Arch Hand Microsurg.  2023 Dec;28(4):226-232. 10.12790/ahm.23.0018.

Affordable and reliable three-dimensional printing: a prospective study of seven distal radius fractures

• Lee JH
• Kim MB

• KMID: 2548593
• DOI: http://doi.org/10.12790/ahm.23.0018

Abstract

Purpose
Three-dimensional (3D) printing is now widely available, and its potential applications to surgery are limitless. However, 3D printing is presently performed at only a few large institutions. We developed a 3D printing workflow using an affordable 3D printer and open-source 3D printing software. We tested whether this combination could produce a model that reliably reflects real bone.
Methods
We performed a prospective study with a target sample size of seven. Patients with distal radius fractures were enrolled from October 2021 to February 2022. The 3D-printed models of the fractures were produced using open-source software (3D Slicer [Surgical Planning Laboratory, Harvard Medical School] and Cura [Ultimaker]) and a $600 printer. The anterior-to-posterior (AP) and radial-to-ulnar (RU) widths of the fracture sites were measured on computed tomography (CT) images, in 3D printed models, and in real bones (during surgery). Surgery was simulated using the 3D models; the locations and profiles of implants were compared to those placed during real surgery, which was performed without simulation data.
Results
The fracture AP and RU widths did not differ significantly among the CT, 3D model, and real bone measurements. Interclass correlation coefficients indicated that the measurements were reliable (0.943 [p<0.001] and 0.917 [p<0.001], respectively). When the implant profiles of the simulations and surgical procedures were compared, only the most distal (radial) screws were significantly longer in the simulations (p=0.016). The plate location also differed significantly (p=0.043).
Conclusions
Our 3D printing workflow is affordable yet produces reliable bone models.

Keyword

Three-dimensional printing; Distal radius fracture; 3D Slicer

Figure

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  Fig. 1. Transformation of computed tomography (CT) DICOM to stereolithography images. (A, C, and D) Axial, coronal, and sagittal CT DICOM images. (B) The volumetric reconstructions are shown when only the osseous portions (green) were selected. DICOM, Digital Imaging and Communications in Medicine.

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  Fig. 2. Schematic showing how DICOM data were converted into stereolithography (STL) and geometric-code (G-code) data, and finally represented in a three-dimensional (3D)-printed model. DICOM, Digital Imaging and Communications in Medicine.

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  Fig. 3. Measurement of the anterior-to-posterior (AP) and radial-to-ulnar (RU) widths of fracture sites. (A) On computed tomography (CT) images, an axial cut at the fracture site is selected, and AP and RU widths between the farthest cortices were measured. (B) On three-dimensional (3D) printed models, the corresponding AP and RU widths were measured using a digital caliper. In this figure, measurement of AP width was captured. (C) On real bones during surgery, after the periosteal dissection at the fracture site, corresponding measurements were made. In this figure, the measurement of AP width was also captured.

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  Fig. 4. Number annotation for plate and screws. (A) The plate location was estimated by measuring three distances: the distance from the radial margin of the fracture to the middle radial k-wire hole; the distance from the radial margin of the fracture to the distal radial Kirschner wire (K-wire) hole; and the distance from the radial margin of the fracture to the proximal K-wire hole. (B) When recording screw sizes, the numbering started from the most radial (distal) hole during both simulations and surgical procedures.

Reference

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