1
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Oud T, Bogaards JA, Nollet F, Brehm MA. Preliminary effectiveness and production time and costs of three-dimensional printed orthoses in chronic hand conditions: an interventional feasibility study. J Rehabil Med 2024; 56:jrm39946. [PMID: 38742877 PMCID: PMC11107831 DOI: 10.2340/jrm.v56.39946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE To assess the preliminary effectiveness of three-dimensional printed orthoses compared with conventionally custom-fabricated orthoses in persons with chronic hand conditions on performance of daily activities, hand function, quality of life, satisfaction, and production time and costs. DESIGN Interventional feasibility study. SUBJECTS Chronic hand orthotic users (n = 21). METHODS Participants received a new three-dimensional printed orthosis according to the same type as their current orthosis, which served as the control condition. Primary outcome was performance of daily activities (Patient-Reported Outcomes Measurement Information System-Upper Extremity; Michigan Hand Questionnaire). Secondary outcomes were hand function, quality of life, and satisfaction. Furthermore, production time and costs were recorded. RESULTS At 4 months' follow-up, no significant differences were found between three-dimensional printed orthoses and participants' existing conventional orthoses on activity performance, hand function, and quality of life. Satisfaction with the three-dimensional printed orthosis was significantly higher and the production time and costs for three-dimensional printed orthoses were significantly lower compared with conventional orthoses. The three-dimensional printed orthosis was preferred by 79% of the participants. CONCLUSIONS This feasibility study in chronic hand conditions suggests that three-dimensional printed orthoses are similar to conventional orthoses in terms of activity performance, hand function, and quality of life. Satisfaction, and production time and costs favoured the three-dimensional printed hand orthoses.
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Affiliation(s)
- Tanja Oud
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands.
| | - Johannes A Bogaards
- Department of Epidemiology & Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Public Health, Methodology, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
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Silva R, Silva B, Fernandes C, Morouço P, Alves N, Veloso A. A Review on 3D Scanners Studies for Producing Customized Orthoses. SENSORS (BASEL, SWITZERLAND) 2024; 24:1373. [PMID: 38474907 DOI: 10.3390/s24051373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024]
Abstract
When a limb suffers a fracture, rupture, or dislocation, it is traditionally immobilized with plaster. This may induce discomfort in the patient, as well as excessive itching and sweating, which creates the growth of bacteria, leading to an unhygienic environment and difficulty in keeping the injury clean during treatment. Furthermore, if the plaster remains for a long period, it may cause lesions in the joints and ligaments. To overcome all of these disadvantages, orthoses have emerged as important medical devices to help patients in rehabilitation, as well as for self-care of deficiencies in clinics and daily life. Traditionally, these devices are produced manually, which is a time-consuming and error-prone method. From another point of view, it is possible to use imageology (X-ray or computed tomography) to scan the human body; a process that may help orthoses manufacturing but which induces radiation to the patient. To overcome this great disadvantage, several types of 3D scanners, without any kind of radiation, have emerged. This article describes the use of various types of scanners capable of digitizing the human body to produce custom orthoses. Studies have shown that photogrammetry is the most used and most suitable 3D scanner for the acquisition of the human body in 3D. With this evolution of technology, it is possible to decrease the scanning time and it will be possible to introduce this technology into clinical environment.
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Affiliation(s)
- Rui Silva
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, 1499-002 Lisbon, Portugal
- CDRSP, Polytechnic University of Leiria, 2430-028 Marinha Grande, Portugal
| | - Bruna Silva
- CDRSP, Polytechnic University of Leiria, 2430-028 Marinha Grande, Portugal
| | | | - Pedro Morouço
- ESECS, Polytechnic University of Leiria, 2411 Leiria, Portugal
- CIDESD, Research Center in Sports Sciences, Health Sciences and Human Development, 6201-001 Covilhã, Portugal
| | - Nuno Alves
- CDRSP, Polytechnic University of Leiria, 2430-028 Marinha Grande, Portugal
| | - António Veloso
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada Dafundo, 1499-002 Lisbon, Portugal
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Mian SH, Abouel Nasr E, Moiduddin K, Saleh M, Alkhalefah H. An Insight into the Characteristics of 3D Printed Polymer Materials for Orthoses Applications: Experimental Study. Polymers (Basel) 2024; 16:403. [PMID: 38337292 DOI: 10.3390/polym16030403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Knee orthoses assist patients with impaired gait through the amendment of knee abnormalities, restoration of mobility, alleviation of pain, shielding, and immobilization. The inevitable issues with laborious traditional plaster molding procedures for orthoses can be resolved with 3D printing. However, a number of challenges have limited the adoption of 3D printing, the most significant of which is the proper material selection for orthoses. This is so because the material used to make an orthosis affects its strength, adaptability, longevity, weight, moisture response, etc. This study intends to examine the mechanical, physical, and dimensional characteristics of three-dimensional (3D) printing materials (PLA, ABS, PETG, TPU, and PP). The aim of this investigation is to gain knowledge about these materials' potential for usage as knee orthosis materials. Tensile testing, Olympus microscope imaging, water absorption studies, and coordinate measuring machine-based dimension analysis are used to characterize the various 3D printing materials. Based on the investigation, PLA outperforms all other materials in terms of yield strength (25.98 MPa), tensile strength (30.89 MPa), and shrinkage (0.46%). PP is the least water absorbent (0.15%) and most flexible (407.99%); however, it is the most difficult to fabricate using 3D printing. When producing knee orthoses with 3D printing, PLA can be used for the orthosis frame and other structural elements, PLA or ABS for moving parts like hinges, PP for padding, and TPU or PP for the straps. This study provides useful information for scientists and medical professionals who are intrigued about various polymer materials for 3D printing and their effective utilization to fabricate knee orthoses.
