The development of a low-cost three-dimensional printed shoulder, arm, and hand prostheses for children

Development and Production of a Children's Upper-Limb Cycling Adapter Using 3D Printing

The research described in this study focuses on the development of an innovative upper-limb adapter for young children aged 1-3 years who have congenital upper-limb defects. The objective was to create a functional and affordable solution that allows children to engage more safely and actively in physical activities such as cycling. The adapter was designed within the DESIGN+ project at the University of West Bohemia in Pilsen in collaboration with the German company Ottobock. The development included a detailed analysis of hand movements during cycling, modelling using CAD software (NX 1888), prototype manufacturing through 3D printing, and subsequent testing. The result is an adapter that allows 360° rotation around the arm axis, provides natural hand movement while turning, and is made of soft material to enhance safety. Despite initial challenges and necessary prototype adjustments, a functional and reliable design was achieved. This adapter will contribute to improving the quality of life for children with upper-limb disabilities, supporting their coordination, strength, and confidence in daily activities.

Prosthetic home intervention induces cortical plasticity in paediatrics with congenital limb reduction

Paediatrics with congenital upper-limb reduction deficiency often face difficulties with normal development such as motor skills, needing assistance with daily activities such as self-care limitations with certain movements, sports, or activities. The purpose of this non-randomized longitudinal controlled trial was to assess, using intent-to-treat analysis, the effects of an 8-week home intervention of prosthetic use on the sensorimotor cortex in paediatrics with congenital upper-limb reduction deficiency. A paediatric population with congenital upper-limb reduction deficiency (n = 14) who were aged 6-18 years and who had a 20° or greater range of motion in the appropriate joint of the affected arm to move the body-powered prosthesis were enrolled. An age- and sex-matched control group (n = 14) was also enrolled. Participants were non-randomized and fitted with a custom low-cost 3D printed prosthesis and participated in 8 weeks of prosthetic use training at home. Control participants utilized a prosthetic simulator. The home intervention incorporated daily use training and exercises utilizing the prosthesis in direct use and assistive tasks explained by the researchers. After the home intervention, both groups displayed significant improvements in gross manual dexterity. During prosthetic use with the affected limb, significant increases in oxygenated hemodynamic responses were only displayed in the left premotor cortex of the upper-limb reduction deficiency group. The novel findings of this non-randomized longitudinal controlled trial suggest that the intervention may have improved the functional role of the left hemisphere which translated to the improvement of learning direction during adaptation to visuomotor control. The prosthetic home intervention was assumed to provide closed-loop training which could provide a direct benefit to the motor development of paediatrics with upper-limb reduction deficiency.

Transformative applications of additive manufacturing in biomedical engineering: bioprinting to surgical innovations

This paper delves into the diverse applications and transformative impact of additive manufacturing (AM) in biomedical engineering. A detailed analysis of various AM technologies showcases their distinct capabilities and specific applications within the medical field. Special emphasis is placed on bioprinting of organs and tissues, a revolutionary area where AM has the potential to revolutionize organ transplantation and regenerative medicine by fabricating functional tissues and organs. The review further explores the customization of implants and prosthetics, demonstrating how tailored medical devices enhance patient comfort and performance. Additionally, the utility of AM in surgical planning is examined, highlighting how printed models contribute to increased surgical precision, reduced operating times, and minimized complications. The discussion extends to the 3D printing of surgical instruments, showcasing how these bespoke tools can improve surgical outcomes. Moreover, the integration of AM in drug delivery systems, including the development of innovative drug-loaded implants, underscores its potential to enhance therapeutic efficacy and reduce side effects. It also addresses personalized prosthetic implants, regulatory frameworks, biocompatibility concerns, and the future potential of AM in global health and sustainable practices.

Comparative Experimental Investigation of Biodegradable Antimicrobial Polymer-Based Composite Produced by 3D Printing Technology Enriched with Metallic Particles

Due to the prevailing existence of the COVID-19 pandemic, novel and practical strategies to combat pathogens are on the rise worldwide. It is estimated that, globally, around 10% of hospital patients will acquire at least one healthcare-associated infection. One of the novel strategies that has been developed is incorporating metallic particles into polymeric materials that neutralize infectious agents. Considering the broad-spectrum antimicrobial potency of some materials, the incorporation of metallic particles into the intended hybrid composite material could inherently add significant value to the final product. Therefore, this research aimed to investigate an antimicrobial polymeric PLA-based composite material enhanced with different microparticles (copper, aluminum, stainless steel, and bronze) for the antimicrobial properties of the hybrid composite. The prepared composite material samples produced with fused filament fabrication (FFF) 3D printing technology were tested for different time intervals to establish their antimicrobial activities. The results presented here depict that the sample prepared with 90% copper and 10% PLA showed the best antibacterial activity (99.5%) after just 20 min against different types of bacteria as compared to the other samples. The metallic-enriched PLA-based antibacterial sheets were remarkably effective against Staphylococcus aureus and Escherichia coli; therefore, they can be a good candidate for future biomedical, food packaging, tissue engineering, prosthetic material, textile industry, and other science and technology applications. Thus, antimicrobial sheets made from PLA mixed with metallic particles offer sustainable solutions for a wide range of applications where touching surfaces is a big concern.

