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Barakeh W, Zein O, Hemdanieh M, Sleem B, Nassereddine M. Enhancing Hip Arthroplasty Outcomes: The Multifaceted Advantages, Limitations, and Future Directions of 3D Printing Technology. Cureus 2024; 16:e60201. [PMID: 38868274 PMCID: PMC11167579 DOI: 10.7759/cureus.60201] [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: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
In the evolving field of orthopedic surgery, the integration of three-dimensional printing (3D printing) has emerged as a transformative technology, particularly in addressing the rising incidence of degenerative joint diseases. The integration of 3D printing technology in hip arthroplasty offers substantial advantages throughout the surgical process. In preoperative planning, 3D models enable meticulous assessments, aiding in accurate implant selection and precise surgical strategies. Intraoperatively, the technology contributes to precise prosthesis design, reducing operation duration, X-ray exposures, and blood loss. Beyond surgery, 3D printing revolutionizes medical equipment production, imaging, and implant design, showcasing benefits such as enhanced osseointegration and reduced stress shielding with titanium cups. Challenges include a higher risk of postoperative infection due to the porous surfaces of 3D-printed implants, technical complexities in the printing process, and the need for skilled manpower. Despite these challenges, the evolving nature of 3D printing technologies underscores the importance of relying on existing orthopedic surgical practices while emphasizing the need for standardized guidelines to fully harness its potential in improving patient care.
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Affiliation(s)
- Wael Barakeh
- Orthopedic Surgery, American University of Beirut, Beirut, LBN
| | - Omar Zein
- Orthopedic Surgery, American University of Beirut, Beirut, LBN
| | - Maya Hemdanieh
- Orthopedic Surgery, American University of Beirut, Beirut, LBN
| | - Bshara Sleem
- Orthopedic Surgery, American University of Beirut, Beirut, LBN
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Kahsai EA, O'Connor B, Khoo KJ, Ogunleye TD, Telfer S, Hagen MS. Improving Patient Understanding of Femoroacetabular Impingement Syndrome With Three-Dimensional Models. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00006. [PMID: 38722846 PMCID: PMC11081616 DOI: 10.5435/jaaosglobal-d-24-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Three-dimensional (3D) printed models may help patients understand complex anatomic pathologies such as femoroacetabular impingement syndrome (FAIS). We aimed to assess patient understanding and satisfaction when using 3D printed models compared with standard imaging modalities for discussion of FAIS diagnosis and surgical plan. METHODS A consecutive series of 76 new patients with FAIS (37 patients in the 3D model cohort and 39 in the control cohort) from a single surgeon's clinic were educated using imaging and representative 3D printed models of FAI or imaging without models (control). Patients received a voluntary post-visit questionnaire that evaluated their understanding of the diagnosis, surgical plan, and visit satisfaction. RESULTS Patients in the 3D model cohort reported a significantly higher mean understanding of FAIS (90.0 ± 11.5 versus 79.8 ± 14.9 out of 100; P = 0.001) and surgery (89.5 ± 11.6 versus 81.0 ± 14.5; P = 0.01) compared with the control cohort. Both groups reported high levels of satisfaction with the visit. CONCLUSION In this study, the use of 3D printed models in clinic visits with patients with FAIS improved patients' perceived understanding of diagnosis and surgical treatment.
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Affiliation(s)
- Ermyas A. Kahsai
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Bailey O'Connor
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Kevin J. Khoo
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Temi D. Ogunleye
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Scott Telfer
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
| | - Mia S. Hagen
- From the Department of Orthopaedics and Sports Medicine, The University of Washington, Seattle, WA
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Choo A, Richard MJ. The Role of 3D Custom Implants in Upper Extremity Surgery. J Orthop Trauma 2024; 38:S30-S36. [PMID: 38502601 DOI: 10.1097/bot.0000000000002760] [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: 01/03/2024] [Indexed: 03/21/2024]
Abstract
SUMMARY As the technology of three-dimensional (3D) printing becomes more refined and accessible, multiple applications of its use are becoming more commonplace in upper extremity surgery. 3D-printed models have been beneficial in preoperative planning of complex cases of acute trauma or malunions, contributing to spatial understanding or even contouring of implants. Custom guides can also be created to assist intraoperatively with precise placement of osteotomies or arthroplasty implants. Finally, custom 3D implants have been described for cases of bone loss in the upper extremity. This can be for relatively small gaps after malunion correction or extensive defects, typically for trauma or tumor. Articular defects can also be addressed with this technology, although special considerations should be given to the implant design and longevity in these situations. Because of the relatively recent nature of 3D implants, long-term data are lacking. However, they show great promise in an expanding range of challenging clinical indications.
