Overview of In-Hospital 3D Printing and Practical Applications in Hand Surgery

Marco Keller, Alissa Guebeli, Florian Thieringer, Philipp Honigmann, Marco Keller, Alissa Guebeli, Florian Thieringer, Philipp Honigmann

Abstract

Three-dimensional (3D) printing is spreading in hand surgery. There is an increasing number of practical applications like the training of junior hand surgeons, patient education, preoperative planning, and 3D printing of customized casts, customized surgical guides, implants, and prostheses. Some high-quality studies highlight the value for surgeons, but there is still a lack of high-level evidence for improved clinical endpoints and hence actual impact on the patient's outcome. This article provides an overview over the latest applications of 3D printing in hand surgery and practical experience of implementing them into daily clinical routine.

Conflict of interest statement

The senior author has an honorary-based consultant function at the company Medartis AG, Basel, Switzerland. Our research group is supported by the company Spentys© (Spentys SA/NV, Brussels, BE) with printing materials and technical support.

Copyright © 2021 Marco Keller et al.

Figures

Figure 1
Figure 1
1 : 1 model based on 3D-Computertomography (CT) data of the carpal bones printed on an FDM-printer. This model allows analysis of intracarpal relationships und surgical training.
Figure 2
Figure 2
(a–d) 3D-printed 1 : 1 model of a displaced, multifragmentary, intra-articular fracture of the proximal part of the first metacarpal bone. The model was used to educate the patient about possible surgical treatment options and for preoperative planning.
Figure 3
Figure 3
(a) Dorsopalmar radiographic view of a displaced, multifragmentary, intra-articular fracture of the distal radius, and ulna of a 45-year-old female. (b, c) Coronar view of the 3D-CT reconstruction and the equivalent view on the 3D-printed Polypropylene-model. (d, e) Sagittal view (radial aspect) of the 3D-CT reconstruction and the equivalent view on the 3D-printed Polypropylene-model. (f, g) Sagittal view (ulnar aspect) of the 3D-CT reconstruction and the equivalent view on the 3D-printed Polypropylene-model. (h, i) Axial CT-projection and the equivalent view on the 3D-printed Polypropylene-model allowing an overview on the intra-articular key fragments of the distal radius fracture.
Figure 4
Figure 4
(a, b) 3D-scanning of the injured forearm using a tablet with an optical sensor (“Spentys© Point-of-Care Solution”, Spentys SA/NV, Brussel, BE). (c) Virtual adjustment of the wrist position if necessary (d, e) Designing of the forearm cast (“Polycast©” [Spentys SA/NV, Brussels, BE]) and generating an STL-file. (f) In-hospital, overnight printing using an FDM-printer with Polypropylene- (PP-) filament. (g) Fitted customized forearm-cast with ventilation openings and Velcro-Fasteners.
Figure 5
Figure 5
(a, b) Patient-specific 3D-printed partial joint replacement made of titanium (Xilloc Medical B.V., Sittard-Geleen, ND). (c) The shaft was designed with porous surface to enable osteointegration. (d) Lateral radiographic view of the finger after implantation of the patient-specific implant fitting precisely to the bone defect.
Figure 6
Figure 6
(a–c) “Flexy Hand 2”, a 3D-printed open source hand prosthesis (http://enablingthefuture.org/upper-limb-prosthetics/the-flexy-hand/).

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Source: PubMed

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