Mechanical Design Optimization of Prosthetic Hand's Fingers: Novel Solutions towards Weight Reduction

From the mechanical function of grabbing objects to the emotional aspect of gesturing, the functionality of human hands is fundamental for both physical and social survival. Therefore, the loss of one or both hands represents a devastating issue, exacerbated by long rehabilitation times and psychological treatments. Prosthetic arms represent an effective solution to provide concrete functional and esthetical support. However, commercial hand prostheses still lack an optimal combination of light weight, durability, adequate cosmetic appearance, and affordability. Among these aspects, the priority for upper-limb prosthesis users is weight, a key parameter that influences both the portability and the functionality of the system. The purpose of this work is to optimize the design of the MyHand prosthesis, by redesigning both the proximal and distal finger and thumb in light of finding an optimal balance between weight reduction and adequate stiffness. Starting from elastic–plastic numerical models and experimental tests on obsolete components, analyzed under the worst loading condition, five different design solutions are suggested. An iterative topology optimization process locates the regions where material removal is permitted. From these results, 2 mm geometrical patterns on the top surface of the hand prosthesis appear as the most prominent, preventing object intrusion.

Bacterial Biofilm Formation on Nano-Copper Added PLA Suited for 3D Printed Face Masks

The COVID-19 Pandemic leads to an increased worldwide demand for personal protection equipment in the medical field, such as face masks. New approaches to satisfy this demand have been developed, and one example is the use of 3D printing face masks. The reusable 3D printed mask may also have a positive effect on the environment due to decreased littering. However, the microbial load on the 3D printed objects is often disregarded. Here we analyze the biofilm formation of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli on suspected antimicrobial Plactive™ PLA 3D printing filaments and non-antimicrobial Giantarm™ PLA. To characterize the biofilm-forming potential scanning electron microscopy (SEM), Confocal scanning electron microscopy (CLSM) and colony-forming unit assays (CFU) were performed. Attached cells could be observed on all tested 3D printing materials. Gram-negative strains P. aeruginosa and E. coli reveal a strong uniform growth independent of the tested 3D filament (for P. aeruginosa even with stressed induced growth reaction by Plactive™). Only Gram-positive S. aureus shows strong growth reduction on Plactive™. These results suggest that the postulated antimicrobial Plactive™ PLA does not affect Gram-negative bacteria species. These results indicate that reusable masks, while better for our environment, may pose another health risk.

3D-printed prostheses in developing countries: A systematic review

BACKGROUND

According to the World Health Organization, only 5%-15% of people in lower-income countries have access to prostheses. This is largely due to low availability of materials and high costs of prostheses. 3D-printing techniques have become easily accessible and can offer functional patient-specific components at relatively low costs, reducing or bypassing the current manufacturing and postprocessing steps. However, it is not yet clear how 3D-printing can provide a sustainable solution to the low availability of limb prostheses for patients with amputations in lower-income countries.

OBJECTIVE

To evaluate 3D-printing for the production of limb prostheses in lower-income countries and lower-middle-income countries (LLMICs).

STUDY DESIGN

Systematic Review.

METHODS

Literature searches, completed in April 2020, were performed in PubMed, Embase, Web of Science, and Cochrane Library. The search results were independently screened and reviewed by four reviewers. Only studies that examined interventions using prostheses in LLMICs for patients with limb amputations were selected for data extraction and synthesis. The web was also searched using Google for projects that did not publish in a scientific journal.

RESULTS

Eighteen studies were included. Results were reported regarding country of use, cost and weight, 3D-printing technology, satisfaction, and failure rate.

CONCLUSION

Low material costs, aesthetic appearance, and the possibility of personalized fitting make 3D-printed prostheses a potential solution for patients with limb amputations in LLMICs. However, the lack of (homogeneous) data shows the need for more published (scientific) research to enable a broader availability of knowledge about 3D-printed prostheses for LLMICs.

Functional performance and patient satisfaction comparison between a 3D printed and a standard transradial prosthesis: a case report

Background

The delay between amputation and prosthesis fitting contributes to the high rate of prosthetic abandonment despite advances in technology. Three-dimensional (3D) printing has allowed for the rapid fabrication of prostheses. Allowing individuals with amputations to interact with a prosthesis shortly after their procedure may reduce rejection chances. The purpose of the current investigation is to compare functional outcomes and patient satisfaction between a standard transradial prosthesis fitted in a clinic with a 3D-printed prosthesis fitted remotely. The standard prosthesis featured a hook terminal device, while the 3D printed prosthesis’ terminal device was a functional hand.

Results

The main finding of this case study was that the use of a 3D printed arm prosthesis fitted remotely resulted in better functional performance, but lower overall patient satisfaction than the standard arm prosthesis. Use of the 3D printed arm resulted in improved gross manual dexterity as measured by the Box and Block test. The 3D printed prosthesis also allowed improved performance in bimanual coordination. However, the standard-hook device scored higher in patient satisfaction survey results. The patient's concerns with the 3D printed prosthesis were the durability and effectiveness of the device.

