An alternative to plaster cast treatment in a pediatric trauma center using the CAD/CAM technology to manufacture customized three-dimensional-printed orthoses in a totally hospital context: a feasibility study

Abstract

The aim of this study is to implement the clinical use of the three-dimensional (3D) design and printing technology in pediatric pathologies requiring immobilization. We describe the manufacturing process of the 3D device in place of the plaster cast usually applied to a child 48/72 h after the access to the Trauma Center Traumatology Hub. This procedure had already been performed at Level II, Trauma Center, Campania Region, Orthopaedic Division of Santobono Children’s Hospital, Naples, Italy. The operative phase was performed by two 3D printers and a scanner in the bioengineering laboratory of the hospital’s outpatient area. The phase of software elaboration requires close cooperation among physicians and engineers. We decided to use a model with a double-shell design and holes varying in width to ensure complete ventilation and lightness of the device. We chose to treat nondisplaced metaphyseal distal fractures of the radius in 18 patients enrolled from January 2017 to November 2017. The flow chart includes clinical and radiological examinations of every enrolled child, collecting information required by the program and its elaboration by bioengineers, and then transfer of the results to 3D printers. The child, immobilized by a temporary splint, wore his 3D device after 12/24 h. Then, he underwent serial check-ups in which the effectiveness and appropriateness of the treatment were clinically monitored and evaluated using subjective scales: visual analogue scale and patient-rated wrist evaluation. All the fractures consolidated both radiologically and clinically after the treatment, with no complications reported. Only one partial breakage of the device happened because of an accidental fall. The statistical analysis of the visual analogue scale and patient-rated wrist evaluation data shows that children’s activities of everyday life improved during the immobilization thanks to this treatment. This first study shows that using a 3D device instead of a traditional plaster cast can be an effective alternative approach in the treatment of pediatric nondisplaced metaphyseal distal radius fractures, with high overall patient satisfaction. We believe that 3D technology could be extended to the treatment of more complex fractures; this will be the subject of our second study.

Anatomic three-dimensional model-assisted surgical planning for treatment of pediatric hip dislocation due to osteomyelitis

“…One study published in 2019 evaluated the clinical use of 3D printing in pediatric fractures requiring immobilization. 8 Eighteen children wore their 3D devices in 12 to 24 h. The results of the study indicated that the use of a 3D device instead of a traditional plaster cast can be an effective treatment of pediatric nondisplaced metaphyseal distal radius fractures, with high overall patient satisfaction. 8 We believe that 3D technology could be extended to the treatment of more complex fractures in the future.…”

“…8 Eighteen children wore their 3D devices in 12 to 24 h. The results of the study indicated that the use of a 3D device instead of a traditional plaster cast can be an effective treatment of pediatric nondisplaced metaphyseal distal radius fractures, with high overall patient satisfaction. 8 We believe that 3D technology could be extended to the treatment of more complex fractures in the future. One systemic review published in 2019 introduced software systems that calculate the deformity parameters for external fixation to treat leg length discrepancies with concomitant angular and/or rotational deformities.…”

An industrial oriented workflow for 3D printed, patient specific orthopedic cast

“…Patient satisfaction using plaster cast is poor [1] due to the physical characteristics of this old medical device. To overcome this drawback, the use of computeraided design (CAD) and 3D printing technology to produce personalized plastic casts, have been largely proposed [1][2][3][4][5] increasing the public awareness in the clinical use of these low cost and widely available technologies.…”

“…Previous studies have demonstrated the feasibility of the clinical use of orthopaedic personalized 3D printed cast for the treatment of forearm fractures in paediatric patients [5]. Thus, in daily clinical activities, it is necessary to implement a production phase compliant with time required by clinical course, less than 24/36 h from trauma.…”

Fast production of customized three-dimensional-printed hand splints

“…Regarding the clinical assessment of 3D-printed splints, two references were found that compare medical results of traditional vs 3D-printed splints (Chen et al , 2017; Guida et al , 2019). Other research studies, such as Li and Tanaka (2018a) and Paterson et al (2014) are focused on analyzing the feasibility of using dedicated CAD applications for the splint design process.…”