Application of 3D–printed and patient-specific cast for the treatment of distal radius fractures: initial experience
Tóm tắt
Distal radius fracture is common in the general population. Fracture management includes a plaster cast, splint and synthetic material cast to immobilise the injured arm. Casting complications are common in those conventional casting technologies. 3D printing technology is a rapidly increasing application in rehabilitation. However, there is no clinical study investigating the application of a 3D–printed orthopaedic cast for the treatment of bone fractures. We have developed a patient-specific casting technology fabricated by 3D printing. This pioneering study aims to use 3D–printed casts we developed for the treatment of distal radius fractures, to provide the foundation for conducting additional clinical trials, and to perform clinical assessments. Ten patients with ages between 5 and 78 years are involved in the clinical trial. Patients are applied 3D–printed casts we developed. Orthopaedic surgeons carried out a six-week follow-up to examine clinical outcomes. Two questionnaires were developed for the assessment of clinical efficacy and patients’ satisfaction. These questionnaires are completed by physicians and participating patients. A 3D–printed cast creates a custom-fitted design to maintain the fractured bone alignment. No loss of reduction is found in all patients. Compartment syndrome and pressure sores are not present. Patient comfort gets positive scores on the questionnaire. All (100%) of the patients opt for the 3D–printed cast instead of the conventional plaster cast. A patient-specific, 3D–printed cast offers a proper fit to immobilise an injured arm and holds the fracture reduction appropriately. A custom-fitted structure reduces the risk of pressure-related complications due to the high and concentrated local stress. The ventilated and lightweight design minimises interference with a patient’s daily activities and reduces the risk of cutaneous complications. Patients express a strong preference for using a 3D–printed cast instead of a plaster cast. Limitations of the novel cast include a slight odour after heavy sweating and the relatively high cost due to the limitations of current 3D printing technologies. This pioneering study is the first clinical trial on the application of a 3D–printed cast for the treatment of forearm fractures. The novel casting technology heals the fracture effectively without casting complications. The 3D–printed cast is patient-specific and ventilated as well as lightweight, and it features both increased patient comfort and satisfaction.
Tài liệu tham khảo
Boutis K, Willan A, Babyn P, Goeree R, Howard A. Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial. Can Med Assoc J. 2010;182(14):1507–12.
Bunch PM, Sheehan SE, Dyer GS, Sodickson A, Khurana B. A biomechanical approach to distal radius fractures for the emergency radiologist. Emerg Radiol. 2016;23(2):175–85.
Davis DI, Baratz M. Soft tissue complications of distal radius fractures. Hand Clin. 2010;26(2):229–35.
Debnath UK, Guha AR, Das S. Distal forearm fractures in children: cast index as predictor of re-manipulation. Indian journal of orthopaedics. 2011;45(4):341.
Casting, S.V., Principles of casting and splinting. 2009.
Grafstein, E., R. Stenstrom, J. Christenson, G. Innes, R. MacCormack, C. Jackson,. .. T. Goetz, A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures. CJEM, 2010. 12(03): p. 192-200.
Inglis M, McClelland B, Sutherland L, Cundy P. Synthetic versus plaster of Paris casts in the treatment of fractures of the forearm in children. Bone Joint J. 2013;95(9):1285–9.
Kamath AF, Zurakowski D, Day CS. Low-profile dorsal plating for dorsally angulated distal radius fractures: an outcomes study. The Journal of hand surgery. 2006;31(7):1061–7.
Tan V, Bratchenko W, Nourbakhsh A, Capo J. Comparative analysis of intramedullary nail fixation versus casting for treatment of distal radius fractures. The Journal of hand surgery. 2012;37(3):460–468. e1.
Egol K, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am. 2010;92(9):1851–7.
Williams KG, Smith G, Luhmann SJ, Mao J, Gunn JD III, Luhmann JD. A randomized controlled trial of cast versus splint for distal radial buckle fracture: an evaluation of satisfaction, convenience, and preference. Pediatr Emerg Care. 2013;29(5):555–9.
Delasobera BE, Place R, Howell J, Davis JE. Serious infectious complications related to extremity cast/splint placement in children. The Journal of emergency medicine. 2011;41(1):47–50.
Lichtman, D.M., R.R. Bindra, M.I. Boyer, M.D. Putnam, D. Ring, D.J. Slutsky,. .. M. Keith, Treatment of distal radius fractures. J Am Acad Orthop Surg, 2010. 18(3): p. 180-189.
Halanski M, Noonan KJ. Cast and splint immobilization: complications. J Am Acad Orthop Surg. 2008;16(1):30–40.
Sun J, Zhang FQ. The application of rapid prototyping in prosthodontics. J Prosthodont. 2012;21(8):641–4.
Hui Lin LS, Wang D. A rapid and intelligent designing technique for patient-specific and 3D-printed orthopedic cast. 3D Printing in Medicine. 2016;2016(2:4)
Kim H, Jeong S. Case study: hybrid model for the customized wrist orthosis using 3D printing. J Mech Sci Technol. 2015;29(12):5151–6.
Wolff I. A pathway to approval for additive-made devices. Manuf Eng. 2014;152(4):89.
Witney-Lagen C, Smith C, Walsh G. Soft cast versus rigid cast for treatment of distal radius buckle fractures in children. Injury. 2013;44(4):508–13.
Edwards P. Questionnaires in clinical trials: guidelines for optimal design and administration. Trials. 2010;11(1):1.
Islam, K., A. Dobbe, A. Komeili, K. Duke, M. El-Rich, S. Dhillon,. .. N. Jomha, Symmetry analysis of talus bone. Bone Joint Res, 2014. 3(5): p. 139-145.
Rizza R, Liu X, Thometz J, Tassone C. Comparison of biomechanical behavior between a cast material torso jacket and a polyethylene based jacket. Scoliosis. 2015;10(Suppl 1):O71.