This page is part of the Uniplanar External Fixation syllabus by Medical Makers for the Global Surgical Training Challenge.This page is not open edit.Read more...

These 3D printed bone models feature a semi-engraved model number, gender symbol, and two drilling direction arrows on the base of each model to assist with model identification and proper orientation of the simulator.

The top of each model displays the outer cortex and inner cancellous bone porosity and microstructure which provide visual fidelity to the surgical simulator.

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 uniplanar external fixation.^{[1][2][3][4][5][6][7][8][9][10]} 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. These open-source, locally reproducible, and high fidelity 3D printed bone models teach essential irrigation and debridement, powered and manual drilling, and uniplanar external fixation skills that are transferable to the performance of other limb-saving and life-saving surgeries that require hardware stabilization and fixation.^[11]

Find Local 3D Print On Demand Services[edit | edit source]

Please click here to find and contact 3D print on demand services in your region.

3D Printing Software, Hardware, and Filament Specifications[edit | edit source]

All 6 requirements below must be met in order to 3D print bone models for orthopedic surgical simulation training.

1. Slicing Program: Ultimaker Cura or Cura Lulzbot Edition only
2. 3D Printer Type: Fused Filament Fabrication
3. Nozzle Size: 0.4 mm
4. Minimum Build Volume Z Height: 180 mm
5. Print Speed on 3D Printer Control Screen: 100% or less
6. Filament: Unexpired White PLA just fresh out of the sealed packaging

We have identified suitable white PLA filament brands for our open-source, high fidelity bone simulators which include but are not limited to:

1. Filaments.ca Standard Milk White PLA 1.75 mm or Bone White PLA 1.75 mm Filament (Shore Hardness 84D) which can be shipped to any country;
2. Filaments.ca 2.85 mm White PLA Filament (requires minimum order of 48 spools) (Shore Hardness 84D) which can be shipped to any country;
3. Prusament Vanilla White PLA or Prusament Pristine White PLA 1.75 mm Filament (Shore Hardness 81D) which is available in 167 countries and territories; *Please do not purchase the Prusament PLA Blend Pearl White 970g because the Shore Hardness D value is only 72D +/- 1.5D*
4. Ultimaker White PLA 2.85 mm Filament (Shore Hardness 84D) which is available in at least 114 countries and territories through Ultimaker re-sellers (including all 69 countries in the Sub-Saharan, Middle East and North African regions through AIGE Limited);
5. Raise3D Premium White PLA Filament (Shore Hardness 79D ± 0.55D)^[13] which is available in the United States from the manufacturer and in Africa through AIGE Limited; or
6. Matterhackers PRO Series White PLA 1.75 mm and 2.85 mm Filament (Shore Hardness 80D-88D) which is available in North America.

Download Ready-To-Print GCODE Files[edit | edit source]

If you have a Creality Ender 3, Prusa i3MK3S, Ultimaker S3, Ultimaker S5, or Ultimaker 2+ Extended 3D printer, please download the pre-tested, ready-to-print g-code files below.

Creality Ender 3 3D Printer[edit | edit source]

Prusa i3MK3S 3D Printer[edit | edit source]

Ultimaker S3 3D Printer[edit | edit source]

Ultimaker S5 3D Printer[edit | edit source]

Ultimaker 2 Extended 3D Printer[edit | edit source]

Fusion 3 F400-S 3D Printer[edit | edit source]

You cannot print .GCODE files that are not prepared for your 3D printer.

Download 3D Model STL Files For Slicing[edit | edit source]

Download the two 3D files (.STL) in the table below to input the required print settings to create the print files (.GCODE) for other 3D printers.

Input Required Print Settings[edit | edit source]

Please pay attention to and input all the required settings below to ensure the bone models are printed properly and display the required visual, tactile, and acoustic fidelity for orthopedic surgical simulation training.

1. Slicing Program: please only use Ultimaker Cura or Cura Lulzbot Edition
2. Filament Material: PLA at all original default settings (click here for image)
3. Printing Temperature: please use the extruder and print bed temperature settings recommended for your specific 3D printer and specific PLA filament brand
4. Support: None (click here for image)
5. Layer Height: 0.3 mm or less (click here for image)
6. Wall Thickness: 6.2 mm (this changes the wall line count) (click here for image)
7. Top Layers: 0 (click here for image)
8. Bottom Layers: default value (not 0) (click here for image)
9. Infill Density: 15% (click here for image)
10. Infill Pattern: Tri-Hexagon (click here for image)
11. Top/Bottom Speed: 15.0 mm/s (click here for image)
12. Build Plate Adhesion Type: No Raft (click here for image)
13. Print Speed on 3D Printer Control Screen: 100% or less (click here for image)

Inspect Printed Models[edit | edit source]

1. Please review the quality assurance checklist below to verify that each model was properly printed.
2. If you are a 3D print on demand service provider, please send photos of the base, top, sides and vise attachment of sample printed models to the consignee.

