In-hospital production of 3D-printed casts for non-displaced wrist and hand fractures

Abstract

Objectives: To examine the clinical feasibility and results of a multidisciplinary workflow, employing rapid three-dimensional (3D) scanning and modeling software along with a high-speed printer, for in-hospital production of patient-specific 3D-printed casts, for the treatment of non-displaced wrist and hand fractures.

Methods: Consenting adult patients admitted to the emergency department (ED) due to wrist or hand fractures between January and February 2021 were prospectively enrolled. The study participants underwent conversion of the standard plaster of Paris cast to a 3D-printed cast one week after the ED visit, and follow-up examinations were performed around two, six, and twelve weeks later. The primary objective was to examine the clinical feasibility in terms of complexity and length of the overall procedure. Secondary outcomes were patient-reported impressions and radiological results.

Results: Twenty patients (16 males, mean age 37 ± 13.1 years) were included. The entire printing workflow took a mean of 161 ± 8 min. All patients demonstrated clinical improvement and fracture union at final follow-up, with no pressure sores or loss of reduction. Patient-reported comfort and satisfaction rates were excellent. The mean Visual Analog Scale was 0.9 ± 1.1 and 0.6 ± 1, and the mean Disabilities of the Arm, Shoulder, and Hand score was 18.7 ± 9.5 and 7.6 ± 7.6 at 2 and 6 weeks after application of the 3D-printed cast, respectively.

Conclusion: The in-hospital workflow was feasible and efficient, with excellent clinical and radiographic results and high patient satisfaction and comfort rates. Our medical center now routinely provides this cast option for non-displaced wrist and hand fractures.

Level of evidence: IV, Therapeutic Study.

Keywords: 3-D printing; Digital Light Processing; Hand fractures; Patient-reported Outcomes; Wrist fracture.

Figure 1

DLP printing: a vertically moving building platform in a tank filled with photosensitive resin, polymerized layer-by-layer by exposure to light (A). Simultaneous printing of two casts (B). With ideal configuration, it is possible to print up to four casts at once without extending the printing time. DLP: digital light processing.

Figure 2

Post-processing of the 3D-printed cast. The cast is placed in a vacuum chamber and exposed to ultraviolet light to verify that all the resin has been cured.

Figure 3

3D-printed thumb spica cast for the treatment of non-displaced scaphoid fracture.

Figure 4

Radiographs demonstrating a radial styloid fracture of the right wrist at presentation to the emergency department. (A). Radiograph at the 6-week follow-up with the 3D-printed cast. Note that the fracture is not concealed, thus allowing for ideal follow-up. (B) Radiograph at 3 months showing union of the fracture with no loss of reduction. (C)