The Tibial Fracture Fixation team is developing a training module based on open-source, high fidelity, 3D printed bone simulation models that can be locally made using biorenewable plastic and open-source, open filament, user-friendly desktop 3D printers to teach modular external fixation skills to stabilize fractures. Thus, they hope to save limbs and reduce permanent disability. 

Using an open-source digital library of downloadable 3D printable models, learners will be able to select gender-specific models which accurately represent bone length and diameter, external contour and cross-sectional shape, bicortical anatomy, cortical hardness, cancellous bone porosity, and microstructure, and far cortex thickness at tibial shaft pin insertion sites for modular external fixation. These are designed to mimic real bone when the learner applies powered and manual drilling techniques.

Besides the physical simulation that teaches psychomotor skills, the module also includes resources designed to teach anatomy, clinical indications, pre-operative and post-operative care. The self-assessment framework consists of a checklist and photo review.

“Our module will offer the highest fidelity simulation training for the lowest cost,” says Dr Umaru. “We are leveraging open-source software and hardware to teach medical officers with no prior orthopaedic surgery experience, as well as surgeons who may not have received this kind of specialized training.”

With the expected expansion of clinicians who can perform this procedure, the team hopes to reduce the morbidity and mortality associated with this common orthopaedic injury. 

The tibia, also known as the shinbone, is the larger and stronger of the two bones in the leg below the knee. It connects the knee with the ankle bones. Open tibial shaft fractures are the most common open long-bone fractures, and absolute fracture counts have been increasing substantially over the past 30 years.

The team led by a surgeon in Nigeria hopes to address the severe shortage of orthopaedic surgical expertise in low and middle income countries to treat this common injury.

“In a country of over 206 million residents, Nigeria has only 400 orthopaedic surgeons,” says Dr Habila Umaru, who is co-leading the team with members from Nigeria, Uganda, Canada and the United States.  

“These national shortages of orthopaedic surgeons leave patients vulnerable to traditional bone setters whose unsafe practices commonly lead to gangrene, limb loss, and death.” 

Their module allows medical officers and surgeons who are not orthopaedic specialists to become competent and confident in performing modular external fixation repairs of open tibial shaft fractures sustained in regions without specialist coverage.