Any model that does not meet the standard for all the quality assurance checklist items must be reprinted in accordance with the instructions outlined below.

#	Action	Meets Standard	Does Not Meet Standard	Does Not Meet Standard	Check most appropriate response	Check most appropriate response
1	Inspect the base.	The base of each model should be smooth, clean, and display three semi-engraved model numbers, a gender symbol, and two drilling direction arrows to assist with model identification and proper orientation of the simulator.	If the semi-engraved features are not visible, the model should be reprinted with the proper settings with no raft (click here to view reference screenshot) and no support material (click here to view reference screenshot). If the base is not smooth or clean (click here to view closeup photo), clean the build plate before reprinting. For build plates that require glue for adhesion of the printed object, apply a thin, smooth, and even layer of glue to the cleaned build plate.	If the base is open, the model should be reprinted with the proper settings of Bottom Layers: set to default value and not set to "0" (click here to view reference screenshot).	Model #1 Meets Standard Model #1 Does Not Meet Standard	Model #2 Meets Standard Model #2 Does Not Meet Standard
2	Inspect the top.	The top of each model should display the outer cortex and inner cancellous bone porosity and microstructure because these features provide visual fidelity to the surgical simulator. Use a ruler or calipers (not shown) to verify that the cortex thickness is 6.2 mm. If the cortex thickness is not 6.2 mm, then the model should be reprinted with Wall Thickness set to "6.2 mm" (click here to view reference screenshot).	If the inner cancellous bone features are not visible, the model should be reprinted with the proper settings of Top Layers set to "0" (click here to view reference screenshot).	If there is no inner cancellous bone, the model should be reprinted with the proper Infill Density of "15%" (click here to view reference screenshott).	Model #1 Meets Standard Model #1 Does Not Meet Standard	Model #2 Meets Standard Model #2 Does Not Meet Standard
3	Inspect both sides.	The surface of the bone model should be smooth to provide visual and tactile fidelity of the surgical simulator.	If the bone model surface is uneven or missing material, the model should be reprinted (i) using brand new white PLA filament fresh out of the sealed package, and (ii) with the proper settings including changing print speed back to default values for the Generic PLA filament profile and reducing the layer height to 0.2 mm or less.	If the bone model surface is uneven or missing material, the model should be reprinted (i) using brand new white PLA filament fresh out of the sealed package, and (ii) with the proper settings including changing print speed back to default values for the Generic PLA filament profile and reducing the layer height to 0.2 mm or less.	Model #1 Meets Standard Model #1 Does Not Meet Standard	Model #2 Meets Standard Model #2 Does Not Meet Standard
4	Inspect the vise attachment.	The entire surface of the vise attachment should be smooth with no missing material and the angled surface of the vise attachment should have no filament drooping.	If the angled surface of the vise attachment is uneven or has drooping filament (click here to view closeup photo), the model should be reprinted (i) using brand new white PLA filament fresh out of the sealed package, (ii) with the proper settings including changing print and fan speeds back to default values for the Generic PLA filament profile, and (iii) while reducing the layer height to 0.2 mm or less.	If any surface of the vise attachment is uneven (click here to view closeup photo) or missing material (click here to view closeup photo), the model should be reprinted (i) using brand new white PLA filament fresh out of the sealed package, and (ii) with the proper settings including changing print speed back to default values for the Generic PLA filament profile and reducing the layer height to 0.2 mm or less.	Model #1 Meets Standard Model #1 Does Not Meet Standard	Model #2 Meets Standard Model #2 Does Not Meet Standard

Calculate Pricing[edit | edit source]

Once you have verified the models meet quality assurance standards, please click here to calculate the price of the models and generate an invoice.

The table below summarizes our 2022-2023 market research across different countries on the pricing for Adult Male Tibial Bone Models #1 and #2 (not including local taxes or shipping costs).

We did not include 2022 pricing from ITESL Fab Lab in Abuja, Nigeria because their Makerbot 3D printer is not capable of 3D printing our bone models. Makerbot 3D printers cannot use g-code files sliced by Ultimaker Cura or Cura Lulzbot and the proprietary Makerbot software does not permit inputting of the custom settings required to manufacture high fidelity bone simulation models for orthopedic surgical training.

Inspect Models Before Delivery[edit | edit source]

1. Click on this link to print the quality assurance checklist for each shipment of 3D printed models by clicking on the "Download PDF" button in the upper righthand corner of this screen and selecting "Layout: Landscape" option for printing.
2. Review the quality assurance checklist to verify that each model was properly printed prior to delivery and click on the checkboxes to check the most appropriate response.
3. Write the model production period, total number of Adult Male Tibial Bone Models #1 and #2 accepted, date of inspection, print and sign your name, and fill in the name, address, and phone number of the consignee at the bottom of the checklist.
4. Attach the completed and signed checklist to the delivery invoice for the consignee.
5. File and save a back-up copy of the completed and signed checklist for your production and inspection and distribution records.

