These 3D printed models accurately simulate bone length and diameter, external contour, cross-sectional shape, bicortical anatomy, cortical hardness, cancellous bone porosity, and microstructure, and far cortex thickness for adult, non-obese males at left tibial shaft fracture pin drilling sites for modular external fixation.[1][2][3][4][5][6][7][8][9][10] These models feature a semi-engraved model number, gender symbol, and drilling direction arrows on the base of each model to assist with model identification and proper orientation. Each model has a vise attachment to allow the user to secure the model inside a standard vise clamp to maximize safety during simulation training. When a model is placed inside a standard vise clamp, the bone model will be properly positioned to simulate a patient in the supine position. These open-source, locally reproducible, and high fidelity 3D printed bone models teach essential irrigation and debridement, powered and manual drilling, and modular external fixation skills that are transferable to the performance of other limb-saving and life-saving surgeries that require hardware stabilization and fixation.[11]
Find Local 3D Print On Demand Services[edit | edit source]
On-site access to a 3D printer is not required to reproduce these bone models. The open-source 3D files can be downloaded by any 3D printing organization anywhere. Please go to this link to follow step-by-step instructions on how to find 3D print on demand services in your region.
On-Site or Remote Access to a 3D Printer[edit | edit source]
All the 3D printed models print support-free and are designed to be made on any fused filament fabrication 3D printer that has a build volume Z height of 200 mm or more (at 100% scale) or a minimum build volume Z height of 180 mm (less than 100% scale).
- If you have on-site access to a fused filament fabrication 3D printer with a minimum build volume Z height of 180 mm, you can load the 3D files (.STL) into the printer's slicer program, go into the advanced settings in the slicer program to input the customized print settings to create the print file (.GCODE) for your 3D printer.
- If you don't have a 3D printer on-site but can access a remotely connected fused filament fabrication 3D printer with a minimum build volume Z height of 180 mm, you can use the following open-source remote 3D printing software programs to load the 3D files (.STL), input the customized print settings, and electronically send the print file (.GCODE) to a local, networked and supported 3D printer:
3D Printer Build Volume Z Height Requirements[edit | edit source]
Print at 100% Scale with a Build Volume Z Height of 200 mm or Higher[edit | edit source]
All the 3D printed models print support-free and are designed to be made at 100% scale on any single or multi-extruder, fused filament fabrication 3D printer with a build volume Z height of 200 mm or more.
These include but are not limited to the following commercially available 3D printers:
- Creality Ender 3 ($189 USD)[12]
- Prusa i3MK3S ($999 USD)[13]
- LulzBot TAZ SideKick 747 ($1,285 USD)[14]
- Ultimaker 2+ Connect ($2,750 USD)[15][16]
- Lulzbot TAZ Workhorse ($2,950 USD)[17]
- FlashForge Creator 3 ($2,999 USD)[18][19]
- LulzBot TAZ Pro S ($3,995 USD)[20]
- LulzBot TAZ Pro ($4,950 USD)[21]
- LulzBot TAZ Pro XT ($5,495 USD)[22]
- Ultimaker S5 ($6,950 USD)[16][23]
- Ultimaker S5 Pro Bundle System ($11,369 USD)[16][24][25]
- Ultimaker 2+ Extended (discontinued as of October 6, 2021)[26][27]
Print at Less than 100% Scale with a Build Volume Z Height of 180 mm to 200 mm[edit | edit source]
If the 3D printer has a maximum build volume Z height between ~180 mm to 200 mm, the 3D Printed Adult Male Tibial Bone Models must be uniformly rescaled to be printed at less than 100% scale. For example, the Ultimaker S3 3D Printer has a maximum build volume Z height of 200 mm and can manufacture the 3D Printed Adult Male Tibial Bone Models at 95% scale.