Conclusion

While durability and complex grip patterns remain a concern, the positive attributes of 3D printed prostheses include visual appeal, ease of donning, and customization of parameters to improve upper-limb symmetry offers a promising option to familiarize new amputee patients with the use of a prosthesis. Rapid manufacturing and remote fitting allows 3D printed devices to serve as postoperative transitional devices and may function as definitive devices with minimal loss of functionality if standard clinic-based prostheses are not available.

Methods

The patient was a 59-year-old male with a traumatic transradial amputation of the dominant arm. A 3D printed transradial prosthesis was remotely fitted and manufactured using photogrammetry. Assessments were performed initially with the standard-hook prosthesis and then with the 3D printed device after a 5-week familiarization period. Functional outcomes were evaluated using the Box and Block Test and Bimanual Coordination Tray Test. Patient satisfaction was evaluated using two self-reported questionnaires (the QUEST 2.0 and the modified OPUS).

Clinical Utility of an Exoskeleton Robot Using Three-Dimensional Scanner Modeling in Burn Patient: A Case Report

Hands are the part of the body that are most commonly involved in burns, and the main complications are finger joint contractures and nerve injuries. Hypertrophic scarring cannot be avoided despite early management of acute hand burn injuries, and some patients may need the application of an exoskeleton robot to restore hand function. To do this, it is essential to individualize the customization of the robot for each patient. Three-dimensional (3D) technology, which is widely used in the field of implants, anatomical models, and tissue fabrication, makes this goal achievable. Therefore, this report is a study on the usefulness of an exoskeleton robot using 3D technology for patients who lost bilateral hand function due to burn injury. Our subject was a 45-year-old man with upper limb dysfunction of 560 days after a flame and chemical burn injury, with resultant impairment of manual physical abilities. After wearing an exoskeleton robot made using 3D printing technology, he could handle objects effectively and satisfactorily. This innovative approach provided considerable advantages in terms of customization of size and reduction in manufacturing time and costs, thereby showing great potential for use in patients with hand dysfunction after burn injury.

CLINICAL APPLICATION OF 3D PRINTING TECHNOLOGY FOR PREOPERATIVE PLANNING OF THUMB RECONSTRUCTION

Objective:

This study aimed to explore the clinical application of preoperative precise design for 3D printing and thumb reconstruction, which could help manage the patients with thumb defect and achieve better function and appearance.

Methods:

This was a retrospective study of 20 patients who underwent the surgery of harvesting toe transplant and thumb reconstruction between January 2015 and December 2016. The 3D model of the thumb defect was created and printed. The dimensions of skin and bones from donor site were precisely designed as reference for surgical operation. The surgery was performed according to the model.

Results:

Perfect repair of defects was achieved with satisfying appearance and function. The reconstructed thumbs all survived (survival rate of 100%). Follow-up was 3-9 months. The maximum dorsiflexion was 8-30° and the maximum flexion was 38-58°. The two-point sensory discrimination was 9-11 mm. In total, 17 patients reposted “Excellent” satisfaction and three “Good”, each for the reconstructed thumb and hand function, respectively. The satisfaction rate was 85%.

Conclusion:

Preoperative digital design and 3D printing according to the donor and recipient sites allowed a tailored operation. The operation was more precise, the appearance of the reconstructed thumb was good. Level of Evidence II, Retrospective Study.

Embracing Additive Manufacturing Technology through Fused Filament Fabrication for Antimicrobial with Enhanced Formulated Materials

Antimicrobial materials produced by 3D Printing technology are very beneficial, especially for biomedical applications. Antimicrobial surfaces specifically with enhanced antibacterial property have been prepared using several quaternary salt-based agents, such as quaternary ammonium salts and metallic nanoparticles (NPs), such as copper and zinc, which are incorporated into a polymeric matrix mainly through copolymerization grafting and ionic exchange. This review compared different materials for their effectiveness in providing antimicrobial properties on surfaces. This study will help researchers choose the most suitable method of developing antimicrobial surfaces with the highest efficiency, which can be applied to develop products compatible with 3D Printing Technology.

Brain lateralization in children with upper-limb reduction deficiency

BACKGROUND

The purpose of the current study was to determine the influence of upper-limb prostheses on brain activity and gross dexterity in children with congenital unilateral upper-limb reduction deficiencies (ULD) compared to typically developing children (TD).

METHODS

Five children with ULD (3 boys, 2 girls, 8.76 ± 3.37 years of age) and five age- and sex-matched TD children (3 boys, 2 girls, 8.96 ± 3.23 years of age) performed a gross manual dexterity task (Box and Block Test) while measuring brain activity (functional near-infrared spectroscopy; fNIRS).