Any model that does not meet the standard for all the quality assurance checklist items must be rejected and will not be delivered to the consignee.

Troubleshooting Guide[edit | edit source]

If you're having problems in properly printing these models, please click on this link and carefully follow the detailed step-by-step instructions.

Cost Savings and Production Efficiency[edit | edit source]

These data-driven, gender-specific, easy to print, labor-saving, eco-friendly, hygienic, and cruelty-free bone simulation models are not made with natural rubber latex, are designed with safety features to protect users, and can be locally reproduced to offer the highest fidelity, standardized orthopedic surgical simulation training at the lowest cost to medical officers and surgeons who are not orthopedic specialists.

The costs of the 3D Printed Adult Tibial Bone Models will vary depending on the region's 3D printing organizations, and locally available brands of filament. In Nigeria, one 750 gram roll of Ultimaker White PLA filament (Shore Hardness 83D) costs €33 Euros which is equal to about 5¢ USD per gram.^[4][21]

In 2022, the 3D Printed Adult Male Tibial Bone Models #1 and #2 produced by a local 3D printing business in Nigeria at 95% scale is $11.25 and $10.90 USD (not including local taxes or shipping costs).^[20][22] The estimated filament weight and printing times for the 3D Printed Adult Male Tibial Bone Models #1 and #2 at 95% scale are 191 grams and 148 grams and 8 hours and 17 minutes, and 6 hours and 34 minutes, respectively.^[22]

The Tibial Shaft Transverse Fracture Simulator is easy and quick to assemble and does not require any tools, specialized equipment, technical expertise, or time-consuming preparation to build, install, operate and maintain this simulator within the intended place of use. By purchasing locally made 3D printed bone models for uniplanar external fixation skills training, the learner also supports the local economy while saving on customs dues, processing fees, and international shipping costs that would be incurred when using artificial bone products that are not made locally and avoids prolonged and uncertain customs clearance times that occur when using artificial bone products that must be imported.

Noteː A product comparison was not made with the:

• Sawbones Tibia, Solid Foam, Large ($16.75 USD) because these models do not provide the tactile fidelity necessary to develop the skills to prevent plunging through the far cortex;
• Tibia with 12 mm Canal, Foam Cortical Shell, Left, Medium ($18.00 USD) because these models “are not designed to accurately reproduce the biomechanical behavior of human bone,” “cut and drill easier than the plastic cortical shell models,” and do not provide the tactile fidelity necessary to develop the skills to prevent plunging through the far cortex;
• Tibia with Fracture, Foam Cortical, Left, Medium ($32.25 USD) because these models “are not designed to accurately reproduce the biomechanical behavior of human bone,” “cut and drill easier than the plastic cortical shell models,” and do not provide the tactile fidelity necessary to develop the skills to prevent plunging through the far cortex;
• Sawbones Cylinder with Encapsulated Oblique Fracture ($41.25 USD) because the hollow short fiber reinforced epoxy cylinder does not have anatomic features that make it suitable for uniplanar external fixation training and does not appear to have adequate length to properly simulate an adult tibial midshaft fracture for uniplanar external fixation training which requires the placement of widely spaced pins in each fracture fragment;
• Sawbones Tibia, Plastic Cortical Shell, Left ($56.00 USD) because these models do not provide the tactile fidelity necessary to develop the skills to prevent plunging through the far cortex; and
• Nacional Ossos 9701 Left Tibia with Fibula - Fracture 2 ($24.00 USD) because the manufacturer has no internal data and/or external studies that demonstrate that these models have similar mechanical properties to human bone.^{[27][31][32][33][34][35][36]}

It is not ethical or safe to have learners (who have no prior experience with drilling into bone) teach themselves orthopedic surgical skills on bone simulators that lack the tactile fidelity required to develop the skills to prevent plunging through the far cortex.

The benefits of 3D printing and delivering one Tibial Shaft Transverse Fracture Simulator locally in India are the cost is at least 13 - 14 times cheaper ($373.25/$28.75 USD and $373.25/$26.84 USD) and the production time is at least 58 - 83 times faster (120,960 minutes/2081 minutes and 120,960 minutes/1450 minutes) than purchasing ($217.25 USD) and shipping ($156 USD) an equivalent Sawbones 4th Generation Composite Bone Model that is manufactured abroad and takes 84 days or more to produce. Local taxes, customs dues, processing fees, and customs clearance times were not included in the cost comparison because these values are not known until the Sawbones 4th Generation Composite Bone Model order (which takes 84 days or more to produce) has shipped.

Acknowledgements[edit | edit source]

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[edit | edit source]