These include but are not limited to the following open-source, open filament 3D printers:
- Prusa Mini ($349-$399 USD)[28]
- LulzBot TAZ SideKick 289 ($1,085 USD)[29]
- LulzBot Mini 2 ($1,495 USD)[30]
- Ultimaker S3 ($4,450 USD)[16][31]
- Ultimaker 3 (discontinued as of spring of 2020)[32]
- Prusa MK2/S
The average maximum length of the left tibial bone from a Nigerian population is 40.80 ± 3.91 cm (mean ± standard deviation) with minimum and maximum values of 34.60 cm to 56.0 cm.[33] Our Team Lead recommends scaling each Adult Tibial Bone Model to no smaller than 18.0 cm (180 mm) for a total tibial bone length of 36.0 cm (360 mm). Therefore, a fused filament fabrication 3D printer that has a maximum build volume Z height of ~180 mm or more can be used to manufacture the 3D Printed Adult Male Tibial Bone Models.
Filament Requirements[edit | edit source]
Orthopedic surgical simulation training requires using bone models with visual, tactile, and acoustic fidelity. Please do not change the filament material and colour and do not revise the print settings because they have been pre-tested by our designers to ensure the fidelity of our gender-specific models.
White Polylactic Acid Filament[edit | edit source]
These 3D printed bone models must be digitally manufactured using white polylactic acid (PLA) filament because PLA filament has a hardness value that is very similar to human cortical bone.[4][34][6]
Proper Storage of PLA Filament[edit | edit source]
PLA is a moisture-sensitive material which may become brittle if improperly stored.[35] According to one filament manufacturer, "To check the quality of PLA, try to snap the filament. If the PLA filament snaps easily, it is too brittle for use and should be replaced."
Proper storage of PLA requires storage:
- in a re-sealable bag with the silica gel desiccant provided to minimize moisture uptake
- out of direct sunlight and in a dry and cool location (the optimal storage temperature for PLA is between -20°C to +30°C)
- for a maximum shelf life of 1 year once the filament has been taken out of its original packaging.
Fresh PLA Filament[edit | edit source]
To minimize the risk of mechanical failure of the bone models during orthopedic surgical simulation training, it is highly recommended to use fresh PLA filament just out of its original packaging.
Advance Notice for Large Volume Orders[edit | edit source]
PLA filament is usually imported in low to middle income countries. If you want to order a large number of 3D printed bone models, please notify your local 3D printing organization well in advance to ensure adequate stock of fresh PLA filament will be available.
Optional: Check PLA Filament Technical Data Sheet for Shore Hardness D Value[edit | edit source]
When possible, try to use PLA filament with a Technical Data Sheet confirming that the filament's Shore Hardness D value is within the 3-sigma range (~79D to 93D) for the Shore Hardness D measurements of 86.7D + 1.91D (ave. ± s.d., n=1815) for human cortical bone.[34][6]
Common Problems and Solutions[edit | edit source]
When importing STL files into your slicer program, check that the Z height of each STL is properly scaled in the printer slicer application.
- Model 1: Z height is 202.2127 mm at 100% scale
- Model 2: Z height is 202.2275 mm at 100% scale
- Model 3: (under revision)
To prevent printing failures, it's recommended to use (i) fresh PLA filament just out of its packaging, or (ii) a commercially available filament dryer before printing to remove moisture that may have accumulated in the PLA filament after removal from its packaging.
Before printing, inspect the printer head (extruder). If it requires cleaning, heat up and carefully clean the printer head without touching it directly to avoid thermal injury.
Watch the first several printed layers to ensure proper adhesion of the filament to the print bed.
If the printed object does not adhere to the print bed, check that the printing temperature is around 215 degrees Celsius (or within the specific filament manufacturer's recommended temperature range) and decrease the layer height to 0.2 mm.
If you are using a glass print bed (like the print bed for the Ultimaker S5 3D Printer), you may need to use the manufacturer's recommended adhesion sheet, glue, hairspray or blue painter's tape or add a brim to help ensure the object adheres to the print bed.[36]
Cost Savings[edit | edit source]
These data-driven, gender-specific, easy to print, labor-saving, eco-friendly, hygienic, and cruelty-free bone simulation models are not made with natural rubber latex, are designed with safety features to protect users, and can be locally reproduced to offer the highest fidelity, standardized orthopedic surgical simulation training at the lowest cost.