RESULTS

There were no significant differences (p = 0.948) in gross dexterity performance between the ULD group with prosthesis (7.23 ± 3.37 blocks per minute) and TD group with the prosthetic simulator (7.63 ± 5.61 blocks per minute). However, there was a significant (p = 0.001) difference in Laterality Index (LI) between the ULD group with prosthesis (LI = - 0.2888 ± 0.0205) and TD group with simulator (LI = 0.0504 ± 0.0296) showing in a significant ipsilateral control for the ULD group. Thus, the major finding of the present investigation was that children with ULD, unlike the control group, showed significant activation in the ipsilateral motor cortex on the non-preferred side using a prosthesis during a gross manual dexterity task.

CONCLUSIONS

This ipsilateral response may be a compensation strategy in which the existing cortical representations of the non-affected (preferred) side are been used by the affected (non-preferred) side to operate the prosthesis. This study is the first to report altered lateralization in children with ULD while using a prosthesis. Trial registration The clinical trial (ClinicalTrial.gov ID: NCT04110730 and unique protocol ID: IRB # 614-16-FB) was registered on October 1, 2019 ( https://clinicaltrials.gov/ct2/show/NCT04110730 ) and posted on October 1, 2019. The study start date was January 10, 2020. The first participant was enrolled on January 14, 2020, and the trial is scheduled to be completed by August 23, 2023. The trial was updated January 18, 2020 and is currently recruiting.

Design and development of a novel 3D-printed non-metallic self-locking prosthetic arm for a forequarter amputation

BACKGROUND

Upper limb, in particular forequarter amputations, require highly customised devices that are often expensive and underutilised.

OBJECTIVES

The objective of this study was to design and develop a comfortable 3D-printed cosmetic forequarter prosthetic device, which was lightweight, cool to wear, had an elbow that could lock, matched the appearance of the contralateral arm and was completely free of metal for a specific user's needs.

STUDY DESIGN

Device design.

TECHNIQUE

An iterative user-centred design approach was used for digitising, designing and developing a functional 3D-printed prosthetic arm for an acquired forequarter amputation, while optimising the fit and function after each prototype.

RESULTS

The cost of the final arm was 20% less expensive than a traditionally-made forequarter prostheses in Singapore. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 survey was administered, with results indicating that the 3D-printed arm was preferred due to its overall effectiveness, accurate size, ease of use and suspension. However, durability had a lower score, and the weight of the arm was 100 g heavier than the user's current prosthesis. The technique described resulted in a precise fitting and shaped forequarter prosthesis for the user. Using the user's feedback in the iterations of the design resulted in improved QUEST survey results indicating the device was effective, easy to use, perceived as lighter and more secure than the user's traditionally-made device.

CONCLUSION

A fully customised cosmetic forequarter prosthesis was designed and developed using digital scanning, computer-aided design modelling and 3D printing for a specific user. These technologies enable new avenues for highly complex prosthetic design innovations.

Three-dimensional printing in medicine: a systematic review of pediatric applications

BACKGROUND

Three-dimensional printing (3DP) addresses distinct clinical challenges in pediatric care including: congenital variants, compact anatomy, high procedural risk, and growth over time. We hypothesized that patient-specific applications of 3DP in pediatrics could be categorized into concise, discrete categories of use.

METHODS

Terms related to "three-dimensional printing" and "pediatrics" were searched on PubMed, Scopus, Ovid MEDLINE, Cochrane CENTRAL, and Web of Science. Initial search yielded 2122 unique articles; 139 articles characterizing 508 patients met full inclusion criteria.

RESULTS

Four categories of patient-specific 3DP applications were identified: Teaching of families and medical staff (9.3%); Developing intervention strategies (33.9%); Procedural applications, including subtypes: contour models, guides, splints, and implants (43.0%); and Material manufacturing of shaping devices or prosthetics (14.0%). Procedural comparative studies found 3DP devices to be equivalent or better than conventional methods, with less operating time and fewer complications.

CONCLUSION

Patient-specific applications of Three-Dimensional Printing in Medicine can be elegantly classified into four major categories: Teaching, Developing, Procedures, and Materials, sharing the same TDPM acronym. Understanding this schema is important because it promotes further innovation and increased implementation of these devices to improve pediatric care.

IMPACT

This article classifies the pediatric applications of patient-specific three-dimensional printing. This is a first comprehensive review of patient-specific three-dimensional printing in both pediatric medical and surgical disciplines, incorporating previously described classification schema to create one unifying paradigm. Understanding these applications is important since three-dimensional printing addresses challenges that are uniquely pediatric including compact anatomy, unique congenital variants, greater procedural risk, and growth over time. We identified four classifications of patient-specific use: teaching, developing, procedural, and material uses. By classifying these applications, this review promotes understanding and incorporation of this expanding technology to improve the pediatric care.

