PAPERS: Novel Applications of Design for AM

Patient-Specific Clavicle Reconstruction Using Digital Design and Additive Manufacturing

[+] Author and Article Information
Marie Cronskär

Sports Tech Research Centre,
Mid Sweden University,
Akademigatan 1,
Östersund 831 25, Sweden
e-mail: marie.cronskar@miun.se

Lars-Erik Rännar

Sports Tech Research Centre,
Mid Sweden University,
Akademigatan 1,
Östersund 831 25, Sweden
e-mail: lars-erik.rannar@miun.se

Mikael Bäckström

Sports Tech Research Centre,
Mid Sweden University,
Akademigatan 1,
Östersund 831 25, Sweden
e-mail: mikael.backstrom@miun.se

Kjell G Nilsson

Department of Surgical and Perioperative
University of Umeå,
Umeå 901 87, Sweden
e-mail: kjell.g.nilsson@umu.se

Börje Samuelsson

Department of Orthopaedics,
Östersunds Hospital,
Östersunds sjukhus, Ortopedmottagningen,
Östersund 831 83, Sweden
e-mail: borje.samuelsson@jll.se

1Corresponding author.

Contributed by the Design for Manufacturing Committee of ASME for publication in the JOURNAL OF MECHANICAL DESIGN. Manuscript received February 13, 2015; final manuscript received May 26, 2015; published online October 12, 2015. Assoc. Editor: David Rosen.

J. Mech. Des 137(11), 111418 (Oct 12, 2015) (4 pages) Paper No: MD-15-1097; doi: 10.1115/1.4030992 History: Received February 13, 2015; Revised May 26, 2015

There is a trend toward operative treatment for certain types of clavicle fractures and these are usually treated with plate osteosynthesis. The subcutaneous location of the clavicle makes the plate fit important, but the clavicle has a complex shape, which varies greatly between individuals and hence standard plates often have a poor fit. Using computed tomography (CT) based design, the plate contour and screw positioning can be optimized to the actual case. A method for patient-specific plating using design based on CT-data, additive manufacturing (AM), and postprocessing was initially evaluated through three case studies, and the plate fit on the reduced fracture was tested during surgery (then replaced by commercial plates). In all three cases, the plates had an adequate fit on the reduced fracture. The time span from CT scan of the fracture to final implant was two days. An approach to achieve functional design and screw-hole positioning was initiated. These initial trials of patient-specific clavicle plating using AM indicate the potential for a smoother plate with optimized screw positioning. Further, the approach facilitates the surgeon's work and operating time can be saved.

