Tibial Fracture Fixation Team Logo.jpg

Caption underneath

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 arrow 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]

Contact 3D Print on Demand Services

Once you have collected contact information for local 3D print on demand services, prepare to inquire about their 3D printing and delivery capabilities.

Advance Notice for Large Volume Orders

Polylactic acid (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.

Estimate National Market Size

(Optional) When reaching out to a local 3D print on demand service, it's helpful to share the total national market size (i.e., total number of physicians who are not orthopedic surgeons in a country) they can potentially serve.

We strongly encourage you to calculate national market size and use this market information to negotiate a reasonable and fair quote with your local 3D printing organization.

Here's how to estimate the total number of physicians who are not orthopedic surgeons in your country:

  1. Go to https://data.worldbank.org/indicator/SH.MED.PHYS.ZS
  2. Scroll down and record the number of physicians per 1,000 people in your country
  3. Go to https://data.worldbank.org/indicator/SP.POP.TOTL
  4. Scroll down and record the total population (in thousands) in your country
  5. Multiple the value in Step #2 with the value in Step #4 to calculate the total number of physicians in your country
  6. Reach out to your local medical licensing board or national surgical college to identify the total number of orthopedic surgeons in your country
  7. Subtract the value in Step #6 from the value in Step #5 to calculate the total number of physicians who are not orthopedic surgeons

Here's an example of how we calculated this statistic in Nigeria:

  1. In 2018, there are 0.4 physicians per 1,000 people in Nigeria[12]
  2. In 2020, there are 206,139.59 thousand people in Nigeria[13]
  3. We multiplied 206,139.59 by 0.4 to calculate that there are 82,455 physicians in Nigeria
  4. According to our Team Lead, there are 400 orthopedic surgeons in Nigeria[14]
  5. We subtracted 400 from 82,455 to calculate there are an estimated total of 82,055 physicians across Nigeria who are not orthopedic surgeons
  6. This estimate does not account for physicians who migrate or are not available due to other factors[15]

Table 3. Estimated National Market Size for 3D Printed Adult Tibial Bone Models in 13 Countries

Estimated National Market Size for 3D Printed Adult Tibial Bone Models in 13 Countries
# Country Estimated Total Number of Physicians[12][13] Estimated Number of Orthopedic Surgeons Total Number of Physicians Who are Not Orthopedic Surgeons
1 Brazil 491,012 15,600[16] 475,412
2 Burundi 1,189 4 1,185
3 Colombia 195,390 Research in progress Research in progress
4 Cote D'Ivoire 5,275 Research in progress Research in progress
5 Ethiopia 11,496 122 11,374
6 Ghana 3,107 24[17] 3,083
7 India 1,242,003 20,000[18] 1,222,003
8 Malawi 266[19] 9[19] 257
9 Nigeria 82,455 400[14] 82,055
10 Rwanda 1,295 8[20] 1,287
11 South Africa 46,853 967[21] 45,886
12 Sudan 13,154 50[22] 13,104
13 Uganda 7,775 70[23] 7,705

Send a Message

Feel free to use and adapt this introductory email template provided in italics below:

  1. *Include your name, clinical title, institutional affiliation, and city location;
  2. **Use your address for shipping the 3D printed bone models;
  3. ***Include the total number of each bone model you wish to order;
  4. ****Use the estimated national market size for your country; and
  5. *****Sign off with your standard email signature.

Greetings,

I hope this message finds you well.

My name is Dr. Habila Umaru, and I am an orthopedic surgeon who works at the National Hospital of Abuja in Nigeria.*

We are looking to potentially purchase 3D printed open-source bone simulation models for training local healthcare practitioners. If this interests you, please review our questions below:

1) Can your fused filament fabrication 3D printer print g-code files prepared using Ultimaker Cura or Cura Lulzbot Edition slicing programs?

2) Does your 3D printer have a build volume Z height of at least 180 mm?

3) Can you obtain brand new white polylactic acid (PLA) filament in a sealed package?

4) Are you able to arrange delivery of our 3D printed models to National Hospital Abuja, Plot 132 Central Business District (Phase II), PMB 425, Garki, Abuja, F.C.T. Nigeria?**

If your answer is yes to all of the questions above, please go to this link: https://www.appropedia.org/3D_Printed_Adult_Male_Tibial_Bone_Models/Confirm_3D_Printing_and_Delivery_Capabilities and follow the instructions in each step of the menu (located in the upper right section on the page) to download or prepare print files, print and review sample models, and submit a price quote and estimated delivery timeframe for one Adult Male Tibial Bone Model #1 and one Adult Male Tibial Bone Model #2.*** Please pay attention to and follow all the instructions closely to ensure the bone models are printed properly and display the required visual, tactile, and acoustic fidelity for orthopedic surgical simulation training.

