Xiao et al.

BMC Musculoskeletal Disorders (2024) 25:104 BMC Musculoskeletal

https://doi.org/10.1186/s12891-024-07212-8
Disorders

RESEARCH Open Access

Clinical application of instant 3D printed cast

versus polymer orthosis in the treatment
of colles fracture: a randomized controlled
trial
Ya-Ping Xiao1, Hai-Jia Xu1, Wen Liao1 and Zhang-Hua Li1*

Abstract
Background The shortcomings of plaster in water resistance, air permeability, skin comfort, fixed stability and weight
of wearing are still to be solved. 3D printed cast can overcome the above shortcomings. At present, there is a relative
lack of data on the clinical application of 3D printed cast, probably due to its complexity, relatively long operating
time, and high price. We aimed to compare and evaluate the short-term effectiveness, safety and advantages of 3D
printed wrist cast versus polymer orthosis in the treatment of Colles fracture.
Methods Forty patients with Colles fracture in our hospital from June to December 2022 were selected and divided
into an observation group (20 patients, treated with instant 3D printed cast) and a control group (20 cases, treated
with polymer orthosis). Both groups treated with manual reduction and external fixation. The visual analogue scale
(VAS), immobilization effectiveness and satisfaction scores, Disability of the Arm, Shoulder and Hand (DASH) score,
complications and imaging data were collected and compared before immobilization and at 2, 6 and 12 weeks after
the fracture.
Results VAS at 2 weeks after the fracture was significantly lower in the observation group than in the control group
( P < 0.05). The immobilization effectiveness and satisfaction scores at 6 weeks after the fracture were significantly
higher in the observation group than in the control group (all P < 0.05). The DASH scores at 2 and 6 weeks after the
fracture were significantly lower in the observation group than in the control group (all P < 0.05). There wasn’t rupture
of the printed cast or orthosis in both groups. There were 2 cases of skin irritation in the control group, and no skin
irritation occurred in the observation group. The palmar tilt angle and ulnar inclination angle at 2 weeks and 12 weeks
after the fracture were significantly higher in the observation group than in the control group (all P < 0.05).
Conclusions Both instant 3D printed cast and polymer orthosis are effective in the treatment of Colles fracture. But
instant 3D printed cast is better than polymer orthosis in areas of good clinical and imaging performance, and high
patient satisfaction and comfort.
Keywords Colles fracture, 3D printing, Distal radius fractures, External fixation, Splint, Orthosis

1
*Correspondence: The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren
Zhang-Hua Li Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan 430000,
18971610121@qq.com Hubei Province, P.R. China

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Xiao et al. BMC Musculoskeletal Disorders (2024) 25:104 Page 2 of 9