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Chu, C., Graf, G., and Rosen, D. W., 2008, “Design for Additive Manufacturing of Cellular Structures,” Comput. Aided Des. Appl., 5(5), pp. 686–696.
Wohlers, T., 2012, Wohlers Report 2012, Wohlers Associates, Inc., Fort Collins, CO.
Dérand, P., Rännar, L.-E., and Hirsch, J.-M., 2012, “Imaging, Virtual Planning, Design, and Production of Patient-Specific Implants and Clinical Validation in Craniomaxillofacial Surgery,” Craniomaxillofac. Trauma Reconstr., 5(3), pp. 137–144. [CrossRef] [PubMed]
Kanatas, A. N., Needs, C., Smith, A. B., Moran, A., Jenkins, G., and Worrall, S. F., 2012, “Short-Term Outcomes Using the Christensen Patient-Specific Temporomandibular Joint Implant System: A Prospective Study,” Br. J. Oral Maxillofac. Surgery, 50(2), pp. 149–153. [CrossRef]
Stieglitz, L., Gerber, N., Schmid, T., Mordasini, P., Fichtner, J., Fung, C., Murek, M., Weber, S., Raabe, A., and Beck, J., 2014, “Intraoperative Fabrication of Patient-Specific Moulded Implants for Skull Reconstruction: Single-Centre Experience of 28 Cases,” Acta Neurochir., 156(4), pp. 793–803. [CrossRef]
Jun, Y., and Choi, K., 2010, “Design of Patient-Specific Hip Implants Based on the 3D Geometry of the Human Femur,” Adv. Eng. Software, 41(4), pp. 537–547. [CrossRef]
Osagie, L., Figgie, M., and Bostrom, M., 2012, “Custom Total Hip Arthroplasty in Skeletal Dysplasia,” Int. Orthop., 36(3), pp. 527–531. [CrossRef] [PubMed]
Harrysson, O., Deaton, B., and Bardin, J., 2006, “Evaluation of Titanium Implant Components Directly Fabricated Through Electron Beam Melting Technology,” Materials and Processes for Medical Devices Conference, Boston, pp. 15–20.
Doi, A., Takahashi, H., Syuto, B., Katayama, M., Nagashima, H., and Okumura, M., 2013, “Tailor-Made Plate Design and Manufacturing System for Treating Bone Fractures in Small Animals,” J. Adv. Comput. Intell. Intell. Inf., 17(4), pp. 588–597.
Albano, T., Grabowsky, M. B., Rodriguez, L., Lavelle, W., Uhl, R., Ledet, E., and Sanders, G., 2011, “Designing Patient-Specific Orthopaedic Mesh Implants to Treat High-Energy Tibial Fractures,” 2011 IEEE 37th Annual Northeast Bioengineering Conference (NEBEC), pp. 1–2.
Cronskär, M., Bäckström, M., and Rännar, L.-E., 2013, “Production of Customized Hip Stem Prostheses—A Comparison Between Conventional Machining and Electron Beam Melting (EBM),” Rapid Prototyping J., 19(5), pp. 365–372. [CrossRef]
Harrysson, O., and Cormier, D., 2006, “Direct Fabrication of Custom Orthopedic Implants Using Electron Beam Melting Technology,” Advanced Manufacturing Technology for Medical Applications, I. Gibson, ed., Wiley, Hong Kong, pp. 191–206.
Koptyug, A., Rännar, L. E., Bäckström, M., and Cronskär, M., 2014, “Additive Manufacturing for Medical and Biomedical Applications: Advances and Challenges,” Mater. Sci. Forum, 783–786, pp. 1286–1291. [CrossRef]
De Palma, A. F., 1983, Surgery of the Shoulder, Vol. 512, Lippincott, Philadelphia, PA.
Vanbeek, C., Boselli, K., Cadet, E., Ahmad, C., and Levine, W., 2011, “Precontoured Plating of Clavicle Fractures: Decreased Hardware-Related Complications?” Clin. Orthop. Related Res., 469(12), pp. 3337–3343. [CrossRef]
Huang, J., Toogood, P., Wilber, J., and Cooperman, D., 2007, “Clavicular Anatomy and the Applicability of Precontoured Plates,” J. Bone Joint Surg. (Am.), 89(10), pp. 2260–2265. [CrossRef] [PubMed]
Cronskär, M., Rännar, L.-E., and Bäckström, M., 2012, “Implementation of Digital Design and Solid Free-Form Fabrication for Customization of Implants in Trauma Orthopaedics,” J. Med. Biol. Eng., 32(2), pp. 91–96. [CrossRef]
Christensen, A., Kircher, R., and Lippincott, A., 2008, “Qualification of Electron Beam Melted (EBM) Ti6Al4V-ELI for Orthopaedic Applications,” Medical Device Materials IV: Proceedings of the Materials and Processes for Medical Devices Conference, pp. 48–53.
Haslauer, C. M., Springer, J. C., Harrysson, O. L., Loboa, E. G., Monteiro-Riviere, N. A., and Marcellin-Little, D. J., 2010, “In Vitro Biocompatibility of Titanium Alloy Discs Made Using Direct Metal Fabrication,” Med. Eng. Phys., 32(6), pp. 645–652. [CrossRef] [PubMed]
Murr, L. E., Quinones, S. A., Gaytan, S. M., Lopez, M. I., Rodela, A., Martinez, E. Y., Hernandez, D. H., Martinez, E., Medina, F., and Wicker, R. B., 2009, “Microstructure and Mechanical Behavior of Ti–6Al–4V Produced by Rapid-Layer Manufacturing, for Biomedical Applications,” J. Mech. Behav. Biomed. Mater., 2(1), pp. 20–32. [CrossRef] [PubMed]
Ponader, S., Vairaktaris, E., Heinl, P., Wilmowsky, C. V., Rottmair, A., Korner, C., Singer, R. F., Holst, S., Schlegel, K. A., Neukam, F. W., and Nkenke, E., 2007, “Effects of Topographical Surface Modifications of Electron Beam Melted Ti–6Al–4V Titanium on Human Fetal Osteoblasts,” J. Biomed. Mater. Res., Part A, 84(4), pp. 1111–1119.
Ponader, S., Wilmovsky, C. V., Widenmayer, R., Lutz, P., Heinl, P., Körner, C., Singer, R. F., Schlegel, K. A., Neukam, F. W., and Nkenke, E., 2008, “in vivo Performance of Selective Electron Beam-Melted Ti–6Al–4V Structures,” J. Biomed. Mater. Res., Part A, 92(1), pp. 56–62.
Schatzker, J., and Tile, M., 1987, The Rationale of Operative Fracture Care, Springer Verlag, New York.
Schmutz, B., Wullschleger, M. E., Kim, H., Noser, H., and Schütz, M. A., 2008, “Fit Assessment of Anatomic Plates for the Distal Medial Tibia,” J. Orthop. Trauma, 22(4), pp. 258–263. [CrossRef] [PubMed]


Grahic Jump Location
Fig. 1

Work flow for modeling and manufacturing of a patient-specific bone plate [17]. SFF is short for solid free form, which is an older term for AM.

Grahic Jump Location
Fig. 2

The procedure from digital 3D reconstruction of the fracture to test fitting the plate in surgery, in C3

Grahic Jump Location
Fig. 3

3D CT reconstructions of the fractures in C1–C3




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