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Affiliation(s)
- Andrew Choo
- Department of Orthopaedic Surgery, McGovern Medical School/University of Texas Health Science Center at Houston, Houston, TX; and
| | - Marc J Richard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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Paxton NC, Wilkinson BG, Fitzpatrick D, Owen EC, Luposchainsky S, Dalton PD. Technical improvements in preparing 3D printed anatomical models for comminuted fracture preoperative planning. 3D Print Med 2023; 9:25. [PMID: 37695521 PMCID: PMC10494395 DOI: 10.1186/s41205-023-00189-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023] Open
Abstract
Preoperative planning of comminuted fracture repair using 3D printed anatomical models is enabling surgeons to visualize and simulate the fracture reduction processes before surgery. However, the preparation of such models can be challenging due to the complexity of certain fractures, particularly in preserving fine detail in bone fragments, maintaining the positioning of displaced fragments, and accurate positioning of multiple bones. This study described several key technical considerations for preparing 3D printed anatomical models for comminuted fracture preoperative planning. An optimized segmentation protocol was developed that preserves fine detail in bone fragments, resulting in a more accurate representation of the fracture. Additionally, struts were manually added to the digital model to maintain the positioning of displaced fragments after fabrication, reducing the likelihood of errors during printing or misrepresentation of fragment positioning. Magnets were also used to enable separation and visualization of accurate positioning of multiple bones, making it easier to visualize fracture components otherwise obscured by the anatomy. Finally, the infill for non-target structures was adjusted to minimize print time and material wastage. These technical optimizations improved the accuracy and efficiency of preparing 3D printed anatomical models for comminuted fracture preoperative planning, improving opportunities for surgeons to better plan surgical treatment in advance, reducing the likelihood of errors, with the goal of improving surgical outcomes.
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Affiliation(s)
- Naomi C Paxton
- Phil & Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, 1505 Franklin Blvd, Eugene, OR, 97403, USA.
| | | | | | - Erin C Owen
- Slocum Research & Education Foundation, Eugene, OR, USA
| | - Simon Luposchainsky
- Phil & Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, 1505 Franklin Blvd, Eugene, OR, 97403, USA
| | - Paul D Dalton
- Phil & Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, 1505 Franklin Blvd, Eugene, OR, 97403, USA
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Stine S, Joiner JD, Andersen D, Schweller E, Vaidya R. Transparency films: intraoperative templating to prevent limb deformity. OTA Int 2023; 6:e280. [PMID: 37601826 PMCID: PMC10438797 DOI: 10.1097/oi9.0000000000000280] [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: 10/12/2022] [Accepted: 06/03/2023] [Indexed: 08/22/2023]
Abstract
Operative management of fractures and malunions can be challenging when restoring native anatomy is not straightforward. Comminuted fractures and managing deformity correction in the setting of osteolysis, callus, and even complete fracture healing must include careful planning. Preoperative planning has been popularized and taught as an integral part of a surgeon's skill set, with critical evaluation and assessment of the implemented plan being the final step in the process. We present a robust, reproducible, and cost-effective technique for intraoperative fracture fixation assessment with case examples, used routinely at our institution.
