title: Cadaveric assessment of a 3D-printed aiming device for implantation of a hinged elbow external fixator.
abstract: BACKGROUND
  Proper implantation of a hinged external elbow fixator (HEEF) is demanding since it requires precise alignment between the flexion-extension's and HEEF's axis. In order to optimize this alignment, we have developed a 3D-printed aiming device. The primary goal of the study was to compare the aiming device-based technique with the conventional pin technique. The secondary goal was to determine whether it is possible to share the aiming device with the surgical community.
  
  
  METHODS
  A HEEF was implanted in cadavers with either the aiming device (n = 6) or the conventional pin technique (n = 6). For both techniques the duration of the procedure, the radiation exposure as well as the offset and angular divergence between the HEEF's and flexion-extension's axis were compared. To achieve the secondary goal, two surgeons used aiming devices 3D-printed from files sent by email in order to implant HEEF on cadaveric specimens (n = 6).
  
  
  RESULTS
  Duration of the procedure was not significantly different between both techniques. However, the aiming device allowed for reduction of the number of image intensifier shots (p = 0.005), angular divergence (p = 0.02) and offset between both axes (p = 0.05). The aiming devices have been delivered less than 15 days after ordering, and they have allowed proper implantation of six HEEF.
  
  
  CONCLUSIONS
  The 3D-printed aiming device allowed less irradiant and more accurate implantation of HEEF. It is possible to share it with other surgeons.
authors.affiliation: Department of Orthopaedic Surgery, Universitary Hospital of Bicêtre, Public Assistance Hospital of Paris, 78 Rue General Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dos Santos
authors.affiliation: Department of Radiology, Universitary Hospital of Bicetre, Public Assistance Hospital of Paris, 78 Rue General Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Maud
authors.initials: M
authors.lastname: Creze
authors.affiliation: Clinique de l'Yvette, 67 Route de Corbeil, 91160, Longjumeau, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Begin
authors.affiliation: Laboratoire de Microcirculation, Faculté de Médecine de Lariboisière, Université Paris-Diderot, 10 Avenue de Verdun, 75010, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Laemmel
authors.affiliation: Faculty of Medicine, University Paris Sud-XI, 63 rue Gabiel Peri, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Bouchra
authors.initials: B
authors.lastname: Assabah
authors.affiliation: Department of Orthopaedic Surgery, Universitary Hospital of Bicêtre, Public Assistance Hospital of Paris, 78 Rue General Leclerc, 94270, Le Kremlin-Bicêtre, France. soubeyrand.marc@gmail.com.|Faculty of Medicine, University Paris Sud-XI, 63 rue Gabiel Peri, 94270, Le Kremlin-Bicêtre, France. soubeyrand.marc@gmail.com.
authors.forename: Marc
authors.initials: M
authors.lastname: Soubeyrand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001858:Bone Nails; D002102:Cadaver; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D016267:External Fixators; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D061646:Operative Time; D066330:Printing, Three-Dimensional; D019919:Prosthesis Implantation / Q000295:instrumentation*; D011829:Radiation Dosage
keywords: 3D printing; Elbow instability; Hinged elbow fixator; Terrible triad