Órteses e próteses de membro superior impressas em 3D: uma revisão integrativa

Resumo Introdução A impressão tridimensional (3D) é capaz de confeccionar produtos físicos avançados e especializados por meio de tecnologia computadorizada e softwares específicos. Alguns desses produtos são as órteses e próteses, que podem favorecer a funcionalidade do sujeito em seu cotidiano. Objetivo Identificar o tipo, o uso e a aplicabilidade da impressão 3D na confecção de órteses e próteses para membro superior. Método Revisão integrativa realizada nas bases de dados PubMed, LILACS, Web of Science, Scopus e Science Direct, sem delimitação de tempo, na língua portuguesa, inglesa ou espanhola, seguindo os critérios de elegibilidade: estudos do tipo experimental, observacional e relatos de casos, cujo objeto de estudo foram as órteses e próteses impressas em 3D, com pacientes de qualquer idade e qualquer diagnóstico de comprometimento do membro superior. Resultados Foram incluídos nove artigos, sete referentes ao uso da impressão 3D na confecção de prótese e dois referentes à confecção de órteses. Muitos dos estudos foram direcionados ao público infantil e os materiais mais utilizados para confecção foram o PLA e o ABS. A equipe multidisciplinar foi apresentada como fundamental no processo de avaliação, criação e testagem dos dispositivos. Conclusão Apesar dos estudos analisados tangenciarem fases iniciais de desenvolvimento e investigação da aplicabilidade da impressão 3D na criação de órteses e próteses, observou-se que já existem melhorias do custo-benefício gerado pelo uso desta tecnologia, bem como a possibilidade de gerar produtos mais versáteis. Apontando-se como um campo promissor para ampliar a aplicação da impressão 3D como recurso facilitador do processo de reabilitação.

Using a 3D-Printed Prosthetic to Improve Participation in a Young Gymnast

BACKGROUND AND PURPOSE

The purpose of this case report was to investigate the application of a 3-dimensional (3D)-printed prosthetic hand to improve a child's participation, confidence, and satisfaction in gymnastic classes, specifically, horizontal bar-related skills.

SUMMARY OF KEY POINTS

A 9-year-old child was unable to participate in horizontal bar-related gymnastic skills due to a congenital hand deficiency. A prosthetic hand was designed, 3D printed, modified repeatedly, and incorporated into a program, which resulted in improvements in the child's ability to participate in gymnastics.

CONCLUSIONS

Using a 3D-printed upper limb prosthetic hand improved the child's participation, confidence, and satisfaction in her gymnastic classes permitting use of horizontal bar. To progress to higher-intensity activities, further safety measures and testing of the prosthetic hand are needed.

WHAT THIS CASE ADDS TO EVIDENCEBASED PRACTICE

A 3D-printed prosthetic hand was manufactured and customized allowing closely monitored, gradually increased, participation in horizontal bar gymnastics.

Evaluation of effectiveness of three-dimensional printed ear splint therapy following ear elevation surgery in microtia patients: A randomized controlled trial

AIM

This study aimed to compare the effectiveness of a 3D-printed ear splint with that of a conventional thermoplastic ear splint after microtia reconstruction.

METHODS

Patients who underwent ear elevation surgery with postauricular fascia coverage between October 2017 and October 2018 were included. They were randomly divided into the experimental group (3D-printed ear splint) and the control group (thermoplastic ear splint) and underwent routine postoperative rehabilitation and antiscar therapy. Splint therapy was initiated 4 weeks postoperatively and continued until 24 weeks postoperatively. The evaluated indices were the Vancouver scar scale score (VSS score), cranioauricular distance, patient compliance, complications (dermatitis, skin ulcers, skin necrosis), and patient satisfaction. A two-group t-test was carried out to compare all variables except patient satisfaction, which was compared using the Mann-Whitney U-test; p < 0.05 was considered significant.

RESULTS

Twenty patients were included in each group. At 4 weeks postoperatively, the VSS score (p = 0.748) and cranioauricular distance (p = 0.647) showed no significant differences between the groups. At 24 weeks postoperatively, the mean VSS scores were 4.85 ± 1.46 and 6.25 ± 1.74 (p = 0.009), the mean cranioauricular distances were 15.80 ± 1.82 mm and 13.95 ± 1.93 mm (p = 0.004), and the patient satisfaction scores were 4.5 ± 0.51 and 3.7 ± 0.47 (p < 0.001) in the experimental group and the control group, respectively, all showing significant differences. Two patients in each group exhibited skin irritation or skin ulcers, which resolved after 6 months of follow-up.

CONCLUSION

The application of 3D-printed ear splints provides better inhibition of scar contracture, better maintenance of ear projection and higher patient satisfaction than conventional ear splints following ear elevation surgery in microtia patients. Therefore, 3D-printed ear splints should be preferred over conventional ear splints whenever possible.

Use of a three-dimensional printed anatomical model for tumor management in a pediatric patient

The purpose of this study was to investigate the usage of an anatomical model to improve surgical planning of a complex schwannoma resection. As advancements in additive manufacturing continue to prosper, new applications of this valuable technology are being implemented in the medical field. One of the most recent applications has been in the development of patient-specific anatomical models for unique clinical education as well as for preoperative planning. In this case, a multidisciplinary team with expertise in research, three-dimensional printing, and medicine was formed to develop a three-dimensional printed model that could be used to help plan the reduction of a tumor from the cervical spine of a pediatric patient. Image segmentation and stereolithography creation were accomplished using Mimics and 3-matic, respectively. Models were developed on two different printer types to view different aspects of the region of interest. Reports from the operating surgeon indicated that the model was instrumental in the planning procedures of the operation and reducing operation time.

