TissueDB/Simulators/Adult Proximal Tibia Intraosseous Access Simulator (maxSIMIO)
The Adult Proximal Tibia Intraosseous Access Simulator (maxSIMIO) is a low-cost, 3D-printed trainer for practising intraosseous (IO) needle insertion into the proximal tibia, designed for emergency-medicine and paramedic training in rural and remote settings.[1] The simulator consists of 3D-printed PLA bone structures overlaid with silicone soft-tissue layers. A replaceable tibial cartridge allows repeated practice of IO needle insertion, landmarking, and catheter attachment using an Arrow EZ-IO Power Driver and needle set. Two versions exist: version one (straight leg, knee fully extended) and version two (bent knee at 90 degrees), redesigned after stakeholder feedback for improved anatomical positioning and modularity. Design files are publicly available on GitHub.
| Field | Details |
|---|---|
| Features and Basic Operation | The simulator has a replaceable tibial cartridge for repeated IO insertion practice. Two versions exist: version one (straight leg) and version two (bent knee at 90 degrees). Version two is modular for portability and anatomical accuracy. Silicone soft-tissue layers overlay the PLA bone structures for landmarking and needle insertion. Compatible with standard IO access equipment. Design files are publicly available on GitHub. |
| Current Development Status | Face validity from clinical team feedback; no transfer or clinical validity testing reported. |
| Estimated Build Time and Cost | US$155 |
| Specialized Tools and Equipment | Arrow EZ-IO Power Driver (Teleflex Medical, Research Triangle Park, NC, USA) and EZ-IO Needle Set for IO insertion practice. Ultimaker S5 3D printer (Ultimaker B.V., Utrecht, Netherlands). SolidWorks CAD software (Dassault Systemes SolidWorks Corporation, Waltham, MA). Ultimaker Cura 3D slicing software (Ultimaker B.V., Utrecht, Netherlands). Autodesk Meshmixer (Autodesk, Inc., San Rafael, CA) for hollowing bones (version one). PLA and PVA (support) filament for 3D printing. Dragon Skin 10 NV silicone and Silc-Pig silicone pigment (Smooth-On, Macungie, PA). |
| Version | Two versions described: version one (straight leg, maxSIMIOv1.0) and version two (bent knee at 90 degrees, maxSIMIOv2.0). Version two was redesigned after clinical team feedback for improved anatomical positioning and modularity; the source prices version one at about US$46 and version two at about US$155. Source anatomy files licensed CC BY-NC-SA 4.0; simulator design files publicly available on GitHub. |
| Development Team Contact Information | Adam Dubrowski, Ontario Tech University, Oshawa, Ontario, Canada; adam.dubrowski@gmail.com. Part of the maxSIMhealth laboratory at Ontario Tech University. |
Tissues
| Tissue | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Bone (replaceable tibial cartridge) | 1 | PLA | — | Hollow PLA cartridge representing the proximal tibia. Replaceable after each IO insertion. Same material in both versions; version one integrates into a straight-leg base, version two is a modular insert in the bent-knee design. |
| Muscle (version one) | 1 | Castable silicone | — | Dragon Skin 10 NV (Smooth-On, Macungie, PA) with red Silc-Pig silicone pigment (Smooth-On) for colour. Cast in a recycled cylindrical tin mold around the 3D-printed bones. Cures in approximately 75 minutes. Eliminated in version two, where silicone is applied directly around the bones. |
| Skin (version one) | 1 | Castable silicone with power mesh fabric | — | Dragon Skin 10 NV (Smooth-On) with skin-coloured Silc-Pig silicone pigment (Smooth-On) for colour. Power mesh fabric embedded to improve skin strength. Cures in approximately 75 minutes. Replaced by a direct-mold method in version two. |
| Skin (version two) | 1 | Castable silicone | — | Dragon Skin 10 NV (Smooth-On) with skin-coloured Silc-Pig silicone pigment (Smooth-On) for colour. Poured directly into casting molds around the 3D-printed bones. No mesh fabric or Velcro straps. Cures in approximately 75 minutes. |
Structural Parts
| Part Name | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Base | 1 | PLA | — | Main frame of the simulator. Both versions. |
| Lower leg (version two) | 1 | PLA | — | Tibia and fibula section of the modular bent-knee design. Attaches via extruded disk interface. |
| Upper leg (version two) | 1 | PLA | — | Femur section of the modular bent-knee design. Attaches via extruded disk interface. |
| Skin mold (version one) | 1 | PLA | — | 3D-printed box-shaped mold for casting the skin layer. Build-time only. |
| Casting molds (version two) | 1 set | PLA | — | 3D-printed molds for pouring silicone around bones. Build-time only. |
| Muscle mold (version one) | 1 | Recycled cylindrical storage tin | — | Cut in half longitudinally to create the mold cavity. Build-time only. |
| Velcro straps (version one) | 1 set | Velcro | — | Secure the skin layer around the model. Not used in version two. |
Consumables
| Consumable | Quantity | Material | Approximate Cost | Notes |
|---|---|---|---|---|
| Replaceable tibial cartridge | 1 per use | PLA | US$1 (CAD 10 for 10) | Hollow PLA cartridge removed and replaced after each IO insertion. |
Build Instructions
Phase 1: Design and print bone structures (both versions)
Step 1: Obtain bone surface scans. Source surface scans of the femur, tibia, fibula, and patella from publicly available digital models licensed under Creative Commons (CC BY-NC-SA 4.0). The finished design files for both versions are on GitHub: version one at https://github.com/maxSIMhealth/maxSIMIOv1.0 and version two at https://github.com/maxSIMhealth/maxSIMIOv2.0.