The costs of the 3D Printed Adult Tibial Bone Models will vary depending on the region's 3D printing organizations, and locally available brands of filament. To help local 3D printing organizations calculate their pricing for 3D printing these bone models, we have provided links to a useful blog article and an online price calculator. In Nigeria, one 750 gram roll of Ultimaker White PLA filament (Shore Hardness 83D) costs €33 Euros which is equal to about 5¢ USD per gram.[4][37]
In 2022, the 3D Printed Adult Male Tibial Bone Models #1 and #2 produced by a local 3D printing business in Nigeria at 95% scale is $11.25 and $10.90 USD (not including local taxes or shipping costs). The estimated filament weight and printing times for the 3D Printed Adult Male Tibial Bone Models #1 and #2 at 95% scale are 190 grams and 147 grams and 8 hours and 5 minutes, and 6 hours and 25 minutes, respectively. In 2021, the 3D Printed Adult Male Tibial Bone Models #1 and #2 produced by a local 3D printing business in Nigeria cost $9.35 and $9.30 USD, respectively.[38] The estimated printing times for the 3D Printed Adult Male Tibial Bone Models #1 and #2 are 9 hours and 46 minutes, and 7 hours and 47 minutes, respectively.
The Tibial Shaft Transverse Fracture Simulator is easy and quick to assemble and does not require any tools, specialized equipment, technical expertise, or time-consuming preparation to build, install, operate and maintain this simulator within the intended place of use. The benefits of 3D printing the Tibial Shaft Transverse Fracture Simulator (3D Printed Adult Tibial Bone Models #1 and #2) locally in Nigeria are that the purchase cost is 2.5 times cheaper and the production time is over 70 times faster than purchasing a comparable artificial bone product that is imported from abroad, and the purchase cost is 7 times cheaper than acquiring a human cadaveric tibia prepared by a local university anatomy lab.[38][39][40][34] By purchasing locally made 3D printed bone models for modular external fixation skills training, the learner also supports the local economy while saving on customs dues, processing fees, and international shipping costs that would be incurred when using artificial bone products that are not made locally.
| Tibial Shaft Transverse Fracture Simulator
(3D Printed Adult Tibial Bone Models #1 and #2) |
Sawbones Tibia, Plastic Cortical Shell, Left
(SKU:1104-9)[34] |
Human Cadaveric Tibia
(Prepared by an University Anatomy Lab in Nigeria)[40] | |
|---|---|---|---|
| Bone Simulator Features and Materials | 3D printed, biorenewable plastic anatomic bone models are made with a rigid plastic shell and inner cancellous material. | Plastic cortical shell models are made of a rigid plastic shell with inner cancellous material. |
|
| Fracture Simulation | Simulates a transverse mid-shaft fracture of the tibia for modular external fixation training. | Requires additional preparation by user to simulate a fracture. | Requires additional preparation to simulate a fracture. |
| Fracture Encapsulation | Encapsulates transverse fracture with cellophane. | Does not encapsulate or re-attach fracture. | No. This would incur additional preparation and storage fees. |
| Vise Attachment | Contains a vise attachment to safely secure the model inside a standard vise clamp. | Does not contain a vise attachment. | Does not contain a vise attachment. |
| Bone Simulator Dimensions | Tibia with an overall length of 41 cm. | Tibia with an overall length of 42 cm. | Varies.[1] |
| Unit Cost | $22.15 USD[38] | $56 USD | $150.00 USD[40] |
| Production Time | 14 hours 30 minutes (when Adult Male Tibial Bone Models #1 and #2 are printed consecutively). | Ready to ship in 42 days or more.[41] | Depends on local availability of cadaver specimens which is difficult to predict. |
| Tibial Shaft Transverse Fracture Simulator
(3D Printed Adult Tibial Bone Models #1 and #2) |
Sawbones Tibia, Plastic Cortical Shell, Left
(SKU:1104-9)[16] |
Human Cadaveric Tibia
(Prepared by an University Anatomy Lab in Nigeria)[40] | |
|---|---|---|---|
| Bone Simulator Features and Materials | 3D printed, biorenewable plastic anatomic bone models are made with a rigid plastic shell and inner cancellous material. | Plastic cortical shell models are made of a rigid plastic shell with inner cancellous material. |
|
| Fracture Simulation | Simulates a transverse mid-shaft fracture of the tibia for modular external fixation training. | Requires additional preparation by user to simulate a fracture. | Requires additional preparation to simulate a fracture. |
