Visualization of complicated fractures by 3D-printed models for teaching and surgery: hands-on transitional fractures of the ankle

Clinical study of 3D printing template in the treatment of pediatric distal tibial epiphyseal fracture

OBJECTIVE

To investigate the clinical efficacy and safety of 3D printing template in the fixation of distal tibial epiphyseal fractures in children.

METHODS

A retrospective analysis was conducted on 57 cases of distal tibial epiphyseal fracture admitted to our hospital between January 2017 and January 2023. 27 patients underwent the conventional operative technique (conventional group), while the remaining 30 patients underwent the 3D printing template (3D printing template group). Exclusions comprised patients presenting with pathological fracture, neuromuscular disorder, metabolic disease, prior tibial fracture or instrumentation, and polytrauma. Additionally, individuals with a follow-up duration of less than 12 months or incomplete medical records were excluded. The reduction effect was evaluated using radiographs, and the times of fluoroscopy, operation time, time to union, and complications (such as infection or loss of reduction) were documented. Ankle joint function was assessed by the AOFAS score.

RESULTS

A total of 57 patients were divided into two groups: the conventional group, comprising 27 patients (14 males, 13 females), and the 3D printing template group, consisting of 30 patients (19 males, 11 females). Patients in both groups were followed up for at least one year, with an average of 2.3 years (1-3 years). The two groups exhibited no statistically significant differences in terms of sex, age, body weight, mechanism of injury, time from injury to surgery, Salter-Harris classification, or concomitant injuries. There was no significant difference in length of hospital stay, time to union, and limb length discrepancy between the two groups (P > 0.05). However, there was significantly less operative time in the 3D template group compared with the conventional group (P < 0.05). Higher intraoperative fluoroscopy frequency was observed in the conventional group than in the 3D template group (P < 0.001). However, the hospitalization expenses were higher in the 3D template group (3784 ± 315.7 $) than in the conventional group (3449 ± 550.6 $). No infection, nonunion, delayed union, malunion, loss of reduction, or premature epiphyseal closure between the two groups. Tendon adhesions were observed in 10 cases in the conventional group, contrasting with 12 cases in the 3D template group. In the final follow-up, AOFAS scores reflected excellence in 26 cases and goodness in one in the conventional group, while excellence was noted in 28 cases and goodness in two in the 3D template group, culminating in an outstanding rate of 100% for both excellence and goodness.

CONCLUSION

The conventional technique and 3D printing template technique both met the treatment requirements of distal tibial epiphyseal fractures. 3D printing guide plate provides a new method for distal tibial epiphyseal fractures with high accuracy and safety compared with traditional method by reducing the times of fluoroscopy and operating time.

CLINICAL TRIAL NUMBER

Not applicable.

Evaluating the value of 3D-printed bone models with fracture fragments connected by flexible rods for training and preoperative planning

BACKGROUND

The emergence of 3D printing has revolutionized medical training and preoperative planning. However, existing models have limitations, prompting the development of newly designed flexible 3D-printed bone fracture models.

METHODS

The designed flexible 3D-printed bone fracture models were evaluated by 133 trauma surgeons with different levels of experience for perceived value as educational tool or as preoperative planning tool.

RESULTS

The models allowed drilling and showed resistance to manipulation and sterilization. Surgeons found the flexible model helpful for teaching and planning the reduction of fractures, planning and simulating osteosynthesis, understanding fractures, visualizing fractures, and planning surgical approaches.

CONCLUSIONS

Flexible 3D-printed bone fracture models offer a dynamic and realistic approach to understanding complex fractures, potentially improving surgical training and preoperative planning.

The application of novel techniques in ophthalmology education

This paper synthesizes recent advances of technologies in ophthalmology education. Advancements in three-dimensional technology are revolutionizing ophthalmology education by enhancing the visualization, understanding, and retention of complex anatomical and pathological concepts. In addition to physical models, artificial intelligence and virtual reality are emerging as significant tools. A systematic search of PubMed was carried out, with a search date from inception to 01/05/2024. A total of 6,686 articles were screened, of which 6,470 were excluded following abstract review. After reading the remaining 216 articles in full, a further 186 were excluded. A total of 30 original articles were included in the review. This review underscores the transformative impact of novel technology in ophthalmology education, offering innovative solutions to enhance learning, surgical training, and diagnostic skills. Further research and development in this field hold promise for continued improvements in ophthalmology education and practice.

The current application of 3D printing simulator in surgical training

In the rapidly evolving field of medical education, the integration of innovative technologies has become paramount to enhance the training and proficiency of future surgeons. Among these advancements, the application of 3D printing technology stands out as a useful tool in surgical training. The advantages of the 3D printing model include customization, re-usability and low-cost. The average cost of the 3D printing simulators was between $100-1000. However, there were extremely high potential labor cost during the 3D printing that hadn't been calculated into. Additionally, in the current stage, the 3D printing simulator still have specific limitations. The most mentioned limitation was poor haptic feedback of the simulators, which was very important during the surgical training, since it is the key element for junior doctors to master practical procedures. Also, some simulators didn't possess the integrated and elaborate structure as the human tissue, hence not the whole surgical procedures can be practiced by the trainees, and further improvement should be made. Although there are shortages, many studies have proved that 3D printing simulator can effectively reduce learning curves and is useful to enhance the trainees' surgical skills.