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Affiliation(s)
- Syed Hammad Mian
- Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia
| | - Emad Abouel Nasr
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia
| | - Khaja Moiduddin
- Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia
| | - Mustafa Saleh
- Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia
| | - Hisham Alkhalefah
- Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia
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4
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Ismaiel S, Massadeh HA, Fakhri RM. A personalized approach to modify axillary crutches using 3D printing technology. Trauma Case Rep 2023; 48:100943. [PMID: 37781165 PMCID: PMC10540037 DOI: 10.1016/j.tcr.2023.100943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
3D printers can produce specific medical objects that are tailored to the individual patient's needs, and if they are combined with a personalized orthopedic rehabilitation, it can result in improved functional outcomes. We present a 26-year-old male war victim with multiple injuries in his lower and upper limbs. The use of standard crutches was impossible, so we developed a customized 3D-printed crutch with a relative low cost. The gait and balance scores-as a part of the Tinetti score-improved immediately, and the patient's QUEST 2.0 questionnaire was high after 4 weeks of the crutches use, indicating high patient's satisfaction.
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5
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Kim JM, Lim J, Choi SY, Rhim SH, Beom J, Ryu JS. Application of 3D scanner to measure physical size and improvement of hip brace manufacturing technology in severe cerebral palsy patients. Sci Rep 2023; 13:20691. [PMID: 38001232 PMCID: PMC10673940 DOI: 10.1038/s41598-023-47665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
This prospective pilot study aimed to develop a personalized hip brace for treating hip subluxation in children with cerebral palsy. Nineteen children, aged 1-15, with severe cerebral palsy participated in the study. Customized hip braces were created based on 3D scanner measurements and worn for 7 days. The primary outcome, Hip Migration Index (MI), and secondary outcomes, including range of motion (ROM) in the hip and knee joints, pain intensity, satisfaction, discomfort scores, CPCHILD, and wearability test, were assessed. The MI and ROM were assessed at screening and at Visit 1 (when the new hip brace was first worn), while other indicators were evaluated at screening, Visit 1, and Visit 2 (7 days after wearing the new hip brace). The study demonstrated significant improvements in the MI for the right hip, left hip, and both sides. However, there were no statistically significant differences in hip and knee joint ROM. Other indicators showed significant changes between screening, Visit 1, and Visit 2. The study suggests that customized hip braces effectively achieved immediate correction, positively impacting the quality of life and satisfaction in children with cerebral palsy. Furthermore, the hip braces have the potential to enhance compliance and prevent hip subluxation.Clinical Trial Registration number: NCT05388422.
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Affiliation(s)
- Jung-Min Kim
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Jiwoon Lim
- Department of Rehabilitation Medicine, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Sun-Young Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Sung-Han Rhim
- Department of Mechanical Engineering, Dankook University, Yongin, South Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
- Seoul National University College of Medicine, Seoul, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
- Seoul National University College of Medicine, Seoul, South Korea.
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6
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Demeco A, Foresti R, Frizziero A, Daracchi N, Renzi F, Rovellini M, Salerno A, Martini C, Pelizzari L, Costantino C. The Upper Limb Orthosis in the Rehabilitation of Stroke Patients: The Role of 3D Printing. Bioengineering (Basel) 2023; 10:1256. [PMID: 38002380 PMCID: PMC10669460 DOI: 10.3390/bioengineering10111256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Stroke represents the third cause of long-term disability in the world. About 80% of stroke patients have an impairment of bio-motor functions and over half fail to regain arm functionality, resulting in motor movement control disorder with serious loss in terms of social independence. Therefore, rehabilitation plays a key role in the reduction of patient disabilities, and 3D printing (3DP) has showed interesting improvements in related fields, thanks to the possibility to produce customized, eco-sustainable and cost-effective orthoses. This study investigated the clinical use of 3DP orthosis in rehabilitation compared to the traditional ones, focusing on the correlation between 3DP technology, therapy and outcomes. We screened 138 articles from PubMed, Scopus and Web of Science, selecting the 10 articles fulfilling the inclusion criteria, which were subsequently examined for the systematic review. The results showed that 3DP provides substantial advantages in terms of upper limb orthosis designed on the patient's needs. Moreover, seven research activities used biodegradable/recyclable materials, underlining the great potential of validated 3DP solutions in a clinical rehabilitation setting. The aim of this study was to highlight how 3DP could overcome the limitations of standard medical devices in order to support clinicians, bioengineers and innovation managers during the implementation of Healthcare 4.0.
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Affiliation(s)
- Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Ruben Foresti
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
- Center of Excellence for Toxicological Research (CERT), University of Parma, 43126 Parma, Italy
- Italian National Research Council, Institute of Materials for Electronics and Magnetism (CNR-IMEM), 43124 Parma, Italy
| | - Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Nicola Daracchi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Francesco Renzi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Margherita Rovellini
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Antonello Salerno
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
| | - Laura Pelizzari
- AUSL Piacenza, Neurorehabilitation and Spinal Unit, Department of Rehabilitative Medicine, 29121 Piacenza, Italy;
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.F.); (N.D.); (F.R.); (M.R.); (A.S.); (C.M.); (C.C.)
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7
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Popescu D, Baciu F, Vlăsceanu D, Marinescu R, Lăptoiu D. Investigations on the Fatigue Behavior of 3D-Printed and Thermoformed Polylactic Acid Wrist-Hand Orthoses. Polymers (Basel) 2023; 15:2737. [PMID: 37376386 DOI: 10.3390/polym15122737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
Additively manufactured wrist-hand orthoses (3DP-WHOs) offer several advantages over traditional splints and casts, but their development based on a patient's 3D scans currently requires advanced engineering skills, while also recording long manufacturing times as they are commonly built in a vertical position. A proposed alternative involves 3D printing the orthoses as a flat model base and then thermoforming them to fit the patient's forearm. This manufacturing approach is faster, cost-effective and allows easier integration of flexible sensors as an example. However, it is unknown whether these flat-shaped 3DP-WHOs offer similar mechanical resistance as the 3D-printed hand-shaped orthoses, with a lack of research in this area being revealed by the literature review. To evaluate the mechanical properties of 3DP-WHOs produced using the two approaches, three-point bending tests and flexural fatigue tests were conducted. The results showed that both types of orthoses had similar stiffness up to 50 N, but the vertically built orthoses failed at a maximum load of 120 N, while the thermoformed orthoses could withstand up to 300 N with no damages observed. The integrity of the thermoformed orthoses was maintained after 2000 cycles at 0.5 Hz and ±2.5 mm displacement. It was observed that the minimum force occurring during fatigue tests was approximately -95 N. After 1100-1200 cycles, it reached -110 N and remained constant. The outcomes of this study are expected to enhance the trust that hand therapists, orthopedists, and patients have in using thermoformable 3DP-WHOs.
