Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients

The optimal treatment for humeral shaft fracture remains controversial. Although a large proportion of these fractures can be treated without surgery, a recent study, involving a randomized controlled trial, compared bridge plate with functional brace fixation for humeral shaft fractures and concluded that surgical plating has a statistically significant advantage with a better DASH score, lower non-union rate, and lower residual deformity rate [1]. As for proximal third humeral shaft fractures, they were thought to be complicated with a higher non-union rate when treated conservatively compared with middle and distal fractures [2, 5, 16]. Since the helical plating technique was introduced for the treatment of humeral fractures, some studies have shown that this technique resulted in increased stiffness compared to fixation with a straight plate under torsional loading and produced satisfactory clinical outcomes [14, 17]. However, how to produce a suitable helical plate for each individual patient is a big question for surgeons. Previous studies have proven that the 3D printing technique is a good tool for designing surgical plans and pre-contouring plates used to treat other bone fractures [18–20]. Our results demonstrate the benefit of pre-contouring plates on a 3D-printed model for this special technique.

In this study, all kinds of fractures (from type A to type C) were treated by helical plating technique, and satisfactory outcomes were obtained. It was coincident with our previous cadaveric study results [11], so we thought this special technique was a good choice for these fractures. Previously, Stedtfeld and Biber reported that approximately 49.3% of the proximal third humeral shaft fractures extend into the humeral head and that this type of fracture cannot be characterized by conventional AO classification [6]. In our study, a total of 41.3% (19/46) of fractures involved the proximal humerus, a rate slightly lower compared with their report, but still a high rate of these fractures. Consequently, attention should be paid on the proximal third humeral shaft fractures since about half of them need adequate proximal fixation.

At the 1-year follow-up visit, all fractures were healed and none of the patients had suffered non-union, an outcome better than that reported for other treatment methods [1, 2, 5, 9, 21–23]. The mean union times of the Synbone group and the 3D-printed groups were 16.16 and 15.57 weeks, respectively, which was similar to other studies even though our patients were older than in other studies [11, 17, 24]. Functional evaluations were satisfactory but were worse than those reported by others who conducted the same surgeries (Constant-Murley score 76.80, 76.95 vs. 88.6) [13, 17]. This may be attributed to the fact that our population was much older, so that humeral fracture might be combined with rotator cuff degeneration in our enrolled patients.

The primary outcomes of this study were that surgical duration and blood loss were reduced by the use of a 3D-printed model for pre-contouring the plates before surgery. This result was consistent with our hypothesis and can be explained by the fact that the humeri of older patients in our country are much shorter than the standard Synbone, requiring surgeons to adjust the plates during surgery. Since the 3D-printed model represented the actual size of the bone, the plates pre-contoured on these models were always suitable for fixing the fractures. Because of MIPO technique application, there was only 15 ml of blood loss difference between the two groups; maybe it was not clinically relevant, but on the whole, it reduced 12.5% of blood loss volume and presented a small part of the benefit of 3D-printed technique.

We compared the outcomes between the two grades of surgeons in the 3D-printed group. Although senior attending doctors are much more experienced than junior attending doctors, the results showed that there was no significant difference between them in terms of outcome. We believed that the 3D printing technique would make this novel technique much easier and make it available for use by less specialized surgeons. However, since all fractures in the Synbone group were finished by senior attending doctors, it was impossible to compare the results with a control group.

There are some limitations to this study: (I) the retrospective design limits the level of evidence and only represents one single center; (II) some patients who died within 1 year of surgery are excluded from this study, which may influence the final results; (III) all these surgeries were finished by surgeons in one trauma center, so personal differences cannot be avoided; and (IV) this study only included Asian population, and maybe the results could be challenged by other races because of different skeletal sizes.

3D printers to allow patients make their own drugs at home

DUBAI // Fast-paced developments in 3-D printing technology could result in patients making their own prescription drugs to treat chronic medical conditions at home.

The latest innovations were on show at the Dubai Health Forum, a two-day conference showcasing what technologies patients can expect to benefit from in the near future.

Although regulation and accessibility remain the key hurdles in bringing 3-D printing to the market, doctors at Dubai Health Authority are confident they can soon take the technology into people’s homes.

It would also probably bring down the cost of providing expensive cancer care drugs that have soared in price and are unaffordable to some healthcare providers.

