APRIL 2022 | The Surgical Technologist | 163 representation of the anatomy in 3D space.15,16 When more than 100 orthopaedic surgeons were asked to choose a locking plate for a complex tibial fracture after looking at radiograph and CT imaging or a 3D-printed model, surgeons classified as inexperienced, having operated on fewer than 15 similar fractures, changed their preoperative plan over 70% of the time after using the 3D model.17 Although experienced surgeons did not change their selection as frequently, more than 70% supported the use of 3D models in their practice if they were available.17 In addition to aiding in hardware selection, 3D models allow for prebending of selected plates before surgery. This technique permits the plate to fit the individual anatomy of patients to facilitate accurate reduction and has shown promise in the treatment of clavicle fractures.18,19 Three-dimensional printed anatomic models have been used in the mirror imaging technique, in which models of the contralateral uninjured side are printed and used in preoperative planning. Surgeons can use the fractured 3Dmodel to simulate their reduction technique and use the uninjured 3D model to optimize plate selection. This technique has been implemented for clavicle fractures, calcaneal fractures, pilon fractures, and ankle fractures with excellent results.20,21 Three-dimensional printed models can be instrumental in medical education. Resident surgeons can develop their technical skills with realistic 3D patient models that illustrate pathologies frequently encountered in the operating room. Trainees who were surveyed regarding the clinical utility of 3D-printed models when planning their surgical approach for percutaneous screw fixation of a posterior column fracture were overall very satisfied, stating that the models deepened their understanding of regional anatomy and the surgical technique.22 Patient education has been augmented with 3D-printed anatomic models and may lead to improved patient perioperative understanding and compliance.16 Despite the growing interest in and use of 3D-printed anatomic models, they are not currently reimbursed by third-party payers; however, the use of these models leads to significantly shorter operating times. At a mean of $62 operating room time per minute, net savings range from $19,384 to $129,589 and $77,536 to $518,358 for lowand high utilization rates, respectively.23 Even at low volumes, approximately 63 models per year, estimated cost savings could potentially cover the costs to maintain a 3D printing laboratory.23 Prosthetics and Orthotics Most braces and orthotics are available only in a limited number of sizes and are designed to fit a large fraction of the population. Although fully customizable prosthetics have proven to be effective, the manufacturing process is complex and adds to the overall cost and time required to make these prosthetics. In contrast, 3D printing has revamped the design and production of ankle-foot orthoses (AFOs). Traditionally, AFOs are made from plaster castings of a patient’s lower extremities, a labor-intensive and costly process that Figure 1 Basic steps of three-dimensional (3D) printing for medical applications. STL = standard triangle language. Figure 2 Steps of powder bed fusion from left to right. A layer of titanium powder (gray) is deposited on the printbed. A thermal energy source uses a beam of energy (red) to selectively fuse titanium powder according to data in the design file. The printbed lowers, and a new layer of titanium powder is deposited. The process repeats until the object or objects are completely printed. Journal of the AAOS Global Research & Reviews® ----- April 2021, Vol 5, No 4 ----- © American Academy of Orthopaedic Surgeons 3 Review Article Colleen M. Wixted, BS, et al
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