Study, design and prototyping of arm splint with additive manufacturing process
The aim1 of this study is to propose the additive manufactured 3D printed technique for adaptive organic design splint as a solution for the problems generated by the use of casts in medical applications. Since the end of the XVIII century, when casts begin to be used, they have barely improved. Thanks to new manufacture and material techniques, we can improve and modernize this commonly used fracture treatment method. Based on three dimensional digitalization techniques and modeling via reverse engineering software, a 3D printed splint is proposed, which will provide the benefits of cast avoiding its deficiencies.
A review of wrist splint designs for additive manufacture
Currently, patients with wrist ailments may be prescribed wrist splints to aid in their treatment regime. The traditional fabrication process of custom-made splints is skill dependent, time-consuming and the splints themselves pose numerous problems with regards to patient compliance. To overcome this, the use of Additive Manufacture has been proposed in recent years and there has been an increase in public awareness and exploration. Many of these developments have been as a result of the Maker-movement, the Internet-of-Things and development of more accessible technologies and infrastructures to enable production of AM builds; hobbyists, industry and academia are exploring the use of AM for splints, all with strengths and weaknesses. This paper highlights and describes specific examples of AM wrist splints currently available in the public domain and summarises strengths, weaknesses, opportunities and threats for the future implementation into the healthcare sector.
Treatment of War Wounds and Fractures
The special features of modern warfare, and particularly the wide use of the aerial bomb, have introduced a great diversity in the type of war wounds, while the new strategy of air attack on the civil population has necessitated fresh arrangements for the reception and treatment of casualties. The organization of the surgical services must be adapted to the requirements of the varying conditions, but the actual treatment of any war wound-whatever the nature or scene of the battle in which it was received-should always be based on certain fundamental biological principles. A Five-point Programme The biological treatment of wounds (if we may so call it) rests on five basic principles. To ensure the greatest possible success in treating a recently inflicted wound, each and all of these five principles or " points," as we shall term them, should be applied. They are: (1) prompt surgical treatment; (2) cleansing of the wound; (3) excision of the wound; (4) provision of drainage; (5) immobilization in a plaster-of-Paris cast. Point 1: Prompt Surgical Treatment.-The successful healing of a wound depends largely on the promptitude with which appropriate treatment is given. The risk of serious post-traumatic infection is directly proportional to the time interval between the receipt of the wound and the surgical operation. The work of the rescue parties, ambulance services, first-aid posts, and resuscitation teams must all be organized in such a way as to enable surgical treatment to be given with the minimum of delay. The shorter the period during which the casualty is left untended, and the shorter the time taken in transport to hospital, the earlier can resuscitation begin and the patient be ready for operation. At this stage let me say that the choice of anaesthetic is important if the operation is not to cause undue risk. Spinal anaesthesia should never be used in shocked patients. Gas-and-oxygen should be given only by an experienced anaesthetist, and if the latter is not available ether should be used. It is important to remember that a patient suffering from shock requires much less anaesthesia than a fit subject. The amount of anaesthetic given should be the minimum required to enable the surgeon to carry out his task. In cases of .evere shock a local anaesthetic should be employed. Point 2: Cleansing of the Wound. No antiseptic known to-day is equal to soap and water as a means of dealing with contamination in a wound. Even the best antiseptic is unable to remove " dirt " from the wound, and the majority in fact actually fix the dirt in the tissues. Others increase the risk of infection by further destruction of the cells. Both sodium coco-nut soap and sodium ricinoleate are more effective in getting rid of bacteria from a wound than are most of the non-caustic antiseptics. The staphylococcus is the only organism that has a certain degree of resistance against these soaps. For the skin a solution of iodine or a similar skin antiseptic should be used. At the end of the operation the wound may be dusted with sulphanilamide. I never used this in my country, where I treated over a thousand cases with this technique, and with only a very few exceptions had uniformly good results; but there now appears to be enough experimental evidence to justify the local application of one of the sulphonamide compounds as a prophylactic measure. Point 3: Excision of the Wound.-This is the keystone of the whole technique and the factor which permits the final procedurenamely, the application of a closed plaster. Without proper excision no recent wound should be enclosed in plaster. This is a rule to which there can be no exception, and it is generally a lack of appreciation of the vital importance of proper excision that is responsible for the failures that may occur with this technique. To ensure proper excision the wound must first be enlarged (the debridement of the French). In wounds caused by high-explosives the extent of damage in deeper tissues, particularly the muscles, is often enormously greater than that in the skin and superficial layers, and consequently, unless the traumatic opening in the skin is considerably enlarged by incision, excision of the deeper tissues is very difficult and must generally be incomplete. After the initial incision of the skin and fascia, and the excision of the dead portions of these tissues, the operation proceeds layer by layer into the deeper tissues in successive stages of incision and excision, until the bottom of the wound is reached. The periosteum, however, must never be incised. Only a narrow strip of skin should be excised; excision of the fascia should be radical, and that of the muscles still more radical, but in the case of the bone we must be as conservative as possible and limit resectioh to fragments which have lost their periosteal connexions or their muscular attachments.