Orthopaedic surgery can present considerable challenges in cases with extensive primary injuries with multiple bone fragmentation, as well as in those presenting bone deformities. The popularity and continuing extensive use of 100 V/100 A/10 kW platforms, leads to the conclusion that these should be the minimum requirement benchmark for any electrical interface design. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Improvements to the biological functionality of 3D-printed synthetic scaffolds have been attempted by ornamenting them with a cell-laid mineralised extracellular matrix (ECM) that mimics a bony micro-environment.42 Metals like titanium can be used particularly in load-bearing areas, such as for hip reconstruction. 3D-printed models can be a useful tool for the teaching and training of novice surgeons, improving the quality of training and the learning curve. Pedicle screws inserted with a standard surgical technique have sometimes penetrated the outer bony wall or even missed the pedicle.49 Complex anatomical relationships (bone fragments in the vicinity of fracture sites, for example) can be better appreciated on 3D solid models ‘in hand’.
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This is due to their reliance of good contacts enabled by strict geometric design and manufacture of these pins and their mating hole inserts, as unlike tabs and even slip rings, there is no or little self-adjustment capability enabled in designs. However, the design of such controllers is beyond the scope of this paper. 3DP plays also an important role in the design and production of personalised instruments and surgical guides, thanks to the availability of sterilisable and biocompatible printing materials. Another important field of application is the 3DP of PS prostheses thanks to the introduction of metal 3D printers based on powder bed fusion or direct energy deposition technology (Table 1). The possibility of building customised objects in stainless steel, titanium, ceramics or high-performance plastics like poly-ether-ether-ketone (PEEK) paved the way for the creation of customised prostheses. Moreover, the advent of selective laser sintering (SLS), an AM technology able to process metal and ceramic powder, allowed the production of personalised prostheses, to be tailored to the specific geometry of each clinical case.
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3DP is not only useful to tailor the prosthesis based on specific anatomy but also to recreate an exact surface finish or a controlled porosity able to aid osteointegration. Examples come from the creation of a personalised osteotomy template for the surgical treatment of cubitus varus deformity,46 and for total knee arthroplasty and the prototyping of PS instruments during simulated pelvic bone tumour surgery.47 Guides for pedicle screw placement have also been created through 3DP techniques48 (Figs 5-7). The main benefit of this approach comes from the reduction of intra-operative time, since the surgeon has already planned the most suitable position of all the instruments before the intervention. Orthopaedic surgeons at the Walter Reed Medical Center (Bethesda, MD) have developed models of the human knee using 3DP technologies. In the following, key literature on the usage of 3DP will be presented, with a special focus on orthopaedics and traumatology applications.
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Tissue engineering aims to aid in the repair and/or regeneration of bone defects by using a scaffold as a platform for carrying cells or therapeutic agents to the site of interest. In order to effectively achieve these properties, a scaffold should have a suitable architecture favouring the flow of nutrients for cell growth. Radiographs are used routinely for orthopaedic surgical planning, yet they provide inadequate information on the precise 3D extent of bone defects.18-19 Examples of the application of 3DP within the orthopedic field have spread rapidly in the last few years and include the use of a 3DP model to assess the surgical approach for corrective osteotomies, in order to gain a more informative overview of the anatomy and to improve the detail of planning, especially in cases of minimally-invasive surgery.
Operations can also be made on plastic models in order to visualise the final outcome of the intervention. при бременност има ли болки в кръста
. Within the orthopaedic and traumatology field, 3DP also enables advance testing of the surgical procedure; this possibility can lead to a better intervention outcome and a reduction of operation time. 3DP models can also aid the visualisation of traumatic situations, such as complex bone fragmentation. Here, 3D printed models appear to be held in high regard. The availability of a 3D printed model can also be a fundamental aid in the placement of screws or surgical plates, mainly thanks to the possibility of testing in advance of the procedure; examples include pedicle screw placement in a clinical case of severe congenital scoliosis23 or, more in general, applications to spinal surgery24, 25 with the aim of designing PS surgical guides. Bioceramics such as hydroxyapatite are currently the preferred material for bone reconstruction.39, 40 Bone graft substitutes created in the use of 3D printed scaffolds are usually made from a composite of polycaprolactone (PCL), poly-lactic-co-glycolic acid (PLGA), and β-tricalcium phosphate (β-TCP).
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5. Raiss P, Edwards TB, da Silva MR, Bruckner T, Loew M, Walch G. Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (type-3 fracture sequelae). The use of internal shifting masses, actively shifting the location of the spacecraft center-of-mass, thus modulating, in direction and magnitude, the aerodynamic torques, is here proposed as a method to reject these aerodynamic disturbances. In particular, Dooley and McCarthy (1993) proposed using dual quaternions as generalized coordinates, and Brodsky and Shoham (1999) proposed a rigorous dual-number based methodology that resulted in a Lagrangian-like framework. Another interesting application of 3DP is the realisation of PS orthoses; created using a reverse engineering approach based on 3D scanners, PS orthoses are able to capture the area of interest. This is one of the most widely-used applications of 3DP to PS model prototyping.