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Affiliation(s)
- Diana Popescu
- Department of Robotics and Production Systems, Faculty of Industrial Engineering and Robotics, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Florin Baciu
- Department of Strength of Materials, Faculty of Industrial Engineering and Robotics, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Daniel Vlăsceanu
- Department of Strength of Materials, Faculty of Industrial Engineering and Robotics, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Rodica Marinescu
- Department of Orthopedics, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Dan Lăptoiu
- Department of Orthopedics, Colentina Clinical Hospital, 020125 Bucharest, Romania
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Niculescu M, Honțaru OS, Popescu G, Sterian AG, Dobra M. Challenges of Integrating New Technologies for Orthopedic Doctors to Face up to Difficulties during the Pandemic Era. Healthcare (Basel) 2023; 11:1524. [PMID: 37297666 PMCID: PMC10288938 DOI: 10.3390/healthcare11111524] [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: 04/03/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
In the field of orthopedics, competitive progress is growing faster because new technologies used to facilitate the work of physicians are continuously developing. Based on the issues generated in the pandemic era in this field, a research study was developed to identify the intention of orthopedic doctors to integrate new medical technologies. The survey was based on a questionnaire that was used for data collection. The quantitative study registered a sample of 145 orthopedic doctors. The data analysis was performed based on the IBM SPSS program. A multiple linear regression model was applied, which analyzed how the independent variables can influence the dependent variables. After analyzing the data, it was observed that the intention of orthopedic doctors to use new medical technologies is influenced by the advantages and disadvantages perceived by them, the perceived risks, the quality of the medical technologies, the experience of physicians in their use, and their receptivity to other digital tools. The obtained results are highly important both for hospital managers and authorities, illustrating the main factors that influence doctors to use emergent technologies in their clinical work.
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Affiliation(s)
- Marius Niculescu
- Faculty of Medicine, “Titu Maiorescu” University of Bucharest, 031593 Bucharest, Romania;
- Colentina Hospital, Șoseaua Ștefan cel Mare 19-21, 020125 Bucharest, Romania
| | - Octavia-Sorina Honțaru
- Faculty of Sciences, Physical Education and Informatics, University of Pitesti, Târgul din Vale 1, 110040 Arges, Romania
- Department of Public Health Arges, Exercitiu 39 bis, 110438 Arges, Romania
| | - George Popescu
- Emergency Clinical Hospital Dr. Bagdasar-Arseni, Șoseaua Berceni 12, 041915 Bucharest, Romania
| | - Alin Gabriel Sterian
- Emergency Hospital for Children Grigore Alexandrescu, 30-32 Iancu de Hunedoara Boulevard, 011743 Bucharest, Romania;
- Department of Pediatric Surgery and Orthopedics, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania
| | - Mihai Dobra
- Center of Uronephrology and Renal Transplant Fundeni, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
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9
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Oud T, Tuijtelaars J, Bogaards H, Nollet F, Brehm MA. Preliminary effectiveness of 3D-printed orthoses in chronic hand conditions: study protocol for a non-randomised interventional feasibility study. BMJ Open 2023; 13:e069424. [PMID: 37024252 PMCID: PMC10083733 DOI: 10.1136/bmjopen-2022-069424] [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] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Hand orthoses are often provided to improve performance of activities of daily life (ADL). Yet, the manufacturing process of conventional custom-fabricated hand orthoses is a time-consuming and labour-intensive process. Even though three-dimensional (3D) printing of orthoses is a rapidly growing area that can facilitate the manufacturing process of hand orthoses, evidence on the effectiveness, costs and production time of 3D-printed orthoses in chronic hand conditions is scarce. This study aims to assess (1) the preliminary effectiveness of 3D-printed orthoses compared with conventionally custom-fabricated orthoses in persons with chronic hand conditions, (2) production time and costs of both orthoses and (3) experiences of the participants and orthotists with the manufacturing process of the 3D-printed orthosis. METHODS AND ANALYSIS In this prospective non-randomised interventional feasibility study, 20 adults with various chronic hand conditions using a conventional thumb, wrist or wrist-thumb orthosis will be provided with a 3D-printed corresponding type of orthosis. Assessments will be done 2 weeks prior to the intervention and at baseline for the conventional orthosis, and at 1 month and 4 months follow-up for the 3D-printed orthosis. The primary outcome is change from baseline in ADL performance (custom short form Dutch-Flemish Patient-Reported Outcomes Measurement Information System-Upper Extremity; ADL domain Michigan Hand Outcomes Questionnaire Dutch language version (MHQ-DLV)) at 4 months follow-up. Secondary outcomes include general hand function (MHQ-DLV), satisfaction with the orthosis (Dutch Client Satisfaction with Device; Dutch version of the Quebec User Evaluation of Satisfaction with Assistive Technology), usability (in-house questionnaire) and quality of life (EuroQoL 5-Dimension 5-Level). Costs and production time of the conventional and 3D-printed orthoses will be prospectively recorded. Experiences regarding the manufacturing process will be obtained from participants and orthotists (in-house questionnaire). ETHICS AND DISSEMINATION The Medical Ethics Committee of the Amsterdam UMC, Academic Medical Centre, has waived the requirement for ethical review of this study. Results will be disseminated through peer-reviewed journals, scientific conferences, and media aimed at a broad audience including patients. TRIAL REGISTRATION NUMBER NCT05320211.