The potential national market size for 3D printed bone models is the estimated 82,055 physicians across Nigeria who are not orthopedic surgeons.**** A research project has found that the 2022 price of 3D printing each Bone Model #1 and #2 at 95% scale in Nigeria is $11.25 and $10.90 USD (not including local taxes or shipping costs).

If your 3D printers are not suitable or available for this potential contract, can you please recommend another local 3D printing organization who might be interested?

Thank you very much for taking the time to review our message. We look forward to hearing back from you soon.

Sincerely,

Habila Umaru, MBBS, FWACS, MDM, MHPM*****

Confirm Order

Once you've received an acceptable price quote and reviewed the attached completed and signed Quality Assurance Checklist for sample prints of Adult Male Tibial Bone Models #1 and #2, then request an order invoice from the 3D print on demand service.

The table below summarizes our 2022 market research across different countries on the pricing for Adult Male Tibial Bone Models #1 and #2 (not including local taxes or shipping costs).

# Country 3D Printing Organization 3D Printer Model Scale Cost of Model #1 Cost of Model #2
1 Cameroon Yansokilab[24] Ultimaker 3 100% ~$14.59 USD (10000 F CFA) ~$13.86 USD (9500F CFA)
2 Cameroon Ongola Fablab[25][26] Creality CR-X

Ultimaker 3

Ultimaker 2 Extended

100% ~$18.74 USD (12840.00 XAF) $14.53 USD (9960.01 XAF)
3 India KAD Enterprises[27] Prusa i3MK3S 100% ~$9.98 USD (₹814) ~$8.79 USD (₹717)
4 India You Imagine We Make[28] Prusa i3MK3S 100% ~$8.09 USD (₹660) ~$6.25 USD (₹510)
5 Nigeria AIGE Limited[29] Ultimaker S3 95% $11.25 USD[30] $10.90 USD[30]

Acknowledgements

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

  1. 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.
  2. 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.
  3. 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. 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.
  5. 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. 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.
  7. Meyers, M. A.; Chen, P.-Y. (2014). Biological Materials Science. Cambridge: Cambridge University Press. ISBN 978-1-107-01045-1.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 12.0 12.1 https://data.worldbank.org/indicator/SH.MED.PHYS.ZS
  13. 13.0 13.1 https://data.worldbank.org/indicator/SP.POP.TOTL
  14. 14.0 14.1 National Hospital records high patronage on knee, hip replacement surgeries. (2020, January 26) The Sun Nigeria. Retrieved November 11, 2020 from https://www.sunnewsonline.com/national-hospital-records-high-patronage-on-knee-hip-replacement-surgeries/.
  15. https://www.thecable.ng/nma-40000-doctors-practising-in-nigeria-out-of-over-80000-registered-with-medical-council
  16. https://www.statista.com/statistics/962193/number-licensed-orthopedists-traumatologists-brazil/
  17. Brouillette MA, Kaiser SP, Konadu P, Kumah-Ametepey RA, Aidoo AJ, Coughlin RC. Orthopedic surgery in the developing world: workforce and operative volumes in Ghana compared to those in the United States. World J Surg. 2014 Apr;38(4):849-57. doi: 10.1007/s00268-013-2314-0. PMID: 24218152.
  18. Jain AK. Current state of orthopedic education in India. Indian J Orthop. 2016 Jul-Aug;50(4):341-4. doi: 10.4103/0019-5413.185586. PMID: 27512213; PMCID: PMC4964764.
  19. 19.0 19.1 Mkandawire N, Ngulube C, Lavy C. Orthopaedic clinical officer program in Malawi: a model for providing orthopaedic care. Clin Orthop Relat Res. 2008 Oct;466(10):2385-91. doi: 10.1007/s11999-008-0366-5. Epub 2008 Jul 15. PMID: 18633684; PMCID: PMC2584281.
  20. https://www.newtimes.co.rw/section/read/51030
  21. Dell AJ, Gray S, Fraser R, Held M, Dunn R. Orthopaedic Surgeon Density in South Africa. World J Surg. 2018 Dec;42(12):3849-3855. doi: 10.1007/s00268-018-4709-4. PMID: 29947987.
  22. https://www.jointreplacementsurgeryhospitalindia.com/en-sd/#:~:text=The%20surprising%20statistics%20by%20Sudan,surgeons%20for%2042%20million%20Sudanese!
  23. ETALO (2022). "ETALO Bone Drilling Module". Appropedia. Retrieved April 26, 2022.
  24. https://www.fablabs.io/labs/yansokilab
  25. https://www.fablabs.io/labs/ongolafablab
  26. https://www.auf.org/afrique-centrale-grands-lacs/
  27. https://www.printables.com/social/350914-anmol/about
  28. https://www.printables.com/social/41361-sharad/about
  29. https://new.aige.info/
  30. 30.0 30.1 AIGE Limited. Personal communication. May 23, 2022.
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