Introduction (7) Patients voluntarily accepted treatment with polymer

Fractures have been immobilized in a similar manner for orthosis or instant 3D printed cast.
centuries with little change [1]. Plaster or splint is a most Exclusion criteria were as follows: (1) Severe open frac-
widely used method for fracture immobilization in China tures. (2) Severe systemic diseases, unable to cooperate
[2]. The technique has changed little since it was invented with manual reduction; (3) Old or pathological fractures.
in the 10th century. The shortcomings of plaster, such (4) Manual reduction failed to achieve functional reduc-
as water resistance, air permeability, skin comfort, fixed tion. (5) Fractures associated with vascular or nerve inju-
stability and weight of cast wear are still to be solved [3]. ries requiring surgical treatment.
Recently polymer orthosis has replaced traditional plas-
ter for the immobilization of fractured limbs and become Study design
the most commonly used external fixation material for This study was a randomized controlled study without
fractures treatment in Chinese hospitals [4]. With the blindness. Both the investigators and the patients were
development of science and technology, 3D printing has aware of the treatment methods. This study was autho-
become more common in the treatment of upper extrem- rized by the Hospital Medical Ethics Committee of our
ity fractures. 3D printed cast offers potentially excellent Hospital. A total of 40 patients in the emergency depart-
features that improve patient care and satisfaction [5]. ment of our hospital from June to December 2022 were
3D printing technology is becoming more practi- included in this study. Evaluation at the time of pre-
cal and has developed rapidly in the medical field [6]. sentation in the emergency department included his-
3D printing technology is widely used in orthopedics, tory taking, physical examination, and confirmation of
including patient education, surgical training, and pre- the suspected injury on radiographs. Written informed
operative preparation [7]. It can plan patient-specific consent to undergo external fixation treatment and be
surgical guidelines and print customized splints and included in the study was obtained from all patients.
prostheses. 3D printed cast is personalized and per- Patients who met the inclusion criteria of Colles frac-
fectly suitable for patient anatomy and pathology, which ture were randomly divided into two groups by random
has the advantages of light, breathable, washable, dirt- number table method. The manual reduction and immo-
resistant and sand-proof characteristic and improves the bilization of the two groups were performed by the same
comfort and satisfaction of patients [8, 9]. In addition, doctor. In the control group, 20 cases were treated with
3D printed cast can also be customized to avoid cover- external fixation of polymer orthosis. In the observa-
ing wounds and injured areas to prevent aggravation of tion group, 20 patients were treated with external fixa-
injury or delay in treatment. At present, there is a rela- tion of instant 3D printed cast. There weren’t significant
tive lack of data on the clinical application of 3D printed differences in baseline data between the two groups (all
cast, probably due to its complexity, relatively long oper- P > 0.05), as shown in Table 1, indicating comparability
ating time, and high price [8–11]. Instant 3D printing can between the two groups.
quickly print the cast, which can be quickly used in the
clinic practice, without long waiting, to meet the needs of Therapeutic methods
fractured patients. In the control group, the polymer orthosis was used for
We hypothesized that instant 3D printed cast would external fixation. The surgeon asked the patients to take
have similar properties and functions to polymer ortho- off the clothes of the affected limb, and explained the
sis. The aim of this study was to test the clinical feasibility treatment method and purpose to reduce the patient’s
and safety of personalized instant 3D printed cast, and to fear and obtain the patient’s cooperation. Fracture reduc-
evaluate and compare the clinical outcomes and radio- tion was performed by manipulation according to the
graphic results between instant 3D printed cast and poly- limb deformity and the X-ray images. After successful
mer orthosis for the immobilization of Colles fracture. reduction, the assistant maintained the palmar-flexion
angle and ulnar deviation angle. Finally, the surgeon per-
Methods formed external fixation with a polymer orthosis (Beijing
Selection criteria Jinwei Kangda Medical Instrument LTD., Beijing, China)
The inclusion criteria were as follows: (1) Patients met (Fig. 1).
the diagnostic criteria of Colles fracture. (2) Anteroposte- The observation group was fixed with 3D printed cast.
rior and lateral wrist radiographs were taken in the radi- The reduction method was the same as the above. After
ology department. (3) The type of the fracture was closed satisfactory fracture reduction, the patients were treated
or grade I open Colles fracture. (4) Anatomical or func- with external fixation of instant 3D printed cast (Fig. 2).
tional reduction was achieved after manual reduction. Anteroposterior and lateral wrist radiographs were
(5) The time from injury to medical attention was ≤ 48 h. performed weekly for the first two weeks in both groups
(6) Patients could successfully complete the follow-up. to assess fracture alignment. If the local symptoms were
Xiao et al. BMC Musculoskeletal Disorders (2024) 25:104 Page 3 of 9

Table 1 Comparison of baseline data between the two groups

Parameters Observation group Control group t/χ2 P
Cases 20 20
Gender(Cases) 0.417 0.519
Male 7 9
Female 13 11
Affected side(Cases) 0.107 0.744
Left 8 7
Right 12 13
Age(Years) 45.7 ± 16.2 44.2 ± 19.0 1.063 0.288
Time from injury to medical attention(Hours) 12.1 ± 12.2 11.9 ± 11.4 1.041 0.298

Fig. 1 Treatment of Colles fracture patients with external fixation of a polymer orthosis. A: The white one in the picture is the pad and the polymer or-
thosis is on it. B: Medial visual field observation of polymer orthosis external fixation; C: The external fixation of the polymer orthosis was observed in the
lateral visual field; D: Polymer orthosis external fixation in the anterior field of view

Fig. 2 Photographs of the Colles fracture patients immobilized with the 3D printed casts. A: Case 1; B: Case 2; C: Case 3; D: Case 4; E: Case 5; F: Case 6
Xiao et al. BMC Musculoskeletal Disorders (2024) 25:104 Page 4 of 9

Fig. 3 Manufacturing process of 3D printed cast. A: 3D scanning of the fracture site was performed using Einsan pro 2x handheld 3D scanner. B: The
BY-3D-I instant printer slicing system was used to segment the model, and the anteroposterior view was obtained after segmentation. C: The segmented
model of the lateral view; D: The segmented model of the axial view; E: The anteroposterior view of point cloud map automatically generated after cut-
ting by the slicing system; F: The lateral view of point cloud map automatically generated after cutting by the slicing system; G: A 3D printed cast had
been designed by a computer; H: A photo that the Instant 3D Cast Printer was printing a 3D printed cast; I: A photo of a patient with a Colles fracture
wore a 3D printed cast

