Affordable and reliable three-dimensional printing: a prospective study of seven distal radius fractures

Abstract

Purpose: Three-dimensional (3D) printing is now widely available, and its potential applications to surgery are limitless. However, 3D printing is presently performed at only a few large institutions. We developed a 3D printing workflow using an affordable 3D printer and open-source 3D printing software. We tested whether this combination could produce a model that reliably reflects real bone. Methods: We performed a prospective study with a target sample size of seven. Patients with distal radius fractures were enrolled from October 2021 to February 2022. The 3D-printed models of the fractures were produced using open-source software (3D Slicer [Surgical Planning Laboratory, Harvard Medical School] and Cura [Ultimaker]) and a $600 printer. The anterior-to-posterior (AP) and radial-to-ulnar (RU) widths of the fracture sites were measured on computed tomography (CT) images, in 3D printed models, and in real bones (during surgery). Surgery was simulated using the 3D models; the locations and profiles of implants were compared to those placed during real surgery, which was performed without simulation data.Results: The fracture AP and RU widths did not differ significantly among the CT, 3D model, and real bone measurements. Interclass correlation coefficients indicated that the measurements were reliable (0.943 [p<0.001] and 0.917 [p<0.001], respectively). When the implant profiles of the simulations and surgical procedures were compared, only the most distal (radial) screws were significantly longer in the simulations (p=0.016). The plate location also differed significantly (p=0.043). Conclusions: Our 3D printing workflow is affordable yet produces reliable bone models.