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Affiliation(s)
- Tanja Oud
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Jana Tuijtelaars
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Hans Bogaards
- Amsterdam UMC location University of Amsterdam, Department of Epidemiology & Data Science, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Frans Nollet
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
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Rodriguez Colon R, Nayak VV, Parente PEL, Leucht P, Tovar N, Lin CC, Rezzadeh K, Hacquebord JH, Coelho PG, Witek L. The presence of 3D printing in orthopedics: A clinical and material review. J Orthop Res 2023; 41:601-613. [PMID: 35634867 DOI: 10.1002/jor.25388] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 04/13/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023]
Abstract
The field of additive manufacturing, 3D printing (3DP), has experienced an exponential growth over the past four decades, in part due to increased accessibility. Developments including computer-aided design and manufacturing, incorporation of more versatile materials, and improved printing techniques/equipment have stimulated growth of 3DP technologies within various industries, but most specifically the medical field. Alternatives to metals including ceramics and polymers have been garnering popularity due to their resorbable properties and physiologic similarity to extracellular matrix. 3DP has the capacity to utilize an assortment of materials and printing techniques for a multitude of indications, each with their own associated benefits. Within the field of medicine, advances in medical imaging have facilitated the integration of 3DP. In particular, the field of orthopedics has been one of the earliest medical specialties to implement 3DP. Current indications include education for patients, providers, and trainees, in addition to surgical planning. Moreover, further possibilities within orthopedic surgery continue to be explored, including the development of patient-specific implants. This review aims to highlight the use of current 3DP technology and materials by the orthopedic community, and includes comments on current trends and future direction(s) within the field.
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Affiliation(s)
- Ricardo Rodriguez Colon
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, USA
| | - Vasudev Vivekanand Nayak
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA.,Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, New York, USA
| | - Paulo E L Parente
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.,Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Philipp Leucht
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, New York, USA.,Department of Cell Biology, NYU Grossman School of Medicine, New York, New York, USA
| | - Nick Tovar
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA
| | - Charles C Lin
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Kevin Rezzadeh
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Jacques H Hacquebord
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, USA.,Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Paulo G Coelho
- Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, USA.,Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA.,Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, New York, USA
| | - Lukasz Witek
- Biomaterials Division - Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York, USA.,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, New York, USA
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Clinical Applications of Three-Dimensional Printing in Upper Extremity Surgery: A Systematic Review. J Pers Med 2023; 13:jpm13020294. [PMID: 36836528 PMCID: PMC9961947 DOI: 10.3390/jpm13020294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Three-dimensional printing for medical applications in surgery of the upper extremity has gained in popularity as reflected by the increasing number of publications. This systematic review aims to provide an overview of the clinical use of 3D printing in upper extremity surgery. METHODS We searched the databases PubMed and Web of Science for clinical studies that described clinical application of 3D printing for upper extremity surgery including trauma and malformations. We evaluated study characteristics, clinical entity, type of clinical application, concerned anatomical structures, reported outcomes, and evidence level. RESULTS We finally included 51 publications with a total of 355 patients, of which 12 were clinical studies (evidence level II/III) and 39 case series (evidence level IV/V). The types of clinical applications were for intraoperative templates (33% of a total of 51 studies), body implants (29%), preoperative planning (27%), prostheses (15%), and orthoses (1%). Over two third of studies were linked to trauma-related injuries (67%). CONCLUSION The clinical application of 3D printing in upper extremity surgery offers great potential for personalized approaches to aid in individualized perioperative management, improvement of function, and ultimately help to benefit certain aspects in the quality of life.
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3D-Printed Polycaprolactone Mechanical Characterization and Suitability Assessment for Producing Wrist-Hand Orthoses. Polymers (Basel) 2023; 15:polym15030576. [PMID: 36771877 PMCID: PMC9919332 DOI: 10.3390/polym15030576] [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] [Received: 12/22/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
In this research, the mechanical properties of 3D-printed polycaprolactone (PCL), a biocompatible and biodegradable semi-crystalline polyester, available as feedstock for additive manufacturing technology based on the material extrusion process, were determined. The influence of the infill pattern (zig-zag vs. gyroid) and ultraviolet (UV-B) exposure over the specimens' mechanical performances were also investigated to gather relevant data on the process parameter settings for different applications. Specimens and samples of 3D-printed PCL were analyzed through tensile and flexural tests. The experimental data showed the good repeatability of the manufacturing process, as well as a mechanical behavior independent of the specimens' infill pattern at full density. No differences between the failure patterns of the tensile specimens were recorded. UV-B exposure proved to have a significant negative impact on the specimens' tensile strength. The 3D printing of PCL and PCL blends is reported mainly for use in scaffold manufacturing or drug delivery applications. As another novelty, the suitability of commercial PCL filaments for producing patient-customized wrist-hand orthoses was also assessed in this study. Semi-cylindrical PCL samples mimicking the forearm part of a wrist-hand orthosis with hexagonal open pockets were 3D-printed and mechanically tested. The results were discussed in comparison to samples with a similar design, made of polylactic acid. The experiments revealed the need to carefully calibrate the manufacturing parameters to generate defect-free, good quality prints. Once settings were established, promising results were obtained when producing orthoses in a ready-to-use form. On the other hand, the attempts to thermoform flat 3D-printed PCL orthoses proved unsuccessful.
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Design of Personalized Cervical Fixation Orthosis Based on 3D Printing Technology. Appl Bionics Biomech 2022; 2022:8243128. [PMID: 35535322 PMCID: PMC9078801 DOI: 10.1155/2022/8243128] [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: 11/04/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
The movement of the cervical spine should be restricted throughout the rehabilitation phase after it has been injured. Cervical orthosis is commonly utilized in clinical settings to guarantee cervical spine stability. However, to date, the investigations are limited to patient-specific cervical fixation orthoses. This study provides a new idea for making personalized orthoses. The CT data of the patient's cervical spine were collected, then mimics were used for reconstructing the skin of the cervical spine, the Geomagic Studio was used for surface fitting, the Inspire Studio was used for structural topology optimization, redundant structures were removed, the resulting orthotics were postprocessed, and finally, it was printed with a 3D printer. No signs of pain or discomfort were observed during the wearing. The cervical spine range of motion in flexion, extension, lateral flexion, and rotation is all less than 8° after using the device. Low cost, quick manufacturing time, high precision, attractive appearance, lightweight structure, waterproof design, and practical customized orthotics for patients are all advantages of 3D printing technology in the field of orthopedics. Many possible benefits of using 3D printing to build new orthotics include unique design, stiffness, weight optimization, and improved biomechanical performance, comfort, and fit. Personalized orthotics may be designed and manufactured utilizing 3D printing technology.