Table 2 Parameters of the Einsan pro 2x handheld 3D scanner

Parameters
Light source form White LED light source, visible light
Scanning accuracy Maximum 0.05 mm
Volume accuracy 0.05 + 0.1 mm/m
Scanning & splicing speed 1,200,000 points/second, 20FPS
Scanning mode Mark splicing, feature splicing, texture splicing, hybrid splicing
Scanning depth of field 200-700 mm
Scanning range ≤ 430 mm*450 mm
Space point distance 0.25-3 mm
Calibration method Fast calibration, accurate calibration
Standard working distance 470 mm ± 30 mm
Color scanning Support
Equipment size ≤ 112 mm×114 mm×241 mm
Equipment weight 703 g ± 5 g (excluding line)
Transmission mode USB3.0

aggravated and the blood supply was impaired, the maintain in the appropriate area (Fig. 3A). Scanner
patients were asked to see a doctor in time and adjust parameters are shown in Table 2. The positioning of the
the brace. The malalignment caused by fracture displace- scanned subject was placed in what the clinician consid-
ment during fixation should be adjusted in time. More ers to be the immobilized position. When the distance is
often than not, closed reduction again restores the frac- appropriate, the system display will prompt green. The
ture position. If closed reduction failed, open reduction system will prompt “too close” or “too far” for improper
and internal fixation were chosen. The external fixator distance. So the operator will adjust the distance in time.
was removed after 6–8 weeks according to the healing The operator should hold the scanner smoothly and scan
of the affected limb. All patients were asked to come to at a uniform speed. Finally, the data obtained after scan-
the outpatient clinic at the 2nd, 6th, and 12th week after ning would be saved into STL format for output.
injury for anteroposterior and lateral wrist radiographs
and various scale evaluations (see the Outcome measures Optimization of 3D models
section below). Scanning data were processed using a BY-3D-I instant
printer slicing system (Wuhan Biying Biotechnology
The manufacturing process of instant 3D printed cast Co., LTD., Wuhan, China). First, the fracture site was
Medical data collection extracted, and then the model was cut and segmented to
The Einsan pro 2x handheld 3D scanner (Wuhan Biyin obtain the area covered by the personalized external fixa-
Biotechnology Co., LTD., Wuhan, China) was used to tion cast (Fig. 3B-D). The system automatically thickened
scan the fracture site. The scanning distance should the model to leave a space for pad to cover the fracture
Xiao et al. BMC Musculoskeletal Disorders (2024) 25:104 Page 5 of 9