| Fracture Encapsulation | Encapsulates transverse fracture with cellophane. | Does not encapsulate or re-attach fracture. | No. This would incur additional preparation and storage fees. |
| Vise Attachment | Contains a vise attachment to safely secure the model inside a standard vise clamp. | Does not contain a vise attachment. | Does not contain a vise attachment. |
| Bone Simulator Dimensions | Tibia with an overall length of 41 cm. | Tibia with an overall length of 42 cm. | Varies.[1] |
| Unit Cost | $18.65 USD[38] | $53.50 USD | $150.00 USD[40] |
| Production Time | 17 hours 33 minutes (when Adult Male Tibial Bone Models #1 and #2 are printed consecutively). | Ready to ship in 21 days or more.[16][41] | Depends on local availability of cadaver specimens which is difficult to predict. |
Noteː A product comparison was not made with the:
- Sawbones Tibia, Solid Foam, Large ($16.00 USD) because this model simulates the intramedullary canal but not cancellous bone, and the foam material does not simulate the hardness of cortical bone and thus, could foster anti-skills, and
- Sawbones Cylinder with Encapsulated Oblique Fracture ($37.50 USD) because the hollow short fiber reinforced epoxy cylinder does not have anatomic features that make it suitable for modular external fixation training and does not appear to have adequate length to properly simulate an adult tibial midshaft fracture for modular external fixation training which requires the placement of widely spaced pins in each fracture fragment.[34][42]
The Tibial Shaft Simulator is easy and quick to assemble and does not require any tools, specialized equipment, technical expertise, or time-consuming preparation to build, install, operate and maintain this simulator within the intended place of use. The benefits of 3D printing the Tibial Shaft Simulator (3D Printed Adult Tibial Bone Model #3) locally in Nigeria are that the purchase cost is 9 times cheaper and the production time is over 79 times faster than purchasing a comparable artificial bone cylinder product that is imported from abroad.[38][43] By purchasing locally made 3D printed bone models for bicortical drilling skills training, the learner also supports the local economy while saving on customs dues, processing fees, and international shipping costs that would be incurred when using artificial bone products that are not made locally.
| Tibial Shaft Simulator
(3D Printed Adult Tibial Bone Model #3) |
Sawbones Composite Cylinder
(SKU:3403-7)[43] | |
|---|---|---|
| Bone Simulator Features | Anatomic model that simulates mid-diaphyseal tibial bone for bicortical drilling skills training in preparation for modular external fixation training of an open tibial shaft transverse fracture. | Cylinder that simulates mid-diaphyseal bone for fracture fixation testing. |
| Bone Simulator Materials | 3D printed, biorenewable plastic anatomic bone models are made with a rigid plastic shell and inner cancellous material. | Hollow short fiber reinforced epoxy cylinder. Customized cellular rigid polyurethane foam filling available upon request. |
| Vise Attachment | Contains a vise attachment to safely secure the model inside a standard vise clamp. | Does not contain a vise attachment. |
| Bone Simulator Dimensions | Variable outer diameter (including 40 mm) x 6.2 mm wall thickness x 203.05 mm length. | 40 mm outer diameter x 6 mm wall thickness x 500 mm length. |
| Unit Cost | $8.90 USD per model[38] | $78.78 USD (original $194.00 USD pricing adjusted for model length of 203.04 mm)[43] |
| Production Time | 6 hours and 23 minutes | Ready to ship in 21 days or more[41][43] |
Find Local 3D Print On Demand Services[edit | edit source]
On-site access to a 3D printer is not required to reproduce these bone models. The open-source 3D files can be downloaded by any 3D printing organization anywhere. Please go to this link to follow step-by-step instructions on how to find 3D print on demand services in your region.
Acknowledgements[edit | edit source]
This work is funded by a grant from the Intuitive Foundation. Any research, findings, conclusions, or recommendations expressed in this work are those of the author(s), and not of the Intuitive Foundation.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Ugochukwu EG, Ugbem LP, Ijomone OM, Ebi OT. Estimation of Maximum Tibia Length from its Measured Anthropometric Parameters in a Nigerian Population. J Forensic Sci Med [serial online] 2016 [cited 2021 Jun 27];2:222-8. Available from: https://www.jfsmonline.com/text.asp?2016/2/4/222/197928.