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Affiliation(s)
- Sasha Stine
- Wayne State University, Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI
| | | | - Daniel Andersen
- Michigan State University College of Osteopathic Medicine, Lansing, MI
| | - Eric Schweller
- Michigan State University College of Osteopathic Medicine, Lansing, MI
| | - Rahul Vaidya
- Wayne State University, Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI
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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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Jo WL, Chung YG, Shin SH, Lim JH, Kim MS, Yoon DK. Structural analysis of customized 3D printed plate for pelvic bone by comparison with conventional plate based on bending process. Sci Rep 2023; 13:10542. [PMID: 37386116 PMCID: PMC10310805 DOI: 10.1038/s41598-023-37433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
Pelvic bone fracture is highly complex, and its anatomical reduction is difficult. Therefore, patient-specific customized plates have been developed using three-dimensional (3D) printing technology and are being increasingly used. In this study, the reduction status in five representative pelvic fracture models was compared between two groups: the 3D printing plate (3DP) group using a patient-specific 3D printed plate after virtual reduction and the conventional plate (CP) group using a conventional plate by manual bending. The 3DP and CP groups included 10 and 5 cases, respectively. The fractured models were reduced virtually and their non-locking metal plates were customized using 3D printing. The process of contouring the conventional plates to fit the contact surface of the bone with the bending tool was conducted by an experienced pelvic bone trauma surgeon. The reduction and fixation achieved using the two different plate groups was compared, and the significance of differences in the results was analyzed using paired t-tests, after verifying the normality of data distribution. The vertex distances between the surface of the bone and the contact surface of the plate were significantly lower in the 3DP group than in the CP group (0.407 ± 0.342 and 2.195 ± 1.643, respectively, P = 0.008). Length and angular variations, which are measurements of the reduction state, were also lower in the 3DP group than in the CP group (length variation: 3.211 ± 2.497 and 5.493 ± 3.609, respectively, P = 0.051; angular variation: 2.958 ± 1.977 and 4.352 ± 1.947, respectively, P = 0.037). The customized 3D printed plate in the virtual reduction model provided a highly accurate reduction of pelvic bone fractures, suggesting that the customized 3D printed plate may help ensure easy and accurate reduction.
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Affiliation(s)
- Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea
| | - Yang-Guk Chung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea.
| | - Seung-Han Shin
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea
| | - Jae-Hak Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea
| | - Moo-Sub Kim
- Industrial R&D Center, KAVILAB Co. Ltd., 06693, Seoul, Republic of Korea
| | - Do-Kun Yoon
- Industrial R&D Center, KAVILAB Co. Ltd., 06693, Seoul, Republic of Korea
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Park HJ, You KH, Huang B, Yoon JH, Kim HN. Can 3-Dimensional Printing for Calcaneal Fracture Surgery Decrease Operation Time and Improve Quality of Fracture Reduction? J Foot Ankle Surg 2022; 62:21-26. [PMID: 35418345 DOI: 10.1053/j.jfas.2022.03.004] [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: 04/27/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 02/03/2023]
Abstract
We investigated whether 3-dimensional (3D) printed models can decrease operation time and improve the quality of reduction for calcaneal fractures. The study involved 48 patients with unilateral intra-articular calcaneal fractures, who were retrospectively case-matched according to Sander's classification, age, and sex. Group A (24 patients) was operated using 3D printed models as a preoperative and intraoperative tool, and group B (24 patients) was operated using standard techniques without 3D printed model. Operation time was significantly shorter for group A, compared to group B (82.3 ± 13.2 vs 91.4 ± 16.0, p = .036). The differences between the radiological parameters of operated calcaneus, compared to the normal side was similar between the 2 groups (Böhler angle, 5.3° ± 3.9° vs 4.2° ± 4.7°, p = .45, Gissane angle, 5.9° ± 12.5° vs 8.4° ± 11.0°, p = .54). The number of screws projecting more than 5 mm from the cortex was lower in group A than in group B (7/187, 4% vs 16/208, 8%, p = .11). The number of screw holes of the plate cut intraoperatively was significantly lower for group A compared to group B (1 vs 138). Although group A started weightbearing 3 to 4 weeks earlier than group B, the radiological parameters were similar between groups that early weightbearing was possible for group A using the 3D printed models (Böhler angle, - 1.5° ± 0.8° vs - 1.8° ± 1.2°, p = .28, Gissane angle, 2.5° ± 2.6° vs 3.5° ± 4.3°, p = .39). The operation time was shorter while using the 3D printed models, compared to that of the standard technique without using the 3D printed model. The radiological parameters were not statistically different, and the quality of fracture reduction seemed similar. However, with the use of 3D printed models, early weightbearing was possible without significant subsidence of reduced fragments or failure of fracture reduction, comparable to non-weightbearing cases.