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Robb H, Scrimgeour G, Boshier P, Przedlacka A, Balyasnikova S, Brown G, Bello F, Kontovounisios C. The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review. Surg Endosc 2022; 36:5907-5920. [PMID: 35277766 PMCID: PMC9283150 DOI: 10.1007/s00464-022-09176-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND 3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research. METHODS A scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated. RESULTS A total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found. CONCLUSION The use of 3D reconstruction is in its infancy in oesophagogastric surgery. The quality of evidence is low and key themes, such as patient engagement and education, remain unexplored. Without high quality research evaluating the application and benefits of 3D modelling, oesophagogastric surgery may be left behind.
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Affiliation(s)
- Henry Robb
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Piers Boshier
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Anna Przedlacka
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | | | - Gina Brown
- Imperial College London, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Christos Kontovounisios
- Imperial College London, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
- Chelsea Westminster NHS Foundation Trust, London, UK.
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15
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Schwartz DA, Schofield KA. Utilization of 3D printed orthoses for musculoskeletal conditions of the upper extremity: A systematic review. J Hand Ther 2021; 36:166-178. [PMID: 34819255 DOI: 10.1016/j.jht.2021.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/02/2021] [Accepted: 10/02/2021] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Systematic Review INTRODUCTION: 3D printed orthoses are emerging as a possible option in the field of hand therapy to fabricate conventional casts and orthoses. It is unknown how this technology is currently being used to treat upper extremity musculoskeletal conditions, and if 3D orthoses are comparable to custom- made low temperature thermoplastic orthoses fabricated by hand therapists. PURPOSE OF THE STUDY The primary aim of this review was to investigate the utilization, effectiveness and feasibility of 3D printed technology to manufacture custom orthoses for musculoskeletal conditions of the upper extremity. METHODS Studies describing 3D printed orthoses or casts used in treatment with patients were included following a comprehensive literature search using CINAHL, PubMed, Medline, ProQuest, and EBSCO databases. The selected studies had to address musculoskeletal conditions of the elbow, wrist, hand and/or digits that would typically be immobilized with a cast or brace or orthotic or orthosis. RESULTS Ten studies met the inclusion criteria. Study designs included case studies, case series, and 1 randomized clinical trial. 3D printed orthoses/casts appear to be comfortable, provide adequate immobilization, and have pleasing aesthetics. However, expensive equipment, lack of appropriate software and scanning tools and lack of highly skilled clinicians are all factors preventing the implementation of 3D printed orthoses into current clinical practice. DISCUSSION 3D printed orthoses appear to be effective at immobilization of a limb, aesthetically pleasing, and utilize lightweight and well -ventilated materials. However, the feasibility of implementing 3D printing technology in hand therapy settings remains challenging in part due to the resources required. CONCLUSIONS While 3D printing shows promise, the high cost of equipment, lack of training and skill of clinicians and the long time required for production are all factors that need to be improved to make 3D printing a viable option in the hand therapy setting.
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Affiliation(s)
- Deborah A Schwartz
- Orfit Industries America, Leonia, NJ, USA; Touro University, Yeshiva University, USA.
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16
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Oud TAM, Lazzari E, Gijsbers HJH, Gobbo M, Nollet F, Brehm MA. Effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions: A scoping review. PLoS One 2021; 16:e0260271. [PMID: 34793566 PMCID: PMC8601455 DOI: 10.1371/journal.pone.0260271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background In the field of orthotics, the use of three-dimensional (3D) technology as an alternative to the conventional production process of orthoses is growing. Purpose This scoping review aimed to systematically map and summarize studies assessing the effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions, and to identify knowledge gaps. Methods The Cochrane Library, PubMed, EMBASE, CINAHL, Web of Science, IEEE, and PEDro were searched for studies of any type of 3D-printed orthoses for traumatic and chronic hand conditions. Any outcome related to the effectiveness of 3D-printed orthoses was considered. Two reviewers selected eligible studies, charted data on study characteristics by impairment type, and critically appraised the studies, except for case reports/series. Results Seventeen studies were included: four randomized controlled trials, four uncontrolled trials, four case series and five case reports. Only three studies had a sample size >20. Impairments described were forearm fractures (n = 5), spasticity (n = 5), muscle weakness (n = 4), joint contractures (n = 2) and pain (n = 1). Four poor to fair quality studies on forearm fractures supported the effectiveness of 3D-printed orthoses on hand function, functionality, and satisfaction. One good quality study on spasticity demonstrated the effectiveness of 3D-printed orthoses on hand function. One poor quality pain study reported limited positive effects on satisfaction. Studies on muscle weakness and joint contractures showed no benefits. Conclusion Current literature addressing the effectiveness of 3D-printed orthoses for traumatic and chronic hand conditions consists primarily of small and poor methodological quality studies. There is a need for well-designed controlled trials including patient-related outcomes, production time and cost analyses.
