 651, Taiwan
| | - Hsien-Te Chen
- Spine Center, China Medical University Hospital, Taichung 404, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedics Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Department of Sports Medicine, China Medical University, Taichung 404, Taiwan
- Correspondence:
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A Two-Step Approach for 3D-Guided Patient-Specific Corrective Limb Osteotomies. J Pers Med 2022; 12:jpm12091458. [PMID: 36143242 PMCID: PMC9503424 DOI: 10.3390/jpm12091458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Corrective osteotomy surgery for long bone anomalies can be very challenging since deformation of the bone is often present in three dimensions. We developed a two-step approach for 3D-planned corrective osteotomies which consists of a cutting and reposition guide in combination with a conventional osteosynthesis plate. This study aimed to assess accuracy of the achieved corrections using this two-step technique. Methods: All patients (≥12 years) treated for post-traumatic malunion with a two-step 3D-planned corrective osteotomy within our center in 2021 were prospectively included. Three-dimensional virtual models of the planned outcome and the clinically achieved outcome were obtained and aligned. Postoperative evaluation of the accuracy of performed corrections was assessed by measuring the preoperative and postoperative alignment error in terms of angulation, rotation and translation. Results: A total of 10 patients were included. All corrective osteotomies were performed according to the predetermined surgical plan without any complications. The preoperative deformities ranged from 7.1 to 27.5° in terms of angulation and 5.3 to 26.1° in terms of rotation. The achieved alignment deviated on average 2.1 ± 1.0 and 3.4 ± 1.6 degrees from the planning for the angulation and rotation, respectively. Conclusions: A two-step approach for 3D-guided patient-specific corrective limb osteotomies is reliable, feasible and accurate.
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Aman ZS, DePhillipo NN, Peebles LA, Familiari F, LaPrade RF, Dekker TJ. Improved Accuracy of Coronal Alignment Can Be Attained Using 3D-Printed Patient-Specific Instrumentation for Knee Osteotomies: A Systematic Review of Level III and IV Studies. Arthroscopy 2022; 38:2741-2758. [PMID: 35247513 DOI: 10.1016/j.arthro.2022.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the accuracy and precision of postoperative coronal plane alignment using 3D-printed patient-specific instrumentation (PSI) in the setting of proximal tibial or distal femoral osteotomies. METHODS A systematic review evaluating the accuracy of 3D-printed PSI for coronal plane alignment correcting knee osteotomies was performed. The primary outcomes were accuracy of coronal plane limb alignment correction and number of correction outliers. Secondary variables were duration of surgery, number of intraoperative fluoroscopic images, complications, cost, and clinical outcomes (as applicable). RESULTS Ninety-three studies were identified, and 14 were included in the final analysis. Overall, mean postoperative deviation from target correction ranged from 0.3° to 1° for all studies using hip-knee angle measurements and 2.3% to 4.9% for all studies using weight-bearing line measurements. The incidence of correction outliers was assessed in 8 total studies and ranged from 0 to 25% (total n = 10 knees) of patients corrected with 3D-printed PSI. Osteotomies performed with 3D-printed cutting guides or wedges demonstrated significantly shorter operative times (P < .05) and fewer intraoperative fluoroscopic images (P < .05) than control groups in four case control studies. CONCLUSION Patients undergoing distal femoral osteotomy or proximal tibial osteotomy procedures with 3D-printed patient-specific cutting guides and wedges had highly accurate coronal plane alignment with a low rate of outliers. Patients treated with 3D printed PSI also demonstrated significantly shorter operative times and decreased intraoperative fluoroscopy when compared to conventional techniques. LEVEL OF EVIDENCE Level IV, systematic review of Level III-IV studies.