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Affiliation(s)
- Hyun-Jin Park
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ki-Han You
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Bingzhe Huang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Joon Hyeok Yoon
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
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Zhang M, Guo J, Li H, Ye J, Chen J, Liu J, Xiao M. Comparing the effectiveness of 3D printing technology in the treatment of clavicular fracture between surgeons with different experiences. BMC Musculoskelet Disord 2022; 23:1003. [PMID: 36419043 PMCID: PMC9682691 DOI: 10.1186/s12891-022-05972-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aims to examine the use of 3D printing technology to treat clavicular fractures by skilled and inexperienced surgeons. METHODS A total of 80 patients with clavicle fractures (from February 2017 to May 2021) were enrolled in this study. Patients were divided randomly into four groups: group A: Patients underwent low-dose CT scans, and 3D models were printed before inexperienced surgeons performed surgeries; group B: Standard-dose CT were taken, and 3D models were printed before experienced surgeons performed surgeries; group C and D: Standard-dose CT scans were taken in both groups, and the operations were performed differently by inexperienced (group C) and experienced (group D) surgeons. This study documented the operation time, blood loss, incision length, and the number of intraoperative fluoroscopies. RESULTS No statistically significant differences were found in age, gender, fracture site, and fracture type (P value: 0.23-0.88). Group A showed shorter incision length and fewer intraoperative fluoroscopy times than groups C and D (P < 0.05). There were no significant differences in blood loss volume, incision length, and intraoperative fluoroscopy times between group A and group B (P value range: 0.11-0.28). The operation time of group A was no longer than those of groups C and D (P value range: 0.11 and 0.24). CONCLUSION The surgical effectiveness of inexperienced surgeons who applied 3D printing technology before clavicular fracture operation was better than those of inexperienced and experienced surgeons who did not use preoperative 3D printing technology.
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Affiliation(s)
- Meng Zhang
- Zhuhai Hospital, GuangdongProvincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Jianglong Guo
- Zhuhai Hospital, GuangdongProvincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Hongyi Li
- Zhuhai Hospital, GuangdongProvincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Jingzhi Ye
- Zhuhai Hospital, GuangdongProvincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Jun Chen
- Zhuhai Hospital, GuangdongProvincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Jingfeng Liu
- Zhuhai Hospital, GuangdongProvincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China
| | - Mengqiang Xiao
- Zhuhai Hospital, GuangdongProvincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
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Does a Customized 3D Printing Plate Based on Virtual Reduction Facilitate the Restoration of Original Anatomy in Fractures? J Pers Med 2022; 12:jpm12060927. [PMID: 35743711 PMCID: PMC9225188 DOI: 10.3390/jpm12060927] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to evaluate the restoration of original anatomy after fixation of sawbone fractures using case-specific 3D printing plates based on virtual reduction (VR). Three-dimensional models of 28 tibia sawbones with cortical marking holes were obtained. The sawbones were fractured at various locations of the shaft and 3D models were obtained. The fractured models were reduced virtually and customized non-locking metal plates that fit the reduced model were produced via 3D printing. The fractured sawbones were actually fixed to the customized plate with nonlocking screws and 3D models were generated. With the proximal fragments of the 3D models overlapped, the changes in length, 3D angulation, and rotation of the distal fragment were evaluated. Compared to the intact model (IN), the virtual reduction model (VR) and the actual fixation model (AF) showed no significant differences in length. Compared to the IN, the VR and the AF had mean 3D angulations of 0.39° and 0.64°, respectively. Compared to the IN model, the VR and the AF showed mean rotations of 0.89° and 1.51°, respectively. A customized plate based on VR facilitates the restoration of near-original anatomy in fractures of tibial sawbone shaft.
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Use of 3D printing and pre-contouring plate in the surgical planning of acetabular fractures: A systematic review. Orthop Traumatol Surg Res 2022; 108:103111. [PMID: 34648997 DOI: 10.1016/j.otsr.2021.103111] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/15/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acetabular fractures are caused by high energy injuries. The treatment aims to reconstruct the articular surface, restoring the anatomical structure. The surgical management of these fractures is difficult because it requires familiarity with the 3D anatomy of the pelvis. With the use of 3D printing technique for planning surgery, this limitation could be overcome. HYPOTHESIS Studies examining the use of 3D printing in pre-operative planning of acetabular fractures tend to agree on its usefulness. METHODS A systematic review of two electronic medical databases was performed by three independent authors, using the following inclusion criteria: any type of acetabular fracture and pre-operative use of 3D printing to plan the surgery. RESULTS Among 93 screened articles, following selection criteria, six randomised controlled human trials (hRCT) were eligible for the study; articles compare a group in which a pre-contouring plate was performed through 3D printing with a control group in which the plate was intraoperatively modelled. CONCLUSION This review demonstrates the advantage of 3D printing in terms of surgical time, reduction of blood losses, quality of fracture reduction, and fixation, and reporting best clinical outcomes. LEVEL OF EVIDENCE II.