- ↑ U.S. Department of Health and Human Services — National Institutes of Health. Human tibia and fibula. [Internet]. Bethesda, (MD): NIH 3D Print Exchange; 2014 May 29 [cited 2021 Aug 17]. Available from: https://3dprint.nih.gov/discover/3DPX-000169.
- ↑ Gosman JH, Hubbell ZR, Shaw CN, Ryan TM. Development of cortical bone geometry in the human femoral and tibial diaphysis. Anat Rec (Hoboken). 2013 May;296(5):774-87. doi: 10.1002/ar.22688. Epub 2013 Mar 27. PMID: 23533061.
- ↑ 4.0 4.1 4.2 Ultimaker. Ultimaker PLA Technical Data Sheet [Internet]. Ultimaker Support. [cited 2021 July 29]. Available from: https://support.ultimaker.com/hc/en-us/articles/360011962720-UltimakerPLA-TDS.
- ↑ Vian, Wei Dai and Denton, Nancy L., "Hardness Comparison of Polymer Specimens Produced with Different Processes" (2018). ASEE IL-IN Section Conference. 3. https://docs.lib.purdue.edu/aseeil-insectionconference/2018/tech/3.
- ↑ 6.0 6.1 6.2 Society For Biomaterials 30th Annual Meeting Transactions, page 332. Femoral Cortical Wall Thickness And Hardness Evaluation. K. Calvert, L.A. Kirkpatrick, D.M. Blakemore, T.S. Johnson. Zimmer, Inc., Warsaw, IN.
- ↑ Meyers, M. A.; Chen, P.-Y. (2014). Biological Materials Science. Cambridge: Cambridge University Press. ISBN 978-1-107-01045-1.
- ↑ Forrest AM, Johnson AE, inventors; Pacific Research Laboratories, Inc., assignee. Artificial bones and methods of making same. United States patent 8,210,852 B2. Date issued 2012 Jul 3.
- ↑ National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. What is Bone? [Internet]. Bethesda (MD): The National Institutes of Health (NIH); 2018. [Cited 2021 Aug 17]. Available from: https://www.bones.nih.gov/health-info/bone/bone-health/what-is-bone.
- ↑ Maeda K, Mochizuki T, Kobayashi K, Tanifuji O, Someya K, Hokari S, Katsumi R, Morise Y, Koga H, Sakamoto M, Koga Y, Kawashima H. Cortical thickness of the tibial diaphysis reveals age- and sex-related characteristics between non-obese healthy young and elderly subjects depending on the tibial regions. J Exp Orthop. 2020 Oct 6;7(1):78. doi: 10.1186/s40634-020-00297-9. PMID: 33025285; PMCID: PMC7538524.
- ↑ Debas, H. T., P. Donkor, A. Gawande, D. T. Jamison, M. E. Kruk, and C. N. Mock, editors. 2015. Essential Surgery. Disease Control Priorities, third edition, volume 1. Washington, DC: World Bank. doi:10.1596/978-1-4648 -0346-8. License: Creative Commons Attribution CC BY 3.0 IGO.
