ABSTRACT

The aim of this study is to evaluate the custom-made three dimensional (3D) printed bio-degradable implants in osteosynthesis of fractures and compare them with widely used titanium implants.

Custom 3D printed bio-degradable poly-L-lactic acid (PLLA) implants were compared with titanium plates. The tibial fracture models were obtained from ankle computerized tomography (CT) images. 3D model files obtained from 10 patients ankle CT images with medial malleolar fractures were used for anatomical reduction and 3D implant modeling. The PLLA and titanium plates were tested on 3D printed bone models. Fracture reduction quality was evaluated by drawing an imaginary line between the proximal and distal cortices of the fracture. A break in this imaginary line was defined as low quality of reduction. Maximum load and compression strengths were evaluated by the mechanical test system. Results were statistically evaluated with independent sample t-test (P < .05).

The maximum load and compression strength values of the titanium plates were significantly higher than the PLLA plates. The reduction quality was perfect in all custom-made plate fixed fracture models; however, in six of 10 fracture models fixed with titanium plates, the reduction was found in low quality.

The results of the study revealed that full anatomical custom plates can be manufactured using 3D printer. The 3D design provided better reduction quality at in vitro fracture models. These bio-degradable implants may be eligible for implantation at fracture stabilization at non-weight bearing areas. The improvement of bio-degradable materials and 3D printing techniques may allow these systems to be eligible for the treatment of fractures.