The use of 3D printing is widely increasing, from the film industry to architecture. It is no surprise to also find its purpose in medicine, and not just in cosmetic surgeries or prosthetics. The use of 3D printing is now being researched in trauma hospitals as well, where speed and on time reaction is everything when fighting for patient’s life.
Mike Belman, MD is one of the trauma surgeons at the ETZ (Elisabeth-TweeSteden Ziekenhuis); a trauma center in the Netherlands whose surgeons are on call 24/7. In 2016, Mike and his colleagues Lars Brouwers (MD, PhD-candidate), and Koen Lansink (MD, trauma surgeon), have started to research the advantages and efficiency of 3D printing in their field.
The idea was to 3D print the scans of bone fractures. The printed models would be easily perceivable by both patient and surgeon and would give a better understanding of the situation even before the surgery.
We know it is very hard to understand the fracture patterns of complex fractures by using only 2DCT or X-ray. We started to print with the Ultimaker. Our goal was to investigate if 3D printing can be of added value in classifying acetabular fractures.
The 3D structure allows surgeons not only to see the fractures up close but to feel it and inspect it more thoroughly, especially when rotating it in their hands. This process helps tremendously with surgical planning.
In emergency hospitals, all of the work needs to be completed rapidly. Within half an hour from the patient’s arrival in the hospital, the 3D printer is already up and running.
Foremost, the CT-scan and X-ray are conducted. From collected information, the 3D representation of the fracture is being made. 3D printed models are finished and in surgeons hands within 24 hours from patient’s arrival in the hospital.
PVA is being used as a material of choice. Not only it is water soluble, but its properties allow it to mold into very detailed complex organic geometries with small cavities.
The research showed that this innovative work could help surgeons by enabling them to have a better understanding of the situation in a patient’s body and ease the assessment for the suitable operation.
A measure of agreement between doctors on treatment is called Kappa score, and it usually depends on the classification of a wound, fracture or the patient’s condition.
Kappa score can value from 0 to 1, where 0 means no agreement and 1 means total agreement. A good agreement is somewhere between 0.7 and 0.8 Kappa.
When given data only from X-rax and 2DCT the students, as well as experienced surgeons, scored no more than 0.2 Kappa. But with the use of 3D printed models, they reached almost 0.7.
It is needless to point out that 3D printing has innumerable benefits for both the surgeon and the patient. For the patient, it is so much easier to understand what is going on in his body with real tangible model and for the doctor is that much easier to explain the surgical procedure than with 2D models. It also makes classification more precise facilitating the choice of a suitable treatment.
We hope that we can prove that 3D printing can be of added value in patient satisfaction, in surgical satisfaction, in reduction of operation time and in the health-related quality of life for the patient because that is the most important thing.