- ↑ https://www.creality3dofficial.com/products/official-creality-ender-3-3d-printer?gclid=EAIaIQobChMIn76Xn4_A9wIVD4FaBR0klwSJEAAYAyAAEgIzRvD_BwE
- ↑ https://www.prusa3d.com/category/original-prusa-i3-mk3s/
- ↑ https://lulzbot.com/store/sidekick747?ref=null
- ↑ https://ultimaker.com/3d-printers/ultimaker-2-plus-connect?utm_medium=cpc&utm_source=google&utm_campaign=2022_Alwayson_srengineer_traffic_do_US
- ↑ 16.0 16.1 16.2 16.3 16.4 16.5 https://www.dynamism.com/ultimaker.html?APC=P870
- ↑ https://lulzbot.com/store/lulzbot-taz-3d-printer-workhorse-boxed-for-retail-na-kt-pr0051na?ref=KT-PR0051NA
- ↑ https://www.flashforgeshop.com/product/flashforge-creator-3-3d-printer-for-industrial-use
- ↑ https://flashforge-usa.com/products/flashforge-creator3-independent-dual-extruder-3d-printer
- ↑ https://lulzbot.com/store/taz-pro-s?ref=KT-PR0055NA
- ↑ https://lulzbot.com/store/taz-pro?ref=KT-PR0050NA
- ↑ https://lulzbot.com/store/lulzbot-taz-3d-printer-pro-xt-boxed-for-retail-na-kt-pr0056na?ref=KT-PR0056NA
- ↑ https://ultimaker.com/3d-printers/ultimaker-s5?utm_medium=cpc&utm_source=google&utm_campaign=2022_Alwayson_srengineer_traffic_do_US
- ↑ https://ultimaker.com/3d-printers/ultimaker-s5-pro-bundle?utm_medium=cpc&utm_source=google&utm_campaign=2022_Alwayson_srengineer_traffic_do_US
- ↑ https://www.dynamism.com/ultimaker-s5-probundle-1.html
- ↑ https://support.ultimaker.com/hc/en-us/articles/360011987939-The-Ultimaker-2-Extended-specifications
- ↑ https://support.ultimaker.com/hc/en-us/articles/360016868480-Product-discontinuance-notice
- ↑ https://www.prusa3d.com/category/original-prusa-mini/
- ↑ https://lulzbot.com/store/sidekick289?ref=null
- ↑ https://lulzbot.com/store/lulzbot-mini-v2-0-boxed-for-retail-na-kt-pr0047na?ref=KT-PR0047NA
- ↑ https://ultimaker.com/3d-printers/ultimaker-s3?utm_medium=cpc&utm_source=google&utm_campaign=2022_Alwayson_srengineer_traffic_do_US
- ↑ https://ultimaker.com/3d-printers/ultimaker-3
- ↑ Ugochukwu EG, Ugbem LP, Ijomone OM, Ebi OT. Estimation of Maximum Tibia Length from its Measured Anthropometric Parameters in a Nigerian Population. J Forensic Sci Med [serial online] 2016 [cited 2021 Jun 27];2:222-8. Available from: https://www.jfsmonline.com/text.asp?2016/2/4/222/197928.
- ↑ 34.0 34.1 34.2 34.3 34.4 Sawbones. Tibia with 12.5 mm Canal, Solid Foam, Left, Large [Internet]. Best Anatomical Medical Training Models Company. 2021 [cited 2021 Dec 11]. Available from: https://www.sawbones.com/tibia-large-left-solid-foam-w-canal1125.html.
- ↑ https://support.ultimaker.com/hc/en-us/articles/360012101319-How-to-store-material
- ↑ https://support.ultimaker.com/hc/en-us/articles/360011987760-How-to-use-adhesion-sheets-for-the-Ultimaker-3
- ↑ Kuunda 3D Ltd. Personal communication. July 14, 2021.
- ↑ 38.0 38.1 38.2 38.3 38.4 38.5 AIGE Limited. 3D printers. [Internet]. 3D Printers | AIGE Limited. [cited 2021 July 29]. Available from: https://www.aige.info/3d-printers.
- ↑ Sawbones. Tibia, Plastic Cortical Shell, Large - SKU:1104-9. [Internet]. Vashon, (WA): Sawbones; [cited 2021 Aug 26]. Available from: https://www.sawbones.com/tibia-large-left-solid-white-plastic-no-canal-1104-9.html.
- ↑ 40.0 40.1 40.2 40.3 40.4 Dr. Habila Umaru. Personal communication. May 13, 2021.
- ↑ 41.0 41.1 41.2 Sawbones. Best Anatomical Medical Training Models Company [Internet]. Sawbones. Sawbones; 2021 [cited 2021 Nov 28]. Available from: https://www.sawbones.com/.
- ↑ Sawbones. Cylinder with encapsulated oblique fracture [Internet]. Best Anatomical Medical Training Models Company. Sawbones; 2021 [cited 2021 Nov 28]. Available from: https://www.sawbones.com/cylinder-short-oblique-fracture-w-single-neoprene-cover-1521-617-4.html.
- ↑ 43.0 43.1 43.2 43.3 Cylinder 40 mm OD x 6 mm Wall, Hollow, Fourth Generation [Internet]. Best Anatomical Medical Training Models Company. [cited 2021 Nov 28]. Available from: https://www.sawbones.com/cylinder-40mm-od-w-6mm-wall-length-500mm-4th-gen-composite3403-7.html.