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Affiliation(s)
- T. A. M. Oud
- Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- * E-mail:
| | - E. Lazzari
- Laboratory of Clinical Integrative Physiology, University of Brescia, Brescia, Italy
| | - H. J. H. Gijsbers
- Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - M. Gobbo
- Laboratory of Clinical Integrative Physiology, University of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - F. Nollet
- Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - M. A. Brehm
- Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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17
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Skibicki HE, Katt BM, Lutsky K, Wang ML, McEntee R, Vaccaro AR, Beredjiklian P, Rivlin M. Three Dimensionally Printed Versus Conventional Casts in Pediatric Wrist Fractures. Cureus 2021; 13:e19090. [PMID: 34868748 PMCID: PMC8626708 DOI: 10.7759/cureus.19090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective With significant advancement in the field of biomaterials, alternatives to conventional fiberglass casts such as customized three-dimensional (3D) orthotics have been developed. However, there is a scarcity of reported experience regarding 3D-printed orthoses. The purpose of this study was to compare radiographic outcomes and patient satisfaction with fractures treated with either conventional or 3D-printed casts. Materials and methods We included 23 limbs from 22 patients, who were aged between 8-18 years, and with a diagnosis of an acute nondisplaced wrist or forearm fracture. Patients were randomized into two groups: consisting of those treated with a 3D-printed orthosis and those with conventional fiberglass cast. Outcomes included X-ray alignment and healing, cast fit, the appearance of the skin, ease of care, and overall satisfaction. Results Of note, 10/11 (91%) in the 3D cast group healed in an excellent position, and 1/11 healed in an acceptable position. Also, 11/12 (92%) in the conventional cast group healed in an excellent position, and 1/12 healed in an acceptable position. Radiographically, 11/11 (100%) of the fractures in the 3D group and 11/12 (92%) in the conventional cast group were found to be fully healed. No differences were found in terms of skin irritation by a blinded hand therapist. Patients reported significant differences in skin irritation, comfort, satisfaction, and cast care favoring 3D casts (p<0.05). Conclusions 3D orthoses offer a promising opportunity to improve patients' experiences with upper extremity casting while also providing appropriate immobilization.
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Affiliation(s)
- Hope E Skibicki
- Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, USA
| | - Brian M Katt
- Department of Orthopedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Kevin Lutsky
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Mark L Wang
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Richard McEntee
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | | | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Michael Rivlin
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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18
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Oud T, Kerkum Y, de Groot P, Gijsbers H, Nollet F, Brehm MA. Production Time and User Satisfaction of 3-Dimensional Printed Orthoses For Chronic Hand Conditions Compared With Conventional Orthoses: A Prospective Case Series. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2021; 4:1000048. [PMID: 33884150 PMCID: PMC8054741 DOI: 10.2340/20030711-1000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
Objective Hand orthoses are often prescribed for persons with chronic hand and wrist impairments. This study assessed the feasibility, in terms of production time and user satisfaction, of 3-dimensional printed hand orthoses compared with conventional hand orthoses for this population. Methods In this prospective case series, both a conventional hand orthosis and a 3-dimensional printed hand orthosis were manufactured for 10 participants. Production time (in minutes) of each orthosis was recorded. Each orthosis was worn for one week, after which participants completed a self-designed questionnaire on satisfaction, scored on a 5-point Likert scale. Functionality and orthosis preference were also assessed. Results The mean (standard deviation (SD)) production time for the 3-dimensional printed orthoses, of 112 (11.0) min, was significantly shorter compared with 239 (29.2) min for the conventional orthoses (95% confidence interval (95% CI) 71-182 min, p = 0.001). Satisfaction scores were similar for both orthoses, except for comfort item "fitting method", which was rated significantly higher for scanning compared with casting (median [IQR] score: 5 [0.0]; 4 [2.0], p = 0.034). Functionality and orthosis preference were rated similar for both orthoses. CONCLUSION As the production time was halved, user satisfaction similar, and scanning experienced as slightly more comfortable than casting, 3-dimensional printed hand orthoses seem feasible and potentially beneficial for use in people with chronic hand and wrist impairments.
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Affiliation(s)
- Tanja Oud
- Amsterdam University Medical Centers, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Yvette Kerkum
- OIM Orthopedie, Research and Development, Assen, The Netherlands
| | - Peter de Groot
- OIM Orthopedie, Research and Development, Assen, The Netherlands
| | - Harm Gijsbers
- Amsterdam University Medical Centers, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Frans Nollet
- Amsterdam University Medical Centers, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Amsterdam University Medical Centers, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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19
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Andrés-Cano P, Calvo-Haro J, Fillat-Gomà F, Andrés-Cano I, Perez-Mañanes R. Role of the orthopaedic surgeon in 3D printing: current applications and legal issues for a personalized medicine. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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20
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Lu P, Liao Z, Zeng Q, Chen H, Huang W, Liu Z, Chen Y, Zhong J, Huang G. Customized Three-Dimensional-Printed Orthopedic Close Contact Casts for the Treatment of Stable Ankle Fractures: Finite Element Analysis and a Pilot Study. ACS OMEGA 2021; 6:3418-3426. [PMID: 33553960 PMCID: PMC7860236 DOI: 10.1021/acsomega.0c06031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
Ankle fracture is one of the most common traumatic fractures among the elderly population. The majority of ankle fractures are stable types with the typically conservative strategy of close contact casting treatment. The continuous use of unventilated standard cast immobilization severely affects patient's satisfaction and compliance and markedly increases the rates of various complications. Three-dimensional (3D) printing for casts has advantages of lightweight, ventilated, proper-fit, and esthetic improvements. In this work, this novel 3D-printed cast has been applied to individuals with stable ankle fractures, and its effectiveness can be successfully validated with finite element analysis and a pilot study. A 30% reduction of the volume was chosen as the optimal result in topology optimization. Both 3D-printed casts and conventional casts showed significant ankle function improvement after immobilization for 6 weeks (p = 0.000). The 3D-printed casts were superior to the traditional casts in Olerud-Molander Ankle Scores (OMAS), with the mean difference of 8.3 ± 8.57 OMAS points (95% CI -10.8 to 27.5; p = 0.354) for 6 weeks, implying that the 3D-printed casts possibly maintain the equal clinical efficacy as the traditional casts. The statistically significant difference between groups from the 3D-printed cast and the traditional one observed in C-QUEST 2.0 was 11.3 ± 1.5 points (95% CI 8.0-14.6; p = 0.000), indicating that the 3D-printed cast possesses outperforming satisfaction and compliance and has great potential in practical applications. There were no severe complications in the 3D-printed casts, but more moderate complications were observed in the traditional casts.