Accuracy of a 3-Dimensionally Printed Navigational Template for Localizing Small Pulmonary Nodules: A Noninferiority Randomized Clinical Trial

Importance

Localization of small lung nodules are challenging because of the difficulty of nodule recognition during video-assisted thoracoscopic surgery. Using 3-dimensional (3-D) printing technology, a navigational template was recently created to assist percutaneous lung nodule localization; however, the efficacy and safety of this template have not yet been evaluated.

Objective

To assess the noninferiority of the efficacy and safety of a 3-D-printed navigational template guide for localizing small peripheral lung nodules.

Design, Setting, and Participants

This noninferiority randomized clinical trial conducted between October 2016 and October 2017 at Shanghai Pulmonary Hospital, Shanghai, China, compared the safety and precision of lung nodule localization using a template-guided approach vs the conventional computed tomography (CT)-guided approach. In total, 213 surgical candidates with small peripheral lung nodules (<2 cm) were recruited to undergo either CT- or template-guided lung nodule localization. An intention-to-treat analysis was conducted.

Interventions

Percutaneous lung nodule localization.

Main Outcomes and Measures

The primary outcome was the accuracy of lung nodule localization (localizer deviation), and secondary outcomes were procedural duration, radiation dosage, and complication rate.

Results

Of the 200 patients randomized at a ratio of 1:1 to the template- and CT-guided groups, most were women (147 vs 53), body mass index ranged from 15.4 to 37.3, the mean (SD) nodule size was 9.7 (2.9) mm, and the mean distance between the outer edge of target nodule and the pleura was 7.8 (range, 0.0-43.9) mm. In total, 190 patients underwent either CT- or template-guided lung nodule localization and subsequent surgery. Among these patients, localizer deviation did not significantly differ between the template- and CT-guided groups (mean [SD], 8.7 [6.9] vs 9.6 [5.8] mm; P = .36). The mean (SD) procedural durations were 7.4 (3.2) minutes for the template-guided group and 9.5 (3.6) minutes for the CT-guided group (P < .001). The mean (SD) radiation dose was 229 (65) mGy × cm in the template-guided group and 313 (84) mGy × cm in CT-guided group (P < .001).

Conclusions and Relevance

The use of the 3-D-printed navigational template for localization of small peripheral lung nodules showed efficacy and safety that were not substantially worse than those for the CT-guided approach while significantly simplifying the localization procedure and decreasing patient radiation exposure.

Trial Registration

ClinicalTrials.gov identifier: NCT02952261.

3D printing and amputation: a scoping review

PURPOSE

Three-dimensional (3D) printing is an innovative technology being utilized to create prostheses for individuals with limb loss. However, there is a paucity of research on the feasibility of using this technology to fabricate prostheses. A scoping review was conducted to map the literature on 3D printing and its applications in the field of amputation.

MATERIALS AND METHODS

Using a scoping review framework, a systematic literature search was conducted in three electronic databases (MEDLINE, EMBASE and CINAHL) for all indexed literature up to 29 June 2018.

RESULTS

Twenty-eight articles met the inclusion criteria. The majority of studies had small sample sizes (five participants or less; n = 20) and used a case study design (n = 17). The benefits of 3D printing technology include higher levels of customization and lower production costs. However, the functionality of 3D printed prostheses is lacking. There is also a need for more robust research designs to obtain a better understanding of the advantages and disadvantages of 3D printed prostheses and its impact on end-user outcomes.

CONCLUSIONS

The use of 3D printing technology has a number of benefits for improving the manufacturing process of devices for people with lower and upper limb loss. However, more research and technological advancements are required to fully understand the impact of this technology on patients and how it will affect their daily life. The long-term effects of this technology will also need to be investigated in order to produce a more sustainable alternative to traditional prostheses.IMPLICATIONS FOR REHABILITATIONThe use of 3D printing technology for the fabrication of prosthetics for persons with limb-loss has a number of promising features to improve the fitting and customization of these devices for this patient population.Although the costs of producing 3D printed devices is less expensive and burdensome than traditional approaches to manufacturing techniques, there is a need for additional technological advancements to improve the functionality of these devices.Future research needs to adopt more robust research designs with larger sample sizes to provide a better understanding of the viability of using 3D printing technology to improve patient outcomes.

Implementation of 3D Printing Technology in the Field of Prosthetics: Past, Present, and Future

There is an interesting and long history of prostheses designed for those with upper-limb difference, and yet issues still persist that have not yet been solved. Prosthesis needs for children are particularly complex, due in part to their growth rates. Access to a device can have a significant impact on a child’s psychosocial development. Often, devices supporting both cosmetic form and user function are not accessible to children due to high costs, insurance policies, medical availability, and their perceived durability and complexity of control. These challenges have encouraged a grassroots effort globally to offer a viable solution for the millions of people living with limb difference around the world. The innovative application of 3D printing for customizable and user-specific hardware has led to open-source Do It Yourself “DIY” production of assistive devices, having an incredible impact globally for families with little recourse. This paper examines new research and development of prostheses by the maker community and nonprofit organizations, as well as a novel case study exploring the development of technology and the training methods available. These design efforts are discussed further in the context of the medical regulatory framework in the United States and highlight new associated clinical studies designed to measure the quality of life impact of such devices.