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Papotto G, Testa G, Mobilia G, Perez S, Dimartino S, Giardina SMC, Sessa G, Pavone V. Use of 3D printing and pre-contouring plate in the surgical planning of acetabular fractures: A systematic review. ORTHOPAEDICS & TRAUMATOLOGY: SURGERY & RESEARCH 2022; 108:103111. [DOI: https:/doi.org/10.1016/j.otsr.2021.103111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
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3D Printing Applications in Orthopaedic Surgery: Clinical Experience and Opportunities. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Three-dimensional (3D) printing is a technology capable of creating solid objects based on the reproduction of computerised images. This technology offers revolutionary impacts on surgical practice, especially in prosthetic and traumatological surgery. Methods: 20 patients with proximal humeral fractures were divided into two groups, one of which involved the processing of a 3D model. The model made it possible to plan the positioning and dimensions of the implants. The results were then compared with those obtained according to the usual procedures. We also reported the irreparable case of a custom revision implants acetabular bone loss treated with a 3D-printed, custom-made implant. Results: In the processed 3D proximal humeral fracture series, in the face of time and costs expenses, surgical and X-ray times were shorter than in the control group. On the other hand, there were no differences in terms of blood loss. The patient who underwent acetabular re-prosthetic surgery in a 3B Paprosky bone loss was managed and solved with a 3D-printed, custom-made implant and reported excellent outcomes at a 1 year follow-up. Conclusion: Three-dimensional printing made it possible to create better pre-operative planning in traumatology in order to optimise surgical procedures and outcomes. It also made it possible to deal with large losses of bone stock in prosthetic revision surgery, even when reconstruction may have appeared impossible with traditional implants.
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14
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In silico analysis of modular bone plates. J Mech Behav Biomed Mater 2021; 124:104847. [PMID: 34555620 DOI: 10.1016/j.jmbbm.2021.104847] [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: 05/26/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inventory management or immediate availability of fracture plates can be problematic since for each surgical intervention a specific plate of varying size and functionality must be ordered. Modularization of the standard monolithic plate is proposed to address this issue. METHODS The effects of four different unit module design parameters (type, degree of modularization, connector screw diameter, sandwich ratio) on the plate bending stiffness and failure are investigated in a finite element four-point-bending analysis. A chosen, best-performing modular plate is then tested in silico for a simple diaphyseal tibial fracture scenario under anatomical compressional, torsional, and bending loads. RESULTS A modularization strategy is proposed to match the monolithic plate bending properties as closely as possible. With the best combination of design parameters, a fully modularized equivalent length plate with a 42.3% decrease in stiffness and 46.2% decrease in strength could be assembled. The chosen modular plate also displayed sufficient mechanical performance under the fracture fixation scenarios for a potentially successful osteosynthesis. CONCLUSIONS Via computational methods, the viability of the modularization strategy as an alternate to the traditional monolithic plate is demonstrated. As a further realized advantage, the modular plates can alleviate stress shielding thanks to the reduced stiffness.