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Affiliation(s)
- Pengcheng Lu
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
| | - Zhengwen Liao
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
| | - Qing Zeng
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
| | - Huan Chen
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
| | - Weichun Huang
- School
of Chemistry and Chemical Engineering, Nantong
University, Nantong 226019, China
| | - Zhen Liu
- Department
of Rehabilitation Medicine, The First People’s
Hospital of Foshan, Foshan 528000, China
| | - Yanjun Chen
- Guangdong
Medical Innovation Platform for Translation of 3D Printing Application,
Department of Medical Radiology, The Third
Affiliated Hospital of Southern Medical University, Guangzhou 510515, China
| | - Jing Zhong
- Guangdong
Engineering Research Center for Translation of Medical 3D Printing
Application, Guangdong Provincial Key Laboratory of Medical Biomechanics,
School of Basic Medical Sciences, Southern
Medical University, Guangzhou 510515, China
| | - Guozhi Huang
- Department
of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Rehabilitation
Medical School, Southern Medical University, Guangzhou 510280, China
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Abstract
PURPOSE OF REVIEW Additive manufacturing (AM) is a rapidly evolving field traditionally utilized in non-medical industries. Recently, the medical use of AM is expanding, especially in orthopedics. The goal of this article is presenting the principles of AM and its main applications in orthopedics. RECENT FINDINGS The main indications for AM in orthopedics are education, orthotics, surgical planning, surgical guides, and custom-made implants. Three-dimensional (3D) digital models can be obtained from tomographic scans using available free software. Then, it can be used to create a physical model, plan surgeries, or develop surgical guides which can aid the orthopedic surgeon during complex cases. Recent studies demonstrated the benefits of using printed models in educating patients and medical residents. Custom-made implants also have been evaluated with promising clinical outcomes. Using 3D technology has become a reality in orthopedics. Surgeons should expect exponential growth of its applications in the upcoming years. It is paramount that orthopedists get familiar with this disruptive technology.
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Andrés-Cano P, Calvo-Haro JA, Fillat-Gomà F, Andrés-Cano I, Perez-Mañanes R. Role of the orthopaedic surgeon in 3D printing: current applications and legal issues for a personalized medicine. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:138-151. [PMID: 33298378 DOI: 10.1016/j.recot.2020.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/14/2020] [Indexed: 12/16/2022] Open
Abstract
3D printing (I3D) is an additive manufacturing technology with a growing interest in medicine and especially in the specialty of orthopaedic surgery and traumatology. There are numerous applications that add value to the personalised treatment of patients: advanced preoperative planning, surgeries with specific tools for each patient, customised orthotic treatments, personalised implants or prostheses and innovative development in the field of bone and cartilage tissue engineering. This paper provides an update on the role that the orthopaedic surgeon and traumatologist plays as a user and prescriber of this technology and a review of the stages required for the correct integration of I3D into the hospital care flow, from the necessary resources to the current legal recommendations.
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Affiliation(s)
- P Andrés-Cano
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - J A Calvo-Haro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - F Fillat-Gomà
- Unidad de Planificación Quirúrgica 3D, Departamento de Cirugía Ortopédica y Traumatología, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - I Andrés-Cano
- Departamento de Radiodiagnóstico Hospital Universitario Puerta del Mar, Cádiz, España
| | - R Perez-Mañanes
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Chae DS, Kim DH, Kang KY, Kim DY, Park SW, Park SJ, Kim JH. The functional effect of 3D-printing individualized orthosis for patients with peripheral nerve injuries: Three case reports. Medicine (Baltimore) 2020; 99:e19791. [PMID: 32311991 PMCID: PMC7440222 DOI: 10.1097/md.0000000000019791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE In the medical field, the use of 3-dimensional (3D) printing is increasing explosively and it is especially widespread in the clinical application of fabricating orthosis. Advantages of 3D-printed orthosis compared to conventional ones include its lower cost, easier modification, and faster fabrication. The 3D-printing technique makes it possible for physicians to easily create individual-tailored products. Recently, many kinds of orthosis through 3D printing have been studied and used. The knee orthosis, ankle-foot orthosis, wrist orthosis, hand orthosis, and foot orthotics are examples used in the rehabilitation fields of orthotics. We reported 3 cases of 3D-printed orthoses in patients with peripheral nerve injuries. PATIENTS CONCERNS In spite of the rapid development of the clinical use of 3D printing, to our knowledge, its application to patients with peripheral nerve injuries has not yet been reported. Two patients suffered from upper limb problems and 1 patient had a foot drop associated with peripheral nerve injury. DIAGNOSIS Three patients diagnosed with median neuropathy, ulnar neuropathy, and right lower lumbar radiculopathy, respectively, by electromyography. INTERVENTIONS Herein we present 3 case reports of patients with peripheral nerve injuries whose orthotic needs were fulfilled with the application of 3D-printed wrist orthosis and ankle-foot orthosis. OUTCOMES For hand function evaluation, we assessed the Jebsen-Taylor hand function test. Grasp and pinch powers were assessed by a hand dynamometer before and after orthosis application. For lower limb functional evaluation, we used a 6-minute walking test and modified Emory Functional Ambulation Profile for ambulatory function. LESSONS The 3D-printed orthosis could help functional improvement in patients with peripheral nerve injuries.