Forearm lengthening and prosthetic management in children with transverse congenital forearm deficiency

In cases of transverse congenital forearm deficiency, achieving a good prosthesis fit during childhood remains a challenge. Ulnar lengthening is a treatment option for improving the prosthesis fit. The objective of this study was to evaluate surgical ulnar lengthening and the subsequent prosthesis fit. We reviewed four cases of ulnar lengthening in children with transverse congenital forearm deficiency. The procedure was evaluated in terms of the duration of lengthening, increase in ulnar length and healing index. The elbow range of motion, functional outcome (Prosthetic Upper Extremity Functional Index, PUFI) and time spent using the prosthesis per day were evaluated. The mean age at the time of the lengthening procedure was 3.5 years, the mean duration of lengthening was 58.3 days, the mean length gain was 21 mm, and the mean healing index was 70.1 days/cm. Elbow range of motion was restricted in one patient (100°-140°) and full in the other three patients. Based on the PUFI, 88.4% of activities were performed without the prosthesis. Children only used their prosthesis to perform specific tasks. Given the high complication rate and the lack of prosthesis use during daily activities, the main indication for forearm lengthening is a very short forearm that prevents prosthesis fitting. This procedure should be performed later in life - in adolescence.

3D Printed Antibacterial Prostheses

The purpose of the current investigation was two-fold: (i) to describe the development of 3D printed prostheses using antibacterial filaments and (ii) to verify the antibacterial properties of the 3D printed prostheses. Three-dimensional printed finger prostheses were manufactured using PLACTIVETM antibacterial 3D printing filaments. Two adults with left index finger amputations at the proximal phalanx were fitted with a customized 3D printed finger prosthesis manufactured with an antibacterial filament. The manual gross dexterity was assessed during the Box and Block Test. Patient satisfaction was assessed using the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0). Bacterial analysis of the 3D printed prostheses was performed by two independent laboratories against Staphylococcus aureus and Escherichia coli (ISO 22196). Two customized 3D printed partial finger prostheses were manufactured using a 3D printed antibacterial filament. The bacterial analysis showed that PLACTIVETM with 1% antibacterial nanoparticles additives was up to 99.99% effective against Staphylococcus aureus and Escherichia coli. The manual gross dexterity assessed was improved after using the 3D printed partial finger prosthesis. The research subjects indicated that they were “quite satisfied” to “very satisfied” with the 3D printed partial finger prosthesis. The present investigation showed that the antibacterial 3D printed filament can be used for the development of functional and effective antibacterial finger prostheses.

Addressing Unmet Clinical Needs with 3D Printing Technologies

Recent advances in 3D printing have enabled the creation of novel 3D constructs and devices with an unprecedented level of complexity, properties, and functionalities. In contrast to manufacturing techniques developed for mass production, 3D printing encompasses a broad class of fabrication technologies that can enable 1) the creation of highly customized and optimized 3D physical architectures from digital designs; 2) the synergistic integration of properties and functionalities of distinct classes of materials to create novel hybrid devices; and 3) a biocompatible fabrication approach that facilitates the creation and cointegration of biological constructs and systems. This progress report describes how these capabilities can potentially address a myriad of unmet clinical needs. First, the creation of 3D-printed prosthetics to regain lost functionalities by providing structural support for skeletal and tubular organs is highlighted. Second, novel drug delivery strategies aided by 3D-printed devices are described. Third, the advancement of medical research heralded by 3D-printed tissue/organ-on-chips systems is discussed. Fourth, the developments of 3D-printed tissue and organ regeneration are explored. Finally, the potential for seamless integration of engineered organs with active devices by leveraging the versatility of multimaterial 3D printing is envisioned.

Three-Dimensional Printing: A Novel Approach to the Creation of Obturator Prostheses Following Palatal Resection for Malignant Palate Tumors

BACKGROUND

A subgroup of patients who have an oronasal fistula live in areas that have limited access to oral prosthetics. For these individuals, a temporary prosthesis, such as a palatal obturator, may be necessary in order to speak, eat, and breath properly. The creation of an obturator, which requires a highly trained prosthodontist, can take time and can be expensive. Through the current proof-of-concept study, there is an attempt to create a patient-specific palatal obturator through use of free and publicly available software, and a low-cost desktop 3-dimensional printer. The ascribed study may provide a means to increase global access to oral prosthetics if suitable biomaterials are developed.

METHODS

Computerized tomography data were acquired from a patient who had an oronasal fistula. Through use of free software, these data were converted into a 3-dimensional image. The image was manipulated in order to isolate the patient's maxilla and was subsequently printed. The palatal obturator models were designed, and reformed, in correspondence with the maxilla model design. A final suitable obturator was determined and printed with 2 differing materials in order to better simulate a patient obturator.

