| The Surgical Technologist | JUNE 2022 270 the patient’s assessment of the procedure. Nevertheless, there are some challenges like the use of more realistic materials, the model’s reusability, and the accessibility of this technology in different institutions to overcome the high costs related (Figure 8). Therefore, more surgeons could use 3DP in everyday practice [223, 224]. Many believe that the future of 3DP technology in the urological field consists of building tissue scaffolds with functionality that can grow organs via biofabrication [206, 209, 225]. However, further studies are needed to assess the feasibility of these advances. 3.5. Musculoskeletal System 3.5.1. Upper Extremities. As the 3DP revolution unravels in the healthcare field, orthopaedical specific applications are becoming increasingly popular due to the versatility in creating patient-specific components [227]. 3DP enables the next level of personalized patient care by creating custom instruments and hardware [39]. This section will examine the current literature on 3D-printed orthopaedic tools for patientspecific upper extremity malunion correction, primary fracture fixation, surgeon instrumentation and preoperative planning models, and total shoulder prosthesis (Figure 9). Upper extremity osteotomies are commonly performed to restore anatomical alignment after bony deformity or malunions secondary to trauma [228]. For example, in the pediatric population, 3DP guides for correctional osteotomies for both-bone forearm fractures have been proven advantageous. In a case series out of Osaka, Japan, 20 patients with symptomatic malunited forearm fractures treated with 3D-printed osteotomy guided osteotomies had an improved average forearm arc range of motion and grip strength from 76 to 152 degrees and from 82% to 94%, respectively, compared to the unaffected side [229]. A different case series conducted in Shrined Hospital seven patients with forearm malunion treated with osteotomy with 3Dprinted correctional guides had improved forearm supination and pronation by 25 degrees and total rotation greater than 120 degrees [230]. As seen in the aforementioned studies, the implementation of 3D-printed osteotomy guides for forearm fracture malunions can improve range of motion. The utilization of 3D-printed guides and plates for primary fracture fixation has been explored for scaphoid and distal radius. In the case of scaphoid fractures, historically, high rates avascular necrosis has urged researchers to investigate the benefits of 3DP for achieving anatomical reduction [231]. In a study by Schweizer et al., 22 patients for scaphoid fixation for nonunion with and without 3D-printed patientspecific guides for fracture reduction, authors found that the patient-specific guide group achieved a more accurate (a) (b) (c) Figure 8: Pyeloplasty is a surgical procedure performed in cases of ureteropelvic junction (UPJ) obstruction. (a)–(c) For surgical training, the 3D-printed models are placed within laparoscopic consoles to recreate and performed the pyeloplasty procedure [226]. Used with permission from Elsevier. (a) (b) (c) (d) Figure 9: Computer-assisted preoperative planning of a scaphoid fracture. (a, b) Green: scaphoid and lunate bones of the hand. Light blue: proximal scaphoid fragment. Violet: distal scaphoid fragment. (a) Scaphoid fragments before the reduction. (b) Scaphoid fragments after the reduction. (c, d) 3D-printed K-wires are placed in to reduce the two scaphoid fragments in order to have a better sealing of the bone [232]. Used with permission from Elsevier. 14 BioMed Research International
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