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Affiliation(s)
| | - Da-Ham Kim
- Department of Physical Medicine and Rehabilitation, Catholic Kwandong University International St Mary's Hospital, Incheon
| | | | - Doo-Young Kim
- Department of Physical Medicine and Rehabilitation, Catholic Kwandong University International St Mary's Hospital, Incheon
| | - Si-Woon Park
- Department of Physical Medicine and Rehabilitation, Catholic Kwandong University International St Mary's Hospital, Incheon
| | - Sung-Jun Park
- 3D Printing Center, Korea National University of Transportation, Chungju-si, Chungbuk, Republic of Korea
| | - Jae-Hyung Kim
- Department of Physical Medicine and Rehabilitation, Catholic Kwandong University International St Mary's Hospital, Incheon
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Schmitz C, Mori YT, Remigio Gamba H, Nohama P, de Souza MA. Development and Evaluation of a Customized Wrist-Hand Orthosis using 3D Technology for a Child with Cerebral Palsy - A Case Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1476-1479. [PMID: 31946172 DOI: 10.1109/embc.2019.8857327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cerebral Palsy (CP) is a disability that affects more than 100 million children. More than 60% of these children have significant difficulties within their hand abilities, affected by involuntary movements and spasticity. So, to overcome this issue, orthoses are being employed as therapeutic intervention and can allow children with CP to have an opportunity to better use their hands. Three-dimensional (3D) technologies provide the generation of high-quality orthopedic products. Although, there are limited studies related to the evaluation of such assistive devices, especially for children. Therefore, the purpose of this research was to design, develop and evaluate a customized wrist-hand orthosis using 3D technologies for a child with CP. So, it was used a high-level 3D scanning to acquire the wrist-hand anatomy, a free software for 3D modelling and a low-cost 3D printer for manufacturing the orthosis. The Jebsen-Taylor Test of Hand Function (JTTHF) was used to evaluate unilateral hand abilities. We noticed improvements while wearing the orthosis at the affected hand, in the following subtests: writing (13 s), lifting small objects (0.9 s) and simulated feeding (69.3 s). The customized orthosis was able not only to improve some functional hand skills, but also to provide comfort, better fitting and with an appealing aesthetic design.
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Zheng Y, Liu G, Yu L, Wang Y, Fang Y, Shen Y, Huang X, Qiao L, Yang J, Zhang Y, Hua Z. Effects of a 3D-printed orthosis compared to a low-temperature thermoplastic plate orthosis on wrist flexor spasticity in chronic hemiparetic stroke patients: a randomized controlled trial. Clin Rehabil 2019; 34:194-204. [PMID: 31686529 DOI: 10.1177/0269215519885174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this study was to compare the effects of two kinds of wrist-hand orthosis on wrist flexor spasticity in chronic stroke patients. Design: This is a randomized controlled trial. Setting: The study was conducted in a rehabilitation center. Participants: A total of 40 chronic hemiparetic stroke patients with wrist flexor spasticity were involved in the study. Interventions: Patients were randomly assigned to either an experimental group (conventional rehabilitation therapy + 3D-printed orthosis, 20 patients) or a control group (conventional rehabilitation therapy + low-temperature thermoplastic plate orthosis, 20 patients). The time of wearing orthosis was about 4–8 hours per day for six weeks. Main measures: Primary outcome measure: Modified Ashworth Scale was assessed three times (at baseline, three weeks, and six weeks). Secondary outcome measures: passive range of motion, Fugl-Meyer Assessment score, visual analogue scale score, and the swelling score were assessed twice (at baseline and six weeks). The subjective feeling score was assessed at six weeks. Results: No significant difference was found between the two groups in the change of Modified Ashworth Scale scores at three weeks (15% versus 25%, P = 0.496). At six weeks, the Modified Ashworth Scale scores (65% versus 30%, P = 0.02), passive range of wrist extension ( P < 0.001), ulnar deviation ( P = 0.028), Fugl-Meyer Assessment scores ( P < 0.001), and swelling scores ( P < 0.001) showed significant changes between the experimental group and the control group. No significant difference was found between the two groups in the change of visual analogue scale scores ( P = 0.637) and the subjective feeling scores ( P = 0.243). Conclusion: 3D-printed orthosis showed greater changes than low-temperature thermoplastic plate orthosis in reducing spasticity and swelling, improving motor function of the wrist and passive range of wrist extension for stroke patients.
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Affiliation(s)
- Yanan Zheng
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Gongliang Liu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yanmin Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yuan Fang
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Yikang Shen
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Xiuling Huang
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Lei Qiao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jianzhong Yang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Zikai Hua
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
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Manocha RHK, Johnson JA, King GJW. The Effectiveness of a Hinged Elbow Orthosis in Medial Collateral Ligament Injuries: An In Vitro Biomechanical Study. Am J Sports Med 2019; 47:2827-2835. [PMID: 31461303 DOI: 10.1177/0363546519870517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial collateral ligament (MCL) injuries are common after elbow trauma and in overhead throwing athletes. A hinged elbow orthosis (HEO) is often used to protect the elbow from valgus stress early after injury and during early return to play. However, there is minimal evidence regarding the efficacy of these orthoses in controlling instability and their influence on long-term clinical outcomes. PURPOSE (1) To quantify the effect of an HEO on elbow stability after simulated MCL injury. (2) To determine whether arm position, forearm rotation, and muscle activation influence the effectiveness of an HEO. STUDY DESIGN Controlled laboratory study. METHODS Seven cadaveric upper extremity specimens were tested in a custom simulator that enabled elbow motion via computer-controlled actuators and motors attached to relevant tendons. Specimens were examined in 2 arm positions (dependent, valgus) and 2 forearm positions (pronation, supination) during passive and simulated active elbow flexion while unbraced and then while braced with an HEO. Testing was performed in intact elbows and repeated after simulated MCL injury. An electromagnetic tracking device measured valgus angulation as an indicator of elbow stability. RESULTS When the arm was dependent, the HEO increased valgus angle with the forearm in pronation (+1.0°± 0.2°, P = .003) and supination (+1.5°± 0.0°, P = .006) during active motion. It had no significant effect on elbow stability during passive motion. In the valgus position, the HEO had no effect on elbow stability during passive or active motion in pronation and supination. With the arm in the valgus position with the HEO, muscle activation reduced instability during pronation (-10.3°± 2.5°, P = .006) but not supination (P = .61). CONCLUSION In this in vitro study, this HEO did not enhance mechanical stability when the arm was in the valgus and dependent positions after MCL injury. CLINICAL RELEVANCE After MCL injury, an HEO likely does not provide mechanical elbow stability during rehabilitative exercises or when the elbow is subjected to valgus stress such as occurs during throwing.
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Affiliation(s)
- Ranita H K Manocha
- Section of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Roth-McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
| | - James A Johnson
- Roth-McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
| | - Graham J W King
- Roth-McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
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