Date Published: August 22, 2017
Publisher: Springer International Publishing
Author(s): Peter C. Liacouras, Divya Sahajwalla, Mark D. Beachler, Todd Sleeman, Vincent B. Ho, John P. Lichtenberger.
The prosthetic devices the military uses to restore function and mobility to our wounded warriors are highly advanced, and in many instances not publically available. There is considerable research aimed at this population of young patients who are extremely active and desire to take part in numerous complex activities. While prosthetists design and manufacture numerous devices with standard materials and limb assemblies, patients often require individualized prosthetic design and/or modifications to enable them to participate fully in complex activities.
Prosthetists and engineers perform research and implement digitally designs in collaboration to generate equipment for their patient’s rehabilitation needs. 3D printing allows for these devices to be manufactured from an array of materials ranging from plastic to titanium alloy. Many designs require form fitting to a prosthetic socket or a complex surface geometry. Specialty items can be scanned using computed tomography and digitally reconstructed to produce a virtual 3D model the engineer can use to design the necessary features of the desired prosthetic, device, or attachment. Completed devices are tested for fit and function.
Numerous custom prostheses and attachments have been successfully translated from the research domain to clinical reality, in particular, those that feature the use of computed tomography (CT) reconstructions. The purpose of this project is to describe the research pathways to implementation for the following clinical designs: sets of bilateral hockey skates; custom weightlifting prosthetic hands; and a wine glass holder.
This article will demonstrate how to incorporate CT imaging and 3D printing in the design and manufacturing process of custom attachments and assistive technology devices. Even though some of these prosthesis attachments may be relatively simple in design to an engineer, they have an enormous impact on the lives of our wounded warriors.
An estimated 1.9 million amputees in the United States  sustained their amputations from trauma and vascular disease. The United States military care system has seen an increase in the number of amputees since the beginning of the conflict overseas. Over 1600 service members have lost limbs since 2001, with over 300 members having lost multiple limbs. Over 40,000 veterans with limb loss also receive care for their amputations within the DOD/VA system .
In this manuscript, we researched and presented several methodologies to construct personalized examples highlighting the benefits CT reconstructions and the 3D printing process provide in successfully manufacturing prosthetic devices in limited quantities. These are but a few examples of the applications of this technique. Three-dimensional reconstructions from computed tomography create an accurate starting geometry for designing custom prosthetic attachment and devices when barriers to traditional design processes and production methods exist. Once 3D reconstructions were obtained anywhere from thirty minutes (Wine Glass Holder) to three hours (Hockey Skate Adapters) were spent on the digital design process. 3D Printing has created new opportunities for the production of prosthetic devices and allows for the creation of unique, customized devices. Some limiting factors of these developed methodologies include the availability of equipment and materials, software, scanners, CT scan expenses, 3D printers, and experienced staff.
Using CT in conjunction with digital design and 3D printing can be utilized to create custom rehabilitation devices. Facility resources and knowledge can be limiting factors. 3D printing has created new opportunities previously unavailable to prosthetics, occupational therapy, and assistive technology departments. This methodology continues to be utilized when conventional techniques are limiting or suboptimal. Interprofessional collaboration, imaging, and digital manufacturing expertise are vital to the successful form, fit, and function of these devices.