RESULTS

Creating a suitable palatal obturator for the specified patient model was possible with a low-cost printer and free software.

CONCLUSIONS

With further development in biomaterials, it may be possible to design and create an oral prosthesis through use of low-cost 3-dimensional printing technology and freeware. This can empower individuals to attain good healthcare, even if they live in rural, developing, or underserviced areas.

Three-dimensional printed upper-limb prostheses lack randomised controlled trials: A systematic review

BACKGROUND

Three-dimensional printing provides an exciting opportunity to customise upper-limb prostheses.

OBJECTIVE

This review summarises the research that assesses the efficacy and effectiveness of three-dimensional printed upper-limb prostheses.

STUDY DESIGN

Systematic review.

METHODS

PubMed, Web of Science and OVID were systematically searched for studies that reported human trials of three-dimensional printed upper-limb prostheses. The studies matching the language, peer-review and relevance criteria were ranked by level of evidence and critically appraised using the Downs and Black Quality Index.

RESULTS

After removing duplicates, 321 records were identified. Eight papers met the inclusion criteria. No studies used controls; five were case studies and three were small case-series studies. All studies showed promising results, but none demonstrated external validity, avoidance of bias or statistically significant improvements over conventional prostheses. The studies demonstrated proof-of-concept rather than assessing efficacy, and the devices were designed to prioritise reduction of manufacturing costs, not customisability for comfort and function.

CONCLUSION

The potential of three-dimensional printing for individual customisation has yet to be fully realised, and the efficacy and effectiveness to be rigorously assessed. Until randomised controlled trials with follow-up are performed, the comfort, functionality, durability and long-term effects on quality of life remain unknown. Clinical relevance Initial studies suggest that three-dimensional printing shows promise for customising low-cost upper-limb prosthetics. However, the efficacy and effectiveness of these devices have yet to be rigorously assessed. Until randomised controlled trials with follow-up are performed, the comfort, functionality, durability and long-term effects on patient quality of life remain unknown.

Functional changes through the usage of 3D-printed transitional prostheses in children

INTRODUCTION

There is limited knowledge on the use of 3 D-printed transitional prostheses, as they relate to changes in function and strength. Therefore, the purpose of this study was to identify functional and strength changes after usage of 3 D-printed transitional prostheses for multiple weeks for children with upper-limb differences.

MATERIALS AND METHODS

Gross manual dexterity was assessed using the Box and Block Test and wrist strength was measured using a dynamometer. This testing was conducted before and after a period of 24 ± 2.61 weeks of using a 3 D-printed transitional prosthesis. The 11 children (five girls and six boys; 3-15 years of age) who participated in the study, were fitted with a 3 D-printed transitional partial hand (n = 9) or an arm (n = 2) prosthesis.

RESULTS

Separate two-way repeated measures ANOVAs were performed to analyze function and strength data. There was a significant hand by time interaction for function, but not for strength. Conclusion and relevance to the study of disability and rehabilitation: The increase in manual gross dexterity suggests that the Cyborg Beast 2 3 D-printed prosthesis can be used as a transitional device to improve function in children with traumatic or congenital upper-limb differences. Implications for Rehabilitation Children's prosthetic needs are complex due to their small size, rapid growth, and psychosocial development. Advancements in computer-aided design and additive manufacturing offer the possibility of designing and printing transitional prostheses at a very low cost, but there is limited knowledge on the function of this type of devices. The use of 3D printed transitional prostheses may improve manual gross dexterity in children after several weeks of using it.

Using computed tomography and 3D printing to construct custom prosthetics attachments and devices

Background

The prosthetic devices the military uses to restore function and mobility to our wounded warriors are highly advanced, and in many instances not publically available. There is considerable research aimed at this population of young patients who are extremely active and desire to take part in numerous complex activities. While prosthetists design and manufacture numerous devices with standard materials and limb assemblies, patients often require individualized prosthetic design and/or modifications to enable them to participate fully in complex activities.

Methods

Prosthetists and engineers perform research and implement digitally designs in collaboration to generate equipment for their patient’s rehabilitation needs. 3D printing allows for these devices to be manufactured from an array of materials ranging from plastic to titanium alloy. Many designs require form fitting to a prosthetic socket or a complex surface geometry. Specialty items can be scanned using computed tomography and digitally reconstructed to produce a virtual 3D model the engineer can use to design the necessary features of the desired prosthetic, device, or attachment. Completed devices are tested for fit and function.

Results

Numerous custom prostheses and attachments have been successfully translated from the research domain to clinical reality, in particular, those that feature the use of computed tomography (CT) reconstructions. The purpose of this project is to describe the research pathways to implementation for the following clinical designs: sets of bilateral hockey skates; custom weightlifting prosthetic hands; and a wine glass holder.

Conclusion

This article will demonstrate how to incorporate CT imaging and 3D printing in the design and manufacturing process of custom attachments and assistive technology devices. Even though some of these prosthesis attachments may be relatively simple in design to an engineer, they have an enormous impact on the lives of our wounded warriors.