title: Application of 3D printed customized external fixator in fracture reduction.
abstract: BACKGROUND
  Long bone fracture is common in traumatic osteopathic patients. Good reduction is beneficial for bone healing, preventing the complications such as delayed union, nonunion, malunion, but is hard to achieve. Repeated attempts during the surgery would increase the operation time, cause new damage to the fracture site and excessive exposure to radiation. Robotic and navigation techniques can help improve the reduction accuracy, however, the high cost and complexity of operation have limited their clinical application.
  
  
  METHODS
  We combined 3D printing with computer-assisted reduction technique to develop a customised external fixator with the function of fracture reduction. The original CT data obtained by scanning the fracture was imported to computer for reconstructing and reducing the 3D image of the fracture, based on which the external fixator (named as Q-Fixator) was designed and then fabricated by 3D printing techniques. The fracture reduction and fixation was achieved by connecting the pins inserted in the bones with the customised Q-Fixator. Experiments were conducted on three fracture models to demonstrate the reduction results.
  
  
  RESULTS
  Good reduction results were obtained on all three fractured bone models, with an average rotation of 1.21°(± 0.24), angulation of 1.84°(± 0.28), and lateral displacement of 2.22 mm(± 0.62).
  
  
  CONCLUSIONS
  A novel customised external fixator for long bone fracture reduction was readily developed using 3D printing technique. The customised external fixator had the advantages of easy manipulation, accurate reduction, minimally invasion and experience-independence. Future application of the customised external fixator can be extended to include the fixation function with stress adjustment and potentially optimise the fracture healing process.
authors.affiliation: Department of Orthopaedics, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, No.555, Youyidong Rd., Xi'an, Shaanxi 710054, China. Electronic address: qiaofeng7502@163.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Qiao
authors.affiliation: Department of Orthopaedics, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China; State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710054, China.
authors.forename: Dichen
authors.initials: D
authors.lastname: Li
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710054, China; Institute of Medical and Biological Engineering, School of Mechanical Engineering, Uinversity of Leeds, LS2 9JT, UK.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Jin
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710054, China.
authors.forename: Yongchang
authors.initials: Y
authors.lastname: Gao
authors.affiliation: State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710054, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedics, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, No.555, Youyidong Rd., Xi'an, Shaanxi 710054, China.
authors.forename: Jinlong
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Orthopaedics, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, No.555, Youyidong Rd., Xi'an, Shaanxi 710054, China.
authors.forename: Li
authors.initials: L
authors.lastname: Cheng
mesh_terms: D016267:External Fixators; D017102:Fracture Healing; D006801:Humans; D021621:Imaging, Three-Dimensional; D057285:Precision Medicine; D066330:Printing, Three-Dimensional; D025321:Surgery, Computer-Assisted; D013978:Tibial Fractures / Q000473:pathology / Q000601:surgery*
keywords: 3D printing; Closed reduction; Computer-assisted surgery; External fixator; Long bone fracture