site. The thickening size was determined according to the process (scanner, software program, etc.) within a week.
situation. The system automatically optimized the model Wrist 3D printed cast can be printed in just 10 min. The
surface and automatically generated the cast point cloud scan takes about 5 min. It takes up to 5 min to operate
map (Fig. 3E, F). computer system, and up to 5 min to process and put
it on the patient after printing. Therefore, a wrist 3D
Design of personalized external fixator printed cast takes about 25 min from the beginning of
The wrist was selected as the center plane of the three- preparation to the patient wearing it.
dimensional model after system optimization. The
three-dimensional model was divided into two parts or Outcome measures
a separate part of the orthosis on this plane. Then the The visual analogue scale (VAS) before immobilization, 2
edge of the wrist model was automatically drawn into the weeks and 6 weeks after the fracture was used to evaluate
external contour of the personalized external fixation cast the wrist pain caused by Colles fracture. Immobilization
by the software. The designer could select the personal- effectiveness at 6th week after the fracture was assessed
ized ventilation hole pattern in the database according according to previous scoring scales, including stability of
to the patient’s preferences and treatment requirements. immobilization, blood circulation, wear-pressure-related
The software would automatically generate the cast pat- pain, and pressure sores (Table 4) [10]. Patients’ com-
tern (Fig. 3G). fort and satisfaction were evaluated at 6th week after the
fracture by a satisfaction questionnaire, which includes
3D printing process questions related to treatment and assessment of patient
The overall size of the patient model needed to be satisfaction [12]. The Disability of the Arm, Shoulder, and
increased by about 3 mm because the fracture site Hand (DASH) scores at 2 and 6 weeks after the fracture
needed to be covered with pad before cast immobi- were used to determine current functional ability [13].
lization. The personalized external fixation cast was Complications, such as orthosis or cast rupture, skin irri-
manufactured by fused deposition modeling (FDM) tation or blister, fracture displacement and nonunion,
technology of 3D printing technology (Fig. 3H). BY-3D-I were recorded. The wrist radiographs before immobili-
instant 3D external fixation printer (Wuhan Biying Bio- zation, at 2 weeks and 12 weeks after the fracture were
logical Technology Co., LTD., Wuhan, China) served as taken to measure the angle of palmar tilt and ulnar incli-
the printer. The parameters of the 3D printer are shown nation angle of the injured wrist joint [14].
in Table 3.The material was made of polyester fiber poly-
mer material (Wuhan Biying Biotechnology Co., LTD., Statistical analysis
Wuhan, China). The wrist cast typically took approxi- The collected clinical data were processed and analyzed
mately 10 min to print and can be quickly applied to using IBM SPSS 19.0 statistical analysis software [15].
clinical treatment (Fig. 3I). After processing, the support Measurement data were expressed as mean ± standard
structure was removed and the surface of the model was deviation. The t test was used for inter-group compari-
simply polished to remove obvious burrs, so as to reduce son. Analysis of variance was used for intra-group com-
the damage to the skin. Firstly, the fracture site was ban- parison. Counting data were compared by chi-square
daged with a medical pad, and then the treated cast was test. Nonparametric test was used to compare data with
installed and immobilized to the fracture site by several uneven variances. The level of significance was set at less
velcro straps. than P 0.05.
The instant 3D external fixation printer used in this
study is highly intelligent and the operation process is Results
simplified, so that clinicians can quickly master the print- All patients in both groups successfully completed 12
ing process and apply it to the patients. Clinicians can weeks follow-up (Table 5). The VAS in both groups were
learn and become proficient in using the 3D printing significantly lower at 2 and 6 weeks after the fracture

Table 3 Parameters of the BY-3D-I instant 3D external fixation printer

Parameters
Filament diameter 4-5 mm
Nozzle temperature Above 200 degrees Celsius
Layer hight 0.5-1.5 mm
Nozzle speed 40 mm/s
Printing molding technology Melt deposition
Molding accuracy L < 100 mm: ±0.5 mm;L ≥ 100 mm: ±0.5% x L
Printing orthosis density 0.74-0.81 g/cm3
Machine size 1250 mm×850 mm×1750 mm
Xiao et al. BMC Musculoskeletal Disorders (2024) 25:104 Page 6 of 9

Table 4 Assessment of immobilization effectiveness of a orthosis [10]

Assessment Item Assessment contents and grading standard
excellent-3 good-2 acceptable-1 poor-0
Stability of Immobilization No loss of reduction Slight shift but no need for Reinforced same cast Loss of reduction
re-manipulation requiring further
procedure
Blood circulation Good terminal cir- Venous obstruction relief after physical Pale skin, low Significant ischaemia
culation with a florid movement or arm lifting temperature of the of involved limb,
complexion arm compartment
syndrome
Wear-pressure-related pain No pain Slight pain with a minor influence on Mild pain causedpoor- Severe pain caused
sleep quality sleep difficulty falling
asleep
Pressure sores No abnormality of the Non-blanchable erythema of the intact Skin breakdown or Full thickness skin
skin skin bleeding blister loss

Table 5 Comparison of clinical data between the observation group and the control group
Parameters Observation group Control group t P
VAS
Before immobilization 7.2 ± 1.3 7.0 ± 1.4 1.333 0.184
At 2 weeks after fracture 1.6 ± 0.48* 1.8 ± 0.38* -2.197 0.033
At 6 weeks after fracture 0.69 ± 0.32*# 0.74 ± 0.33*# -0.316 0.755
Immobilization effectiveness score 9.8 ± 0.96 9.4 ± 1.07 3.849 0.000
Immobilization satisfaction score 11.6 ± 1.4 10.8 ± 1.8 4.686 0.000
DASH
At 2 weeks after fracture 20.2 ± 5.7 22.6 ± 5.7 -5.781 0.000
At 6 weeks after fracture 8.1 ± 3.9# 10.2 ± 3.1# -5.319 0.000
Palmar tilt angle
Before immobilization -5.7 ± 4.0 -5.7 ± 4.1 -0.380 0.704
At 2 weeks after fracture 11.1 ± 2.8* 10.0 ± 3.2* 3.628 0.000
At 12 weeks after fracture 9.8 ± 2.7*# 8.1 ± 2.7*# 5.604 0.000
Ulnar inclination angle
Before immobilization 8.5 ± 3.6 8.8 ± 2.9 0.747 0.456
At 2 weeks after fracture 20.8 ± 2.5* 19.1 ± 2.8* 9.146 0.000
At 12 weeks after fracture 19.7 ± 2.5*# 17.5 ± 2.6*# 11.278 0.000
* Compared with before immobilization, P < 0.05
# compared with the 2nd week after fracture, P < 0.05

