Uniplanar External Fixation/3D Printed Adult Male Tibial Bone Models

▼Created by Medical Makers for the Global Surgical Training Challenge.This page is not open edit.

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.^{[2][3][4][5][6][7][8][9][10][11]} Each model has a vise attachment to allow the user to secure the model inside a standard vise clamp to maximize safety during simulation-based skills 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.^[12]

On-site access to a 3D printer is not required to reproduce these bone models. The open-source 3D files can be downloaded by any 3D printing organization anywhere.

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

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

1. Slicing Program: Ultimaker Cura, Cura Lulzbot Edition, Prusa Slicer, Bambu Studio, or FLsun Slicer

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

Ultimaker Cura, the world’s most popular 3D printing software with millions of users, already has profiles for many commercially available 3D printers, allows you to create a custom profile for other 3D printers, and is open-source and free to download.^[13]

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

1. Prusament Vanilla White PLA or Prusament Pristine White PLA 1.75 mm Filament (Shore Hardness 81D)^[14][15] which is available in 167 countries and territories;

2. Prusament recycled PLA (rPLA) Rissoto 1.75 mm Filament (Shore Hardness 86D)^[1] which is available in 167 countries and territories;

3. Raise3D Premium White PLA Filament 1.75 mm Filament (Shore Hardness 84D)^[16] or Raise3D Hyperspeed White PLA Filament (Shore Hardness 80D-81D)^[17] which is available in the United States from the manufacturer and in Africa through AIGE Limited;

4. Matterhackers PRO Series White PLA 1.75 mm and 2.85 mm Filament (Shore Hardness 80D-88D)^[6][18][19] which is available in North America; or

5. Ultimaker White PLA 2.85 mm Filament (Shore Hardness 84D)^[20] 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).

Any white PLA filament brand with a Technical Datasheet with Shore Hardness D values between 79D-93D is suitable for 3D printing high fidelity bone models for simulation-based skills training.

We do not recommend using the PLA filament brands listed below because they do not have a Technical Datasheet with Shore Hardness D values between 79D-93D.

If you have a Creality Ender 3, Bambu Lab A1 Mini, FLsun T1, Bambu Lab P1S, Prusa MK4, Prusa i3MK3S, Ultimaker 2+ Extended, Ultimaker S3, Fusion 3 F400-S, or Ultimaker S5 3D printer,^{[38][39][40][41][42][43][44][45][46][47]} please download the pre-tested, ready-to-print g-code files below.

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

Please remember to clean your printer extruder nozzle before initiating each print to help ensure that the white base of the bone models do not have any brown marks.

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.

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 use Ultimaker Cura, Cura Lulzbot Edition, Prusa Slicer, Bambu Studio, or FLsun Slicer

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) or Vertical Shells: Perimeters or Wall Loops: 15 (= 6.2 mm wall thickness/0.4 mm nozzle)

7. Top Layers (click here for image) or Horizontal Shells: Top Solid Layers or Top Shell Layers: 0

The Top Layers should be "0" to allow the tibial bone's interior anatomy (outer cortex and inner cancellous bone) to be exposed at each fracture end to provide proper visual fidelity for the Tibial Shaft Transverse Fracture Simulator

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) or 3D Honeycomb

11. Top/Bottom Speed or First or Initial Layer Speed: 15.0 mm/s (click here for image)

12. Build Plate Adhesion Type: No Raft (click here for image)

You may need to include a brim if you are using a glass build plate.

13. Print Speed on 3D Printer Control Screen: 100% or less (click here for image)

If you are not familiar with using Ultimaker Cura or Cura Lulzbot Edition slicing programs, please click here to follow step-by-step instructions to prepare the models for printing.

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.				Model #1 Meets Standard Model #1 Does Not Meet Standard	Model #2 Meets Standard Model #2 Does Not Meet Standard
2	Inspect the top.				Model #1 Meets Standard Model #1 Does Not Meet Standard	Model #2 Meets Standard Model #2 Does Not Meet Standard
3	Inspect both sides.				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.				Model #1 Meets Standard Model #1 Does Not Meet Standard	Model #2 Meets Standard Model #2 Does Not Meet Standard

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

All the 3D printed models print support-free and are designed to be made on any single or multi-extruder, fused filament fabrication 3D printer that can use g-code files sliced on Ultimaker Cura, Cura Lulzbot Edition, Prusa Slicer, Bambu Studio or FLsun Slicer, and has a build volume Z height of 180 mm or more.

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.

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

The benefits of 3D printing the Tibial Shaft Transverse Fracture Simulator locally in Nigeria are that: (i) the production and delivery costs are 5 - 7 times cheaper and the production time is 34 times faster than purchasing an equivalent Sawbones 4th Generation Composite Bone Model which takes 21 days to produce and must be imported into LMICs; and (ii) the production cost is over 7 times cheaper than acquiring a human cadaveric tibia prepared by a local university anatomy lab.

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.^[5][59]

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).^[60][61] 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.^[61]

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.

Note: A product comparison was not made with the:

• Sawbones Tibia, Solid Foam, Large (SKU: 1125; $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 (SKU: 1117; $18.25 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;
• Tibia with Fracture, Foam Cortical, Left, Medium (SKU: 1117-26; $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 (SKU: 1521-617-4; $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 (SKU: 1104-9; $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 (code 9701; $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.^{[66][70][71][72][73][74][75][76]}

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.

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.