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Affiliation(s)
- Zachary S Aman
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | | | - Liam A Peebles
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Filippo Familiari
- Department of Orthopaedics and Trauma Surgery, Magna Graecia University, Catanzaro, Italy
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Artificial Intelligence-Empowered 3D and 4D Printing Technologies toward Smarter Biomedical Materials and Approaches. Polymers (Basel) 2022; 14:polym14142794. [PMID: 35890571 PMCID: PMC9319487 DOI: 10.3390/polym14142794] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/17/2022] Open
Abstract
In the last decades, 3D printing has played a crucial role as an innovative technology for tissue and organ fabrication, patient-specific orthoses, drug delivery, and surgical planning. However, biomedical materials used for 3D printing are usually static and unable to dynamically respond or transform within the internal environment of the body. These materials are fabricated ex situ, which involves first printing on a planar substrate and then deploying it to the target surface, thus resulting in a possible mismatch between the printed part and the target surfaces. The emergence of 4D printing addresses some of these drawbacks, opening an attractive path for the biomedical sector. By preprogramming smart materials, 4D printing is able to manufacture structures that dynamically respond to external stimuli. Despite these potentials, 4D printed dynamic materials are still in their infancy of development. The rise of artificial intelligence (AI) could push these technologies forward enlarging their applicability, boosting the design space of smart materials by selecting promising ones with desired architectures, properties, and functions, reducing the time to manufacturing, and allowing the in situ printing directly on target surfaces achieving high-fidelity of human body micro-structures. In this review, an overview of 4D printing as a fascinating tool for designing advanced smart materials is provided. Then will be discussed the recent progress in AI-empowered 3D and 4D printing with open-loop and closed-loop methods, in particular regarding shape-morphing 4D-responsive materials, printing on moving targets, and surgical robots for in situ printing. Lastly, an outlook on 5D printing is given as an advanced future technique, in which AI will assume the role of the fifth dimension to empower the effectiveness of 3D and 4D printing for developing intelligent systems in the biomedical sector and beyond.
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Rapid Personalised Virtual Planning and On-Demand Surgery for Acute Spinal Trauma Using 3D-Printing, Biomodelling and Patient-Specific Implant Manufacture. J Pers Med 2022; 12:jpm12060997. [PMID: 35743781 PMCID: PMC9224763 DOI: 10.3390/jpm12060997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Three-dimensional printing is a rapidly growing field, with extensive application to orthopaedics and spinal surgery. Three-dimensional-printed (3DP) patient-specific implants (PSIs) offer multiple potential benefits over generic alternatives, with their use increasingly being described in the spinal literature. This report details a unique, emergency case of a traumatic spinal injury in a 31-year-old male, acquired rurally and treated with a 3DP PSI in a tertiary unit. With increasing design automation and process improvements, rapid, on-demand virtual surgical planning (VSP) and 3DP PSIs may present the future of orthopaedics and trauma care, enabling faster, safer, and more cost-effective patient-specific procedures.
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Assink N, Reininga IHF, Ten Duis K, Doornberg JN, Hoekstra H, Kraeima J, Witjes MJH, de Vries JPPM, IJpma FFA. Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients. Eur J Trauma Emerg Surg 2022; 48:1737-1749. [PMID: 34463771 PMCID: PMC9192447 DOI: 10.1007/s00068-021-01773-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/15/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this systematic review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess whether 3D-assisted surgery results in improved clinical outcome as compared to surgery based on conventional imaging modalities. METHODS A literature search was performed in Pubmed and Embase for articles reporting on the use of 3D techniques in operative management of tibial plateau fractures. This systematic review was performed in concordance with the PRISMA-guidelines. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Differences in terms of operation time, blood loss, fluoroscopy frequency, intra-operative revision rates and patient-reported outcomes between 3D-assisted and conventional surgery were assessed. Data were pooled using the inverse variance weighting method in RevMan. RESULTS Twenty articles evaluating 948 patients treated with 3D-assisted surgery and 126 patients with conventional surgery were included. Five different concepts of 3D-assisted surgery were identified: '3D virtual visualization', '3D printed hand-held fracture models', 'Pre-contouring of osteosynthesis plates', '3D printed surgical guides', and 'Intra-operative 3D imaging'. 3D-assisted surgery resulted in reduced operation time (104.7 vs. 126.4 min; P < 0.01), less blood loss (241 ml vs. 306 ml; P < 0.01), decreased frequency of fluoroscopy (5.8 vs. 9.1 times; P < 0.01). No differences in functional outcome was found (Hospital for Special Surgery Knee-Rating Scale: 88.6 vs. 82.8; P = 0.23). CONCLUSIONS Five concepts of 3D-assisted surgical management of tibial plateau fractures emerged over the last decade. These include 3D virtual fracture visualization, 3D-printed hand-held fracture models for surgical planning, 3D-printed models for pre-contouring of osteosynthesis plates, 3D-printed surgical guides, and intra-operative 3D imaging. 3D-assisted surgery may have a positive effect on operation time, blood loss, and fluoroscopy frequency.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Inge H F Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Job N Doornberg
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Harm Hoekstra
- Department of Traumatology, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Fang C, Cai L, Chu G, Jarayabhand R, Kim JW, O’Neill G. 3D-Druck in der Frakturversorgung. Unfallchirurg 2022; 125:342-350. [DOI: 10.1007/s00113-022-01158-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 01/14/2023]
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