FabRx, a UK-based biotech company focused on developing 3-D printing technology for making pharmaceuticals and medical devices, presented the latest developments in personalised medicines at the forum.

“Our idea is not to scale up the process, but to bring this into hospitals, clinics and at home,” said the company’s director of development Alvaro Goyanes.

“Eventually, we see prescriptions being sent to people’s homes so they can print their own medication. Patients will be able to print the right dose, or combination of drugs, for themselves.”

Pharmacists will need to develop the correct dosage for each filament used to print off each batch of pills. The filament is the raw material used by printers to create the final product. Filaments will be sold to hospitals to print their own drugs using in-house printers.

The method should also reduce the incidence of counterfeit medication, because the filament will be harder to replicate, developers claim.

“With the right application, this method will be cheaper and faster for patients to use,” Mr Goyanes said.

“Hospitals are not currently manufacturing medicine, but that could change to allow medical centres to manage their own manufacturing process.”

Although 3-D printed medication has been tested on animals, it is yet to be used in human trials. It would need to be approved by regulators before use, but developers are confident this could be reached within two years.

3-D printing could result in the cost of the most expensive drugs being reduced, including those used in cancer treatment.

A 2015 study by the US National Bureau of Economic Research found the prices of cancer drugs had increased 10 per cent every year between 1995 and 2013.

According to Cancer Research UK, Cancer costs the world £895 billion (Dh3.99 trillion) a year – more than any other disease. In the US, pricing freedom means the best-selling drugs are on average three times more expensive than in the UK.

Dr Mohammad Al Redha, director of the executive office for organisational transformation at the DHA, said the development could be a game-changer for health care.

“Technology is challenging us every day, and while we must be careful how we spend our dollars, we want to give the best to our patients,” he said.

“This will potentially change the way health care works.”

Dr Al Redha said any home printing of 3-D drugs would be strictly controlled. Log-in codes similar to a bank account would allow access to domestic 3-D printing machines used for medication.

“Three-D printing can be compared to the transportation industry with automated systems,” he said. “If you no longer need a kidney donor because you can use bio-ink that is a 100 per cent match to the recipient, it is a lot cheaper and there is zero risk of rejection, the development is huge.

“It is the same with medication.”

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3D Printed Organs And Tissue Could Soon Be A Reality For Transplant Patients

3D Printer

(Photo : Getty Images/Spencer Platt) A new breakthrough in 3D printing technology has seen researchers create body parts including an ear, muscle, cartilage, skull bone and even a jawbone – that have all been transplanted into mice and rats.

A new breakthrough in 3D printing technology has seen researchers create body parts including an ear, muscle, cartilage, skull bone and even a jawbone – that have all been transplanted into mice and rats.

It may sound like science fiction but the results of the study, conducted by researchers from the Wake Forest Baptist Medical Center in Winston-Salem, N.C., show that printing living tissue to replace injured or diseased tissue in patients could soon become commonplace, writes New York Daily News.

“This novel tissue and organ printer is an important advance in our quest to make replacement tissue for patients,” Anthony Atala, M.D., director of the Wake Forest Institute for Regenerative Medicine (WFIRM) and senior author on the study, said in a statement.

Once transplanted into mice and rats in the lab, the ear, cartilage and bone began to grow and develop connective blood vessels.

The technology will be fit for human trials once the researchers have conducted more tests and received government approval.

The researchers have received funding from the U.S. military for the study, as they hope they technology can be used to treat injuries sustained in battle.

“Our goal is to treat patients and our wounded warriors,” Atala said in a statement.

While 3D organ printing technology has been around for years, the new tissue is more stable than those that have been printed in the past.

“The concept is, you would take a small piece of tissue from a patient – less than half the size of a postage stamp – then we can expand the cells outside the body and place them in the printer so we could print tissues for that same patient,” Atala said.

The cells for the body parts take several weeks to grow and just a few hours to print.

The Wake Forest School of Medicine built a customized 3D printer that scans a blueprint design uses bio-gel and biodegradable materials to print the product.

Atala said that the technology could be available in the near future.

Researchers are aiming to engineer tissue to produce replacement tissue and organs in the lab to increase stockpiles of organs used for transplants and overcome the current shortages.

The paper was published in Nature Biotechnology.