Tobler-Ammann Bernadette, Schuind Frédéric, Voillat Loïc, Gentilhomme Théophile, Vögelin Esther, Murith Noé, Masserey Bernard
Department of Orthopaedic, Plastic and Hand Surgery, Inselspital Bern, University of Bern, Bern, Switzerland.
Department of Orthopaedics and Surgery, Université Libre de Bruxelles, Brussels, Belgium.
J Wrist Surg. 2024 Feb 2;13(5):390-397. doi: 10.1055/s-0044-1779053. eCollection 2024 Oct.
The purpose of this study is to optimize conservative treatment of distal radius and scaphoid fracture, in terms of comfort, fracture stabilization, and prevention of cast complications. Advances in additive manufacturing have allowed the development of patient-specific anatomical braces (PSABs) which have the potential to fulfill this purpose. Our specific aims were to develop a model of PSAB, adapted to fracture care, to evaluate if this brace would be well tolerated by healthy volunteers and to determine its mechanical properties as compared with conventional methods of wrist immobilization. Several three-dimensional-printed splint prototypes were designed by mechanical engineers based on surgeons' and hand therapists' clinical expertise. These experimental braces underwent testing in a preclinical study involving 10 healthy volunteers, assessing comfort, satisfaction, and activities. The final prototype was mechanically compared with a conventional cast and a prefabricated splint, testing different closing systems. A mathematical algorithm was created to automatically adapt the final PSAB model to the patient's anatomy. The final prototype achieved an overall satisfaction score of 79%, weighing less than 90 g, made from polyamide, and fixed using hook and loop straps. The PSAB stiffness varied between 0.64 and 0.99 Nm/degree, surpassing the performance of both conventional plaster casts and prefabricated splints. The final wrist PSAB model, adapted for fracture treatment, is lightweight, comfortable, and provides anatomical contention. It is currently being tested for the treatment of stable distal radius and scaphoid fractures in comparison to conventional plaster cast.
本研究的目的是在舒适度、骨折固定以及预防石膏并发症方面优化桡骨远端和舟骨骨折的保守治疗。增材制造技术的进步使得定制解剖型支具（PSABs）得以开发，其有潜力实现这一目的。我们的具体目标是开发一种适用于骨折护理的PSAB模型，评估健康志愿者对这种支具的耐受性，并与传统的手腕固定方法相比，确定其力学性能。机械工程师根据外科医生和手部治疗师的临床专业知识设计了几个三维打印的夹板原型。这些实验性支具在一项涉及10名健康志愿者的临床前研究中进行了测试，评估舒适度、满意度和活动情况。将最终原型与传统石膏和预制夹板进行力学比较，测试不同的闭合系统。创建了一种数学算法，以使最终的PSAB模型自动适应患者的解剖结构。最终原型的总体满意度得分为79%，重量小于90克，由聚酰胺制成，使用钩环带固定。PSAB的刚度在0.64至0.99 Nm/度之间变化，超过了传统石膏绷带和预制夹板的性能。最终的手腕PSAB模型适用于骨折治疗，重量轻、舒适度高，并提供解剖学支撑。目前正在与传统石膏绷带对比，测试其对稳定型桡骨远端和舟骨骨折的治疗效果。