than before immobilization (all P < 0.05). The VAS in were significantly increased in the both groups at the 2nd
both groups was significantly lower at 6 weeks after the and 12th week after the fracture compared with before
fracture than at 2 weeks after the fracture (all P < 0.05). immobilization (all P < 0.05). The palmar tilt angle and
But the VAS at 2 weeks after fracture were significantly ulnar inclination angle in the both groups were decreased
lower in the observation group than in the control group at the 12th week after the fracture compared with the 2nd
(An example shown in Fig. 4) (P < 0.05). The immobiliza- week after the fracture (all P < 0.05). However, the palmar
tion effectiveness score and immobilization satisfaction tilt angle and ulnar inclination angle at 2 and 12 weeks
score at the 6th week after the fracture were significantly after fracture were significantly increased in the observa-
higher in the observation group than in the control group tion group compared with the control group (all P < 0.05).
(all P < 0.05). The DASH scores at 2 and 6 weeks after
the fracture were significantly lower in the observation Discussion
group than in the control group (all P < 0.05). 3D printed Although traditional fixation techniques such as casts
cast or orthosis weren’t broken in the two groups. There and splints have been widely used for external fixation
were 2 cases of skin irritation in the control group, and of fractures, few modifications have been made to them
no skin irritation occurred in the observation group. [5, 12]. In recent years, polymer orthosis has become
Complications such as skin blister, obvious fracture dis- more and more popular in China [4]. Although tradi-
placement and non-union weren’t reported in the both tional plaster and polymer orthosis are highly favored
groups. The palmar tilt angle and ulnar inclination angle from a clinical perspective due to their low cost, strength,
Xiao et al. BMC Musculoskeletal Disorders (2024) 25:104 Page 7 of 9

Fig. 4 A 60-year-old female with Colles fracture was treated with a polymer orthosis. A: Before treatment; B: After immobilization; C: After removing the
immobilization

and ease of application, the disadvantages of tradi- to the questionnaire score, the immobilization effective-
tional splints are also obvious such as heavy weight, low ness score and immobilization satisfaction score were
breathability, inability to get wet or clean, and lack of significantly higher in instant 3D printed cast group
transparency [16–18]. Compared to traditional plas- than in the polymer orthosis group. The DASH score
ter, a 3D-printed cast can be tailored to fit the patient’s was significantly lower in instant 3D printed cast group
anatomy and pathology, thus increasing the patient com- than in the polymer orthosis group. All these factors
fort and satisfaction [8, 9]. Personalized 3D printed cast were beneficial to pain relief and dysfunction improve-
increases direct skin visualization to minimize the need ment. After 3 months of follow-up, the angle of palmar
of keeping dry to maintain comfort [8]. At present, Use of tilt and ulnar inclination angle in both groups increased
3D printed technology is showing promise in orthopedic significantly at 2 weeks and 12 weeks after fracture com-
clinical practice. pared with before fracture. As the fracture healing, the
Hoogervorst et al. [19] showed in the cadaver model angle of palmar tilt and ulnar inclination angle in both
that, in immobilizing subacute distal radius fractures, group decreased at 12 weeks after the fracture compared
compared with traditional fiberglass plaster, 3D printed with 2 weeks after the fracture. But the angle of palmar
cast had non-inferior performance and had clinical appli- tilt and ulnar inclination angle were significantly higher
cation value. Chen et al. [10] conducted a clinical trial in the observation group than in the control group. We
using a 3D printed cast for forearm fracture and con- confirmed that both instant 3D printed cast and polymer
cluded that it increased patient comfort and satisfaction, orthosis can effectively treat Colles fractures, but instant
but their study included only 10 patients ranging in age 3D printed cast is superior to polymer orthosis.
from 5 to 78 years. Keller et al. [9] published a multidis- At present, 3D printed cast has been widely used to
ciplinary workflow study to verify the feasibility of mass construct high-precision bone models, which can be
production of patient-specific 3D printed devices for used for advanced imaging and preoperative simulation
hand and wrist rehabilitation in hospitals. There aren’t in preoperative planning [20, 21]. 3D printing technicians
clinical studies that have examined the efficacy of instant have mastered the professional knowledge and skills of
3D printed cast for the management of distal radius wrist therapists to accurately scan the patient’s upper
fractures. limbs. The use of 3D printing equipment can be used to
We designed this study under the assumption that manufacture customized 3D printing braces to improve
the properties and functions of instant 3D printed cast clinical practice for the field of orthopedic rehabilitation
is similar to those of polymer orthosis. We hypoth- treatment. Because the technology is still in its infancy,
esized that the instant 3D printed cast would be effec- the actual cost of producing 3D printed brace is in flux.
tive in good clinical and radiographic findings and high Although there are fixed costs associated with purchasing
patient satisfaction and comfort. Our study confirmed a scanner and printer, the printing materials are relatively
our hypothesis. Both the instant 3D printed cast and inexpensive. The fixed costs of 3D printing are expected
the polymer orthosis could effectively relieve the pain to decrease over time.
of Colles fracture. The pain was gradually relieved as the The goal of manufacturing 3D printed orthosis, with
fracture healed, but the instant 3D printed cast could waterproof, washable, lightweight, static, and remov-
relieve the pain more effectively at 2 weeks after fracture able padded materials, is to improve the quality of life of
than that of the polymer orthosis (P < 0.05). According patients and their compliance of immobilization methods
Xiao et al. BMC Musculoskeletal Disorders (2024) 25:104 Page 8 of 9

