3-D Printed Fracture Models Improve Resident Performance and Clinical Outcomes in Operative Fracture Management

The role of three-dimensional printing models in medical education: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The objective of this study is to evaluate the role of three-dimensional printing models (3DPMs) in the medical education for undergrade students.

METHOD

A comprehensive search was performed across three online databases including Medline, EMBASE, CINAHL, Web of SCI, and Scopus spanning from their inception to October 30, 2024. Studies that satisfied the predefined inclusion criteria were incorporated into the analysis. Data analysis was executed utilizing RevMan 5.4.1. Subgroup analyses were conducted based on various models, and overall effects were estimated using either the fixed effects model or the random effects model. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.

RESULTS

A total of 33 studies were included in this study, involving 2716 medical undergraduates. The findings indicate that 3DPMs demonstrated significant advantages over the control group in theory test of the skeletal system with a moderate effect size (N = 646, P < 0.00001, I2 = 80%, SMD = 0.56, 95% CI 0.20-0.93, Random effect model).Moreover, 3DPMs showed a moderate effect size advantage over the control group in laboratory tests with moderate effect size (N = 299, P < 0.00001, I2 = 0%, SMD = 0.57, 95% CI 0.34 - 0.80, Fixed effect model). Additionally, 3DP showed advantage over the control group in total tests with small effect size (N = 832, P = 0.20, I2 = 84%, SMD = 0.26, 95% CI -0.14-0.66, Random effect model).

CONCLUSION

3DPMs serve as a valuable adjunct to traditional teaching methodologies and have the potential to enhance both the theoretical understanding and practical laboratory skills of medical students. Nevertheless, caution must be exercised in interpreting the current findings due to variations in model types, low quality of included studies, and the limited number of studies with small sample sizes.

The Use of 3D Printing as an Educational Tool in Orthopaedics

Background

Three-dimensional (3D) printing has proven to be effective in orthopaedic surgery, improving both surgical planning and outcomes. Despite its increasing use in surgical programs, reviews evaluating its educational impact are sparse. Therefore, the aim of this review was to provide educators with evidence-based findings on 3D printing's potential in training junior surgeons, as well as discuss its benefits in enhancing patient communication.

Methods

A comprehensive search using PubMed and Web of Science databases was performed to identify articles related to orthopaedics, 3D printing, and education. After removing duplicates, 2,160 articles were screened, 152 underwent full-text review, and 50 met inclusion criteria. Articles discussed the impact of 3D-printed models on comprehension or surgical performance. Data on publication details, sample size, teaching focus, learning outcomes, costs, and conclusions were extracted. Learning effects in the control (didactic) and experimental (3DP) groups were compared.

Results

In fracture management training, studies demonstrated significantly improved fracture classification accuracy, surgical performance, and interobserver classification agreement with 3D models compared with didactic learning and traditional imaging modalities. These benefits were particularly evident in cases of complex fractures and junior trainees. In arthroscopy, 3D-printed simulators improved procedural accuracy and were more cost-effective than virtual reality simulators and cadaveric laboratory results. Three-dimensionally printed simulators were also assessed for skills related to spine surgery, in which trainees demonstrated clear learning curve improvements for pedicle screw placement and osteotomy techniques, as well as a better understanding of vital paraspinal structures. The application of 3D printing in patient education was equally promising, as it facilitated the process of informed consent, ultimately promoting shared decision making.

Conclusion

The use of 3D-printed models offers effective and customizable methods for developing essential surgical skills. Future research should focus on larger, more diverse study populations and should include long-term follow-up to better assess the impact of 3D printing on education and patient outcomes.

Specialized educational program for high-grade liver injury management: a three-dimensional printed model approach

PURPOSE

The study aims to present a specialized educational program using a 3D printed model for managing Grade IV and V liver injuries. Hepatic packing, a common technique, may not always achieve sufficient hemostasis in these cases, warranting alternative solutions such as mesh liver wrapping. However, mastering this procedure is challenging due to limited teaching resources and the need for repeated practice.

METHODS

A computer-based model was created from an abdominal CT scan to produce a real-sized injured liver model using thermoplastic elastomer TPU-95. Trainees received systematic instruction from an instructor, allowing them to perform the procedure under supervision and independently.

RESULTS

Eight surgical residents at Hillel Yaffe Medical Center participated in the program, with the majority successfully completing the procedure under supervision. Furthermore, trainees demonstrated reduced procedure times when performing independently, indicating improved proficiency.

CONCLUSION

This educational approach offers a simple and repeatable method for continuous training in managing high-grade liver injuries, holding potential for enhanced patient outcomes.