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Zeng B, Zhang H, Xu X, Wu Z, Xiong C. A correlation analysis of short-term imaging manifestations and long-term function using ROC curve after tibial fracture surgery. Am J Transl Res 2021; 13:6724-6730. [PMID: 34306418 PMCID: PMC8290639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the correlation between short-term imaging techniques and long-term function using receiver operating characteristic (ROC) curve after tibia fracture surgery. METHODS Seventy patients with tibia fracture admitted to our hospital were selected as the study subjects, and were divided into a < 60 years old group (n = 40) and a ≥ 60 years old group (n = 30), a removed internal fixation group (n = 26) and a retained internal fixation group (n = 44). The short-term imaging results, long-term function, the degree of pain, the range of ankle joint motion, and the subjective satisfaction of patient care were scored and compared among the four groups. The influencing factors of subjective satisfaction of patients were analyzed using logistic regression analysis. RESULTS There were marked differences in the scores of Jakim, Garland & Werley scoring system, and Kofoed's scale and subjective satisfaction between the < 60 years old group and the ≥ 60 years old group, and between the removed internal fixation group and the retained internal fixation group (P < 0.05), but there was no remarkable difference in visual analog scale (VAS) scores (P > 0.05). Spearman's correlation analysis revealed a correlation between the short-term imaging manifestations and the long-term function in tibia fracture patients, and the correlation was remarkable in patients aged < 60 years without internal fixation (P < 0.05). Logistic correlation analysis showed that Kofoed's scale scores were significantly correlated with patients' subjective satisfaction (P < 0.05). CONCLUSION There is a correlation between early imaging and long-term function in tibia fracture patients, and the correlation was remarkable in patients aged < 60 years and without internal fixation. The range of joint motion and degree of pain are the primary influencing factors for evaluation of patients' subjective satisfaction.
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Affiliation(s)
- Bo Zeng
- Department of Orthopedics, Jinggangshan University Affiliated HospitalJi’an 343000, Jiangxi Province, China
| | - Huiling Zhang
- Operating Room, Jinggangshan University Affiliated HospitalJi’an 343000, Jiangxi Province, China
| | - Xian Xu
- Department of Physical Examination, Jinggangshan University Affiliated HospitalJi’an 43000, Jiangxi Province, China
| | - Zhian Wu
- Department of Orthopedics, Jinggangshan University Affiliated HospitalJi’an 343000, Jiangxi Province, China
| | - Chun Xiong
- Department of Imaging, Jinggangshan University Affiliated HospitalJi’an 343000, Jiangxi Province, China
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16
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Oguzkaya S, Misir A, Ozcamdalli M, Eken G, Kizkapan TB, Kurk MB, Uzun E. Impact of the COVID-19 pandemic on orthopedic fracture characteristics in three hospitals in Turkey: A multi-center epidemiological study. Jt Dis Relat Surg 2021; 32:323-332. [PMID: 34145802 PMCID: PMC8343845 DOI: 10.52312/jdrs.2021.20] [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: 01/05/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives
In this study, we present the use of case specific three- dimensional (3D) printed plastic models and custom-made acetabular implants in orthopedic surgery. Materials and methods
Between March 2018 and September 2020, surgeries were simulated using plastic models manufactured by 3D printers on the two patients with pilon fractures. Also, custom-made acetabular implants were used on two patients with an acetabular bone defect for the revision of total hip arthroplasty (THA). Results
More comfortable surgeries were experienced in pilon fractures using preoperative plastic models. Similarly, during the follow-up period, the patients that applied custom-made acetabular implants showed a fixed and well-positioning in radiographic examination. These patients did not experience any surgical complications and achieved an excellent recovery. Conclusion
Preoperative surgical simulation with 3D printed models can increase the comfort of fracture surgeries. Also, custom-made 3D printed acetabular implants can perform an important task in patients treated with revision THA surgery due to severe acetabular defects.
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Affiliation(s)
- Sinan Oguzkaya
- Sarkışla Devlet Hastanesi Ortopedi ve Travmatoloji Kliniği, 58400 Sarkışla, Sivas, Türkiye.
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Kadakia RJ, Wixted CM, Kelly CN, Hanselman AE, Adams SB. From Patient to Procedure: The Process of Creating a Custom 3D-Printed Medical Device for Foot and Ankle Pathology. Foot Ankle Spec 2021; 14:271-280. [PMID: 33269644 DOI: 10.1177/1938640020971415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Three-dimensional (3D) printing technology has advanced greatly over the past decade and is being used extensively throughout the field of medicine. Several orthopaedic surgery specialties have demonstrated that 3D printing technology can improve patient care and physician education. Foot and ankle pathology can be complex as the 3D anatomy can be challenging to appreciate. Deformity can occur in several planes simultaneously and bone defects either from previous surgery or trauma can further complicate surgical correction. Three-dimensional printing technology provides an avenue to tackle the challenges associated with complex foot and ankle pathology. A basic understanding of how these implants are designed and made is important for surgeons as this technology is becoming more widespread and the clinical applications continue to grow within foot and ankle surgery.Levels of Evidence: Level V.