[8, 9]. The quality of these orthosis has a huge impact the costs of 3D printing cast are expected to significantly
on the wearer’s experience, especially for children, the decrease over time. 3D printed cast was functionally
elderly, athletes who need regular skin observation [8, noninferior to traditional brace, while providing a water-
10, 11]. However, the orthosis must be safe and func- resistant, lightweight, and breathable alternative [11].
tionally noninferior to the conventional brace currently Except for mild irritation, there weren’t adverse reactions
available. In terms of the wearable characteristics of the in the short term. Instant 3D printing takes about 10 min
orthosis, the instant 3D printed cast group was signifi- to print the wrist brace. After completion of printing,
cantly better than the polymer orthosis group, probably it can be applied to patients immediately after product
due to the more streamlined design and lighter structure improvement, which does not require patients to wait
of the instant 3D printed cast than the polymer orthosis. too long, and can quickly meet clinical needs. This is one
The function, effectiveness, comfort and satisfaction of of the advantages of instant 3D printing braces and the
the observation group were better than those of the con- key to their potential for widespread clinical use.
trol group. Two patients in the control group needed to The emerging technologies allow clinician to use better
replace the orthosis again because of discomfort. There casts and braces, providing more precise fitting for reli-
was no case of discomfort in the observation group. able, seamless, and waterproof immobilization. The suc-
These are consistent with our hypothesis and with previ- cessful application of this technique has a huge impact
ous studies [11]. on injury care and patient satisfaction, especially in the
Polymer orthosis is widely used in fracture treatment field of orthopedics. For patients who may require brace
in hospital emergency department and orthopedic clini- treatment, such as orthopedic injuries and chronic dis-
cal practice [5]. From the perspective of material prop- eases (such as arthritis and joint deformities), 3D printed
erties, polymer orthosis is light and easy to shape, which braces have great potential in improving the living quality
is better than traditional plaster. These features are the of patients.
key to its wide use. Polymer orthosis is widely favored in The limitations of this study are as follows. Medical
clinical practice because of their low cost, high strength conditions were not managed, and underlying medical
and ease of application. However, parents of children conditions may have affected the results of this functional
who wear polymer orthosis do not always satisfy and wear and safety study. Since 3D printing technology is a
need further improvement. Key concerns for parents and new technology, patients have a “cool factor” and may be
children include heavy weight, reduced movement of subjectively biased toward 3D printing braces. Data bias
the affected limb due to fear of sweating or getting wet, may have occurred when data were collected. Further
reduced movement of the affected limb to perform reha- studies need to blind volunteers to prevent subjective
bilitation functions, and inability to remove or see the bias. The wearing time in this study was short, and long-
skin under the orthosis to adequately examine for break- term wearing may cause more complications in patients
down, ulcers, or pressure sores [5, 22]. The 3D printed with fragile skin. Future studies are needed to further
cast can open windows and openings at the affected site, evaluate the safety and benefits of 3D-printed casts in
even allow the cast to be removed for skin examination if patients with orthopedic disease or injury. This study is
necessary. a single-center study with a small sample size. Further
While fit and safety are ensured, cost and printing time well-designed, randomized, controlled polycentric trials
are two significant factors in the clinical determination are needed to clarify the clinical application of this new
of treatment regimens with 3D printing technology. Pre- device.
sumably, the advantages of 3D printed cast far outweigh
all the advantages of polymer orthosis, thermoplastic Conclusions
orthoses, or prefabricated orthoses. The advantages of 3D Both instant 3D printed cast and polymer orthosis are
printed cast include but not limited to high fit, aesthetic effective in the treatment of Colles fracture, But instant
appeal, lightweight structure, waterproof design, and 3D printed cast is better than polymer orthosis in areas
improved medical rehabilitation and skin care capabili- of good clinical and imaging performance, and high
ties. However, its cost is higher than these of traditional patient satisfaction and comfort. This study is a prelimi-
brace, which increases the economic burden of patients. nary clinical exploration, and further research is needed
This is an important factor to consider for health care to verify our results, especially a large sample size multi-
professionals considering 3D printed cast. In clinical center controlled study.
practice, the cost of 3D printing scanner and printer is
Acknowledgements
the main cost for clinical use, while the printing materi- Many thanks to Ms. Sha Liang for the language polishing and grammar
als are relatively inexpensive. The 3D printing equipment correction of this article. We are very grateful for the help and cooperation
usage fee mainly increases the cost of patients. As the given during this study by medical personnel from other medical staff and
nursing staff of our orthopedic department.
scale of clinical application of 3D printing cast expands,
Xiao et al. BMC Musculoskeletal Disorders (2024) 25:104 Page 9 of 9