Step 2: Create the bone model in CAD. Import the scans into SolidWorks and assemble in the correct orientation. For version one (straight leg), orient the knee in full extension. For version two (bent knee), arrange the bones at a 90-degree knee position using the SolidWorks Assembly feature.
Step 3: Generate the replaceable tibial cartridge and structural components. For version one, make three plane cuts on the main model (merge off) to isolate the cartridge as a separate solid; cap off the remaining bone model by sketching and extruding thin cylinders at the ends; export both as STL files; finalize in Autodesk Meshmixer using its hollow feature. For version two, create a freehand spline sketch around the bones and revolve it to form the leg shape; hollow the leg solid; make plane cuts at the femur, knee joint, and lower tibia; extrude a disk at each cut location to provide an attachment interface; export all components as STL files.
Step 4: Create the molds. For version one, create a skin mold in SolidWorks by sketching two rectangles and extruding them to form a simple box shape. For version two, create casting molds for each modular section.
Step 5: Slice and print. Open all STL files in Ultimaker Cura. Transfer to an Ultimaker S5 3D printer via SD card. Print all components using PLA filament for the body and PVA filament for support structures.
Checkpoint: Verify all PLA parts are intact. Confirm the replaceable cartridge fits into the base. For version two, confirm the upper leg, lower leg, and cartridge sections attach at their disk interfaces.
Phase 2: Fabricate silicone soft-tissue layers
Version one:
Step 6: Cast the muscle layer. Cut recycled cylindrical storage tins in half longitudinally. Place the 3D-printed bone model inside and tape the ends to the mold with duct tape. Mix Dragon Skin 10 NV silicone with red Silc-Pig silicone pigment and pour into the mold. Allow to cure for approximately 75 minutes, then remove the mold.
Step 7: Cast the skin layer. Place a piece of power mesh fabric into the 3D-printed skin mold. Mix Dragon Skin 10 NV silicone with skin-coloured Silc-Pig silicone pigment and pour into the mold. Allow to cure for approximately 75 minutes. Cut five vertical slits into the ends of the skin.
Version two:
Step 8: Cast silicone directly around bones. Mix Dragon Skin 10 NV silicone with skin-coloured Silc-Pig silicone pigment. Pour into the casting molds that already contain the 3D-printed bone components. Allow to cure for approximately 75 minutes. Remove the four parts from their molds.
Checkpoint: Verify all silicone layers have cured completely and are flexible. For version one, confirm the muscle layer surrounds the bones and the skin layer is intact with slits at the ends. For version two, confirm each modular section has an even silicone coating.
Phase 3: Assemble the simulator
Version one:
Step 9: Install the replaceable cartridge. Place the hollow PLA tibial cartridge into the base assembly.
Step 10: Attach the skin. Stretch the cured skin layer around the bone and muscle model. Secure with Velcro straps.
Version two:
Step 11: Attach the modular sections. Connect the upper leg (femur), lower leg (tibia and fibula), and base at the extruded disk interfaces.
Step 12: Install the replaceable cartridge. Place the hollow PLA tibial cartridge into the bent-knee assembly.
Checkpoint: Verify the complete assembly is stable. Confirm the replaceable cartridge can be removed and replaced without disassembling the model. For version one, verify skin is secured by Velcro and the cartridge is accessible through the skin. For version two, verify modular sections attach and detach cleanly for transport.
References
- ↑ Sivanathan M, Micallef J, Clarke KM, Gino B, Joshi S, Abdo S, Buttu D, Mnaymneh M, Siraj S, Torres A, Brock G, Button D, Pereira C, Dubrowski A (2022). "The Development and Initial End-Point User Feedback of a 3D-Printed Adult Proximal Tibia IO Simulator." Cureus 14(5):e25481. DOI: 10.7759/cureus.25481. PMID: 35800805.
| Authors | Arturopelayo |
|---|---|
| License | CC-BY-SA-4.0 |
| Cite as | Arturopelayo (2026). "TissueDB/Simulators/Adult Proximal Tibia Intraosseous Access Simulator (maxSIMIO)". Appropedia. Retrieved September 21, 2026. |