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Affiliation(s)
- Rishin J Kadakia
- Department of Orthopaedic Surgery, Duke University Durham, North Carolina
| | - Colleen M Wixted
- Department of Orthopaedic Surgery, Duke University Durham, North Carolina
| | - Cambre N Kelly
- Department of Orthopaedic Surgery, Duke University Durham, North Carolina
| | - Andrew E Hanselman
- Department of Orthopaedic Surgery, Duke University Durham, North Carolina
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Durham, North Carolina
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18
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Three-dimensional Printing in Orthopaedic Surgery: Current Applications and Future Developments. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:e20.00230-11. [PMID: 33877073 PMCID: PMC8059996 DOI: 10.5435/jaaosglobal-d-20-00230] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/09/2021] [Indexed: 12/27/2022]
Abstract
Three-dimensional (3D) printing is an exciting form of manufacturing technology that has transformed the way we can treat various medical pathologies. Also known as additive manufacturing, 3D printing fuses materials together in a layer-by-layer fashion to construct a final 3D product. This technology allows flexibility in the design process and enables efficient production of both off-the-shelf and personalized medical products that accommodate patient needs better than traditional manufacturing processes. In the field of orthopaedic surgery, 3D printing implants and instrumentation can be used to address a variety of pathologies that would otherwise be challenging to manage with products made from traditional subtractive manufacturing. Furthermore, 3D bioprinting has significantly impacted bone and cartilage restoration procedures and has the potential to completely transform how we treat patients with debilitating musculoskeletal injuries. Although costs can be high, as technology advances, the economics of 3D printing will improve, especially as the benefits of this technology have clearly been demonstrated in both orthopaedic surgery and medicine as a whole. This review outlines the basics of 3D printing technology and its current applications in orthopaedic surgery and ends with a brief summary of 3D bioprinting and its potential future impact.
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Segaran N, Saini G, Mayer JL, Naidu S, Patel I, Alzubaidi S, Oklu R. Application of 3D Printing in Preoperative Planning. J Clin Med 2021; 10:jcm10050917. [PMID: 33652844 PMCID: PMC7956651 DOI: 10.3390/jcm10050917] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
Preoperative planning is critical for success in the surgical suite. Current techniques for surgical planning are limited; clinicians often rely on prior experience and medical imaging to guide the decision-making process. Furthermore, two-dimensional (2D) presentations of anatomical structures may not accurately portray their three-dimensional (3D) complexity, often leaving physicians ill-equipped for the procedure. Although 3D postprocessed images are an improvement on traditional 2D image sets, they are often inadequate for surgical simulation. Medical 3D printing is a rapidly expanding field and could provide an innovative solution to current constraints of preoperative planning. As 3D printing becomes more prevalent in medical settings, it is important that clinicians develop an understanding of the technologies, as well as its uses. Here, we review the fundamentals of 3D printing and key aspects of its workflow. The many applications of 3D printing for preoperative planning are discussed, along with their challenges.
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Affiliation(s)
- Nicole Segaran
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (N.S.); (G.S.)
| | - Gia Saini
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (N.S.); (G.S.)
| | - Joseph L. Mayer
- 3D Innovations Laboratory, Mayo Clinic Arizona, 5711 E. Mayo Blvd. Support Services Building, Phoenix, AZ 85054, USA;
| | - Sailen Naidu
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
| | - Indravadan Patel
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
| | - Sadeer Alzubaidi
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
| | - Rahmi Oklu
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (N.S.); (G.S.)
- 3D Innovations Laboratory, Mayo Clinic Arizona, 5711 E. Mayo Blvd. Support Services Building, Phoenix, AZ 85054, USA;
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (S.N.); (I.P.); (S.A.)