Author contributions 6. Muhindo D, Elkanayati R, Srinivasan P, Repka MA, Ashour EA. Recent advances
All authors made substantive intellectual contributions in this study to qualify in the applications of Additive Manufacturing (3D Printing) in drug delivery: a
as authors. X YP and L ZH designed this study. X YP and X HJ participated in Comprehensive Review. AAPS PharmSciTech. 2023;24(2):57.
collecting and analyzing raw materials. L W and X HJ played an important role 7. Portnoy Y, Koren J, Khoury A, Factor S, Dadia S, Ran Y, Benady A. Three-
in statistical analysis and language editing. An initial draft of the manuscript dimensional technologies in presurgical planning of bone surgeries: current
was written by X YP and X HJ. L ZH re-drafted parts of the manuscript and evidence and future perspectives. Int J Surg. 2023;109(1):3–10.
provided helpful advice on the final revision. All authors were involved in 8. Factor S, Atlan F, Pritsch T, Rumack N, Golden E, Dadia S. In-hospital produc-
writing the manuscript. All authors read and approved the final manuscript. tion of 3D-printed casts for non-displaced wrist and hand fractures. SICOT J.
2022;8:20.
Funding 9. Keller M, Guebeli A, Thieringer F, Honigmann P. In-hospital professional
Ya-Ping Xiao was funded by the Wuhan Medical Scientific Research Project production of patient-specific 3D-printed devices for hand and wrist rehabili-
(WX20Z07) during the implementation of the research. tation. Hand Surg Rehabil. 2021;40(2):126–33.
10. Chen YJ, Lin H, Zhang X, Huang W, Shi L, Wang D. Application of 3D-printed
Data availability and patient-specific cast for the treatment of distal radius fractures: initial
The datasets used and/or analysed during the current study are available from experience. 3D Print Med. 2017;3(1):11.
the corresponding author on reasonable request. 11. Graham J, Wang M, Frizzell K, Watkins C, Beredjiklian P, Rivlin M. Conventional
vs 3-Dimensional printed cast wear comfort. Hand (N Y). 2020;15(3):388–92.
12. Inglis M, McClelland B, Sutherland LM, Cundy PJ. Synthetic versus plaster
Declarations of Paris casts in the treatment of fractures of the forearm in children: a
randomised trial of clinical outcomes and patient satisfaction. Bone Joint J.
Ethics approval and consent to participate 2013;95–B(9):1285–9.
This study was approved by the institutional review boards/Ethics Committees 13. Novak CB, Mackinnon SE, Anastakis DJ, McCabe SJ. Factor structure of the
of Tongren Hospital of Wuhan University, and was conducted in compliance disabilities of the arm, shoulder and Hand Questionnaire in Upper Extremity
with the ethical principles of the Helsinki Declaration of 1975. Informed nerve Injury. Plast Reconstr Surg. 2019;144(5):1116–22.
consent was obtained from all subjects or their family members. 14. Zhang N, Fang J. Clinical Features and Surgical Strategies of Distal Radius
Posttraumatic Deformity. Emerg Med Int 2022, 2022:5268822.
Consent for publication 15. Bezzaouha A, Bouamra A, Ammimer A, Ben Abdelaziz A. Non-parametric tests
Not applicable. on SPSS to compare two or more means on matched samples. Tunis Med.