The impact of surgical simulation and training technologies on general surgery education

The landscape of general surgery education has undergone a significant transformation over the past few years, driven in large part by the advent of surgical simulation and training technologies. These innovative tools have revolutionized the way surgeons are trained, allowing for a more immersive, interactive, and effective learning experience. In this review, we will explore the impact of surgical simulation and training technologies on general surgery education, highlighting their benefits, challenges, and future directions. Enhancing the technical proficiency of surgical residents is one of the main benefits of surgical simulation and training technologies. By providing a realistic and controlled environment, With the use of simulations, residents may hone their surgical skills without compromising patient safety. Research has consistently demonstrated that training with simulations enhances surgical skills., reduces errors, and enhances overall performance. Furthermore, simulators can be programmed to mimic a wide range of surgical scenarios, enabling residents to cultivate the essential critical thinking and decision-making abilities required to manage intricate surgical cases. Another area of development is incorporating simulation-based training into the wider surgical curriculum. As simulation technologies become more widespread, they will need to be incorporated into the fabric of surgical education, rather than simply serving as an adjunct to traditional training methods. This will require a fundamental shift in the way surgical education is delivered, with a greater emphasis on simulation-based training and assessment.

3D-printed model is a useful addition in orthopedic resident education for the understanding of tibial plateau fractures

This study aimed to explore the role of the three-dimension (3D) printed models in orthopedic resident training of tibial plateau fractures. A total of 41 residents from our institution were divided into two groups. The intervention group, consisting of 20 residents, had access to 3D-printed models illustrating thirteen tibial plateau fractures. In contrast, the control group, comprising 21 residents, received digital images of thirteen identical tibial plateau fractures. Evaluation of learning outcomes included the accurate identification of tibial plateau fracture patterns, deduction of traumatic mechanisms, preoperative plan, assessment time, and subjective questionnaire responses. The participants with 3D printed models scored significantly higher in both the Schatzker classification and Luo three-column classification compared to those without 3D printed models. Residents in the intervention group performed better in accuracy in deducing traumatic mechanisms compared to the control group. In addition, the sum score of preoperative plan in the intervention group was significantly higher than that in the control group. Specifically, participants with 3D printed models scored higher in surgical approach choice and implants placement than these in the control group. Residents exposed to 3D printed models also spent less time to complete the assessment than those with access only to digital imaging. Subjective assessments indicated that 3D-printed models boosted confidence in fracture identification, improved preoperative plan for fracture management and enhanced the understanding in injury mechanism of tibial plateau fractures. Furthermore, residents agreed that the use of 3D-printed models heightened their interest in learning tibial plateau fractures. Therefore, the addition of 3D printed models significantly contributed to a comprehensive understanding of tibial plateau fractures, the improvement in fracture identification, inferring injury mechanisms and preoperative plan.

Case Report: Custom made 3D implants for glenoid tumor reconstruction should be designed as reverse total shoulder arthroplasty

Background and objectives

Isolated bone tumors of the glenoid are exceedingly rare occurrence and pose a substantial surgical challenge. 3D printing technology has been proved to be a reliable tool to reconstruct complex anatomical part of the skeleton. We initially used this technology to reconstruct the glenoid component of the shoulder in a hemiarthroplasty configuration. We subsequently changed to a reverse shoulder arthroplasty.

Methods

Two patients were reconstructed with a hemiarthroplasty and 2 with a reverse configuration. Patients files were reviewed for radiographic analysis, pain and function scores.

Results

Mean follow-up was 36.44 ± 16.27 months. All patients are alive and disease free. The two patients who benefitted from a hemiarthroplasty demonstrated a rapid deterioration of the proximal humeral articular surface. Given their pain and function scores, they subsequently required revision towards a total shoulder arthroplasty. Following this conversion, one patient presented a shoulder dislocation requiring surgical reintervention. We did not observe any loosening or infection in this short series.

Conclusions

Custom made glenoid reconstruction should be designed as a reverse shoulder arthroplasty given the mechanical constrains on the proximal humerus and the extent of the surgery invariably damaging the suprascapular neurovascular bundle.

A novel 3D printed model for educating medical students on limb fractures: a randomized controlled preliminary study

BACKGROUND

Medical education related to bone fracture must address numerous challenges including complex anatomical characteristics, diverse injury mechanisms, fracture typing, and treatment modalities. Our newly developed 3D printed model comprises components that may be combined or split to simulate various anatomical features, fracture types, and treatment modalities. This study aims to analyze the teaching utility of the new 3D-printed model compared with the traditional solid model.

METHODS

This prospective study included 112 students randomly assigned to fracture-related education with a conventional model or the newly developed 3D-printed model. All students received 40 min of lecture, 20 min for femoral neck and 20 min for tibiofibular fractures, and a post-class quiz (10 min each) immediately followed. Scores on tests of fracture-related knowledge and user satisfaction were measured pre and post education for comparison.

RESULTS

The 3D printing group had an advantage in retention of anatomic knowledge, fracture typing and choice of treatment for the femoral neck fracture (P < 0.05). For the tibiofibular fracture the 3D printing group had an advantage in retention of anatomic knowledge and fracture complications (P < 0.05).Scores on the questionnaire survey also showed increased satisfaction in the 3D-printed model group(P < 0.05).

CONCLUSIONS

The proposed 3D-printed model can enhance the teaching effect significantly and has potential for widespread use in medical student education.