- Correspondence: ; Tel.: +1-480-342-5664
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20
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Three-dimensional Printing in Orthopedic Surgery. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Xiao M, Zhang M, Lei M, Hu X, Wang Q, Chen Y, Ye J, Xu R, Chen J. Application of ultra-low-dose CT in 3D printing of distal radial fractures. Eur J Radiol 2020; 135:109488. [PMID: 33385624 DOI: 10.1016/j.ejrad.2020.109488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore the effect of ultra-low-dose computed tomography (CT) on three-dimensional (3D) printing models and the diagnosis of wrist fractures. METHOD This study enrolled 76 patients with distal radial fractures (DRFs). All patients underwent 320-row detector CT and were divided randomly into two groups. In Group A, 38 patients were scanned with the standard-dose protocol using a tube voltage of 120 kV and current of 100 mA. In Group B, 38 patients were scanned with the ultra-low-dose protocol using a tube voltage of 80 kV and current of 10 mA. For objective image quality assessment, the noise, CT number, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured. Subjectively, two experienced orthopaedic surgeons blinded to the scan parameters evaluated the clarity of the 3D printing model and fracture line using a 3-point scale (the diagnosis was considered acceptable with scores ≥2). The mean radiation dose was calculated. The diagnostic performances for the fractures between the two groups were compared. RESULTS The effective radiation dose was significantly reduced by 97.1 % in Group B, compared to Group A (0.28 ± 0.05vs. 9.75 ± 2.23 μSv, respectively). Quantitative objective image quality parameters (e.g., CNR, SNR, and CT numbers) were higher in the standard-dose group (p < 0.001). However, there was no difference in subjective scoring of the 3D printing model. Although the fracture line score was higher in Group A (2.92±0.27 vs. 2.16 ± 0.37; p < 0.001), the diagnostic performance of the two groups was consistent (all scores ≥2). There were no statistically significant differences in the sensitivity, specificity or accuracy between standard-dose group and ultra-low-dose group. CONCLUSIONS The ultra-low-dose protocol effectively reduced the radiation dose by 97.1 %, while maintaining the image quality for diagnosis of DRFs. Therefore, this protocol can meet the needs of 3D printing models for preoperative assessments.
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Affiliation(s)
- Mengqiang Xiao
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Meng Zhang
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Ming Lei
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Xiaolu Hu
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Qingshan Wang
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Yanxia Chen
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Jingzhi Ye
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
| | - Rulin Xu
- Radiology Group, Canon Medical Systems(China) Co., LTD, Rm 2906, R&F Centre, No.10 Huaxia Road, Guangzhou City, Guangdong Province, China.
| | - Jun Chen
- Department of Radiology, Zhuhai Hospital, Guangdong Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai City, Guangdong Province, China.
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22
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Shah D, Naik L, Paunipagar B, Rasalkar D, Chaudhary K, Bagaria V. Setting Up 3D Printing Services for Orthopaedic Applications: A Step-by-Step Guide and an Overview of 3DBioSphere. Indian J Orthop 2020; 54:217-227. [PMID: 33194095 PMCID: PMC7609604 DOI: 10.1007/s43465-020-00254-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/03/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION 3D printing has widespread applications in orthopaedics including creating biomodels, patient-specific instruments, implants, and developing bioprints. 3DGraphy or printing 3D models enable the surgeon to understand, plan, and simulate different procedures on it. Despite widespread applications in non-healthcare specialties, it has failed to gain traction in healthcare settings. This is perhaps due to perceived capital expenditure cost and the lack of knowledge and skill required to execute the process. PURPOSE This article is written with an aim to provide step-by-step instructions for setting up a cost-efficient 3D printing laboratory in an institution or standalone radiology centre. The article with the help of video modules will explain the key process of segmentation, especially the technique of edge detection and thresholding which are the heart of 3D printing. CONCLUSION This is likely to enable the practising orthopaedician and radiologist to set up a 3D printing unit in their departments or even standalone radiology centres at minimal startup costs. This will enable maximal utilisation of this technology that is likely to bring about a paradigm shift in planning, simulation, and execution of complex surgeries.
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Affiliation(s)
- Darshil Shah
- grid.465035.1Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Lokesh Naik
- grid.465035.1Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Bhawan Paunipagar
- Department of Radiology, Akshay PET-CT, Akshay CT, Sai MRI Scans, Sangli, India ,Department of Radiology, Akshay CT and Sai MRI Scans, Sangli, Kolhapur India
| | - Darshana Rasalkar
- Department of Radiology, Akshay PET-CT, Akshay CT, Sai MRI Scans, Sangli, India ,Department of Radiology, Akshay CT and Sai MRI Scans, Sangli, Kolhapur India
| | - Kshitij Chaudhary
- grid.465035.1Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Vaibhav Bagaria
- grid.465035.1Department of Orthopaedics, Sir HN Reliance Foundation Hospital, Mumbai, India
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