2020;98(12):932–41.
Competing interests 16. Gou Q, Xiong X, Cao D, He Y, Li X. Volar locking plate versus external fixa-
The authors declare no competing interests. tion for unstable distal radius fractures: a systematic review and meta-
analysis based on randomized controlled trials. BMC Musculoskelet Disord.
Received: 17 April 2023 / Accepted: 17 January 2024 2021;22(1):433.
17. Meng H, Xu B, Xu Y, Niu H, Liu N, Sun D. Treatment of distal radius fractures
using a cemented K-wire frame. BMC Musculoskelet Disord. 2022;23(1):591.
18. Espejo-Reina A, Carrascal-Morillo MT, Delgado-Martinez AD. Comparison of
two different ways to apply a circular plaster cast for distal radius fractures:
References biomechanical study. J Orthop Surg Res. 2021;16(1):99.
1. Berger AC, Barvelink B, Reijman M, Gosens T, Kraan GA, De Vries MR, Verhof- 19. Hoogervorst P, Knox R, Tanaka K, Working ZM, El Naga AN, Herfat S, Lee N. A
stad MHJ, Lansink KWW, Hannemann PFW, Colaris JW. Does circumferential Biomechanical comparison of Fiberglass casts and 3-Dimensional-Printed,
casting prevent fracture redisplacement in reduced distal radius fractures? A Open-Latticed, ventilated casts. Hand (N Y). 2020;15(6):842–9.
retrospective multicentre study. J Orthop Surg Res. 2021;16(1):722. 20. Tan L, Wang Z, Jiang H, Han B, Tang J, Kang C, Zhang N, Xu Y. Full color 3D
2. Chen Y, Lin H, Yu Q, Zhang X, Wang D, Shi L, Huang W, Zhong S. Application printing of anatomical models. Clin Anat. 2022;35(5):598–608.
of 3D-Printed Orthopedic Cast for the Treatment of Forearm Fractures: Finite 21. Ardila CM, Gonzalez-Arroyave D, Zuluaga-Gomez M. Efficacy of three-
Element Analysis and Comparative Clinical Assessment. Biomed Res Int 2020, dimensional models for medical education: a systematic scoping review of
2020:9569530. randomized clinical trials. Heliyon. 2023;9(2):e13395.
3. Jafari D, Birjandinejad A, Daliri M, Emami K, Moradi A. Treatment outcomes 22. Sedigh A, Kachooei AR, Beredjiklian PK, Vaccaro AR, Rivlin M. Safety and Effi-
of applying external fixator on distal radius fractures: a randomized clinical cacy of casting during COVID-19 pandemic: a comparison of the Mechanical
trial to compare between two directions of force exertion in parallel to radius properties of polymers used for 3D Printing to Conventional materials used
shaft and perpendicular to the distal radius articular surface. BMC Musculo- for the generation of Orthopaedic Orthoses. Arch Bone Jt Surg. 2020;8(Suppl
skelet Disord. 2023;24(1):283. 1):281–5.
4. Zhu XT, Sun YT, Sun YF, Lin S, Jiang H, Liu JT. [Clinical observation on plastic
splint treatment of middle clavicle fracture based on a new classification].
Zhongguo Gu Shang. 2022;35(3):258–64. Publisher’s Note
5. Schlegl AT, Told R, Kardos K, Szoke A, Ujfalusi Z, Maroti P. Evaluation and Com- Springer Nature remains neutral with regard to jurisdictional claims in
parison of Traditional Plaster and Fiberglass Casts with 3D-Printed PLA and published maps and institutional affiliations.
PLA-CaCO(3) Composite Splints for Bone-Fracture Management. Polymers
(Basel) 2022, 14(17).