Evaluation of a 3D-printed hands-on radius fracture model during teaching courses

OBJECTIVE

This study aimed to evaluate the effectiveness of a 3D-printed hands-on radius fracture model for teaching courses. The model was designed to enhance understanding and knowledge of radius fractures among medical students during their clinical training.

METHODS

The 3D models of radius fractures were generated using CT scans and computer-aided design software. The models were then 3D printed using Fused-Filament-Fabrication (FFF) technology. A total of 170 undergraduate medical students participated in the study and were divided into three groups. Each group was assigned one of three learning aids: conventional X-ray, CT data, or a 3D-printed model. After learning about the fractures, students completed a questionnaire to assess their understanding of fracture mechanisms, ability to assign fractures to the AO classification, knowledge of surgical procedures, and perception of the teaching method as well as the influence of such courses on their interest in the specialty of trauma surgery. Additionally, students were tested on their ability to allocate postoperative X-ray images to the correct preoperative image or model and to classify them to the AO classification.

RESULTS

The 3D models were well received by the students, who rated them as at least equal or better than traditional methods such as X-ray and CT scans. Students felt that the 3D models improved their understanding of fracture mechanisms and their ability to explain surgical procedures. The results of the allocation test showed that the combination of the 3D model and X-ray yielded the highest accuracy in classifying fractures according to the AO classification system, although the results were not statistically significant.

CONCLUSION

The 3D-printed hands-on radius fracture model proved to be an effective teaching tool for enhancing students' understanding of fracture anatomy. The combination of 3D models with the traditional imaging methods improved students' ability to classify fractures and allocate postoperative images correctly.

Sterilization of PLA after Fused Filament Fabrication 3D Printing: Evaluation on Inherent Sterility and the Impossibility of Autoclavation

Three-dimensional printing, especially fused filament fabrication (FFF), offers great possibilities in (bio-)medical applications, but a major downside is the difficulty in sterilizing the produced parts. This study evaluates the questions of whether autoclaving is a possible solution for FFF-printed parts and if the printer itself could be seen as an inherent sterilization method. In a first step, an investigation was performed on the deformation of cylindrically shaped test parts after running them through the autoclaving process. Furthermore, the inherent sterility possibilities of the printing process itself were evaluated using culture medium sterility tests. It could be shown that, depending on the needed accuracy, parts down to a diameter of 5-10 mm can still be sterilized using autoclaving, while finer parts suffer from major deformations. For these, inherent sterilization of the printer itself is an option. During the printing process, over a certain contact time, heat at a higher level than that used in autoclaving is applied to the printed parts. The contact time, depending on the printing parameters, is calculated using the established formula. The results show that for stronger parts, autoclaving offers a cheap and good option for sterilization after FFF-printing. However, the inherent sterility possibilities of the printer itself can be considered, especially when printing with small layer heights for finer parts.

Intercalary fragments in posterior malleolar fractures: incidence, treatment implications, and distribution within CT-based classification systems

Introduction

Complex ankle fractures frequently include the posterior malleolus (PM). Despite advances in diagnostic and treatment strategies, PM fracture involvement still predisposes to worse outcomes. While not incorporated into the most common PM fracture classifications, the presence of an intercalary fragment (ICF) complicates treatment. This study aims to describe the incidence, morphology, and location of ICFs in PM fractures.

Materials and methods

A total of 135 patients with a mean age of 54.4 (SD ± 18.9) years and PM fractures were analyzed for the presence of an ICF. Patients with an ICF were compared to those without in terms of age, gender, and treatment received. Characteristics of the ICFs in terms of location and size were assessed. Furthermore, the presence of an ICF in relation to the PM fracture classification according to Haraguchi et al., Bartoníček/Rammelt et al., and Mason et al. was investigated.

Results

ICFs presented in 55 (41%) of the 135 patients. Patients with an ICF were younger, and the PM was more often operatively treated when compared to patients without an ICF. A posterolateral approach was used significantly more often in patients with an ICF. Almost all ICFs were found in the posterolateral (58%) and posterocentral (35%) regions. The majority of fragments were found in Bartoníček/Rammelt type 2 fractures, the most common fracture type. Bartoníček/Rammelt type 3 fractures had the highest relative frequency of ICFs.

Conclusion

ICFs are frequently found in PM fractures; however, they are not incorporated into any of the common classifications. They are generally found in younger patients and associated with more complex PM fractures. As they can complicate reduction of the main fragment and may require direct exposure to restore joint congruency, ICFs should be considered in PM fracture classifications. Due to their location, the majority of ICFs are able to be accessed using a posterolateral approach.