Case Study: Return-to-Duty With A Novel Treatment Approach for Scaphoid

ActivArmor Case Study 1

Date of Case: March 20, 2025 Author: Kathleen E. McKeon, MD, Orthopedic Surgeon at Andrews Sports Medicine & Orthopedic Centers, Birmingham, AL

Patient Information

Patient is a 39 year-old right-hand-dominant male who works as a civilian hairstylist.

Case Presentation

Patient presented to the clinic complaining of right wrist pain, starting after a fall 1.5 years ago. He did not seek care at the time of injury, but he has continued to have pain and swelling, which prompted him to seek care at this time.

Exam/Diagnosis/Assessment

X-rays showed a nonunion of the scaphoid waist with cystic change and mild radial styloid beaking.

Treatment

After discussing treatment options, he elected to proceed with a scaphoid nonunion repair using distal radius autograft and a radial styloidectomy. Surgery went well. The patient was placed in a splint post-operatively, then transitioned to a fiberglass cast 8 days post-op to allow for continued immobilization and to protect the healing wounds.

Traditional treatment for a scaphoid nonunion repair typically involves a short arm thumb spica cast for 8-12 weeks. However, since his job required getting his hands wet daily, and to explore the potential for improved comfort and compliance with a waterproof, hygienic cast alternative, the decision was made to utilize a custom 3D printed cast.

At 4 weeks post-op, once surgical wounds were healed, the patient was transitioned to a 3D printed cast, designed to immobilize the wrist and MP joint of the thumb, but leave the IP joint free.

3D Printed Casting Process

Imaging:

An iPhone app was used to create a digital 3D model of the patient’s wrist.

Design

The thumb spica cast was designed to provide customized immobilization while allowing for ventilation and comfort. The cast design was low-profile, specifically for the patient, allowing for as much function as possible while adequately immobilizing the healing bone. wrist.

Material

A biocompatible, lightweight thermoplastic material was used, ensuring durability, hygiene, and ease of wear.

Printing

The cast was printed in-clinic in just under 5 hours on an FDM 3D printer, and applied to the patient the same following day.

Application of the Cast

The patient was fitted with the 3D printed cast in the clinic. It fit snugly around the wrist, providing adequate support to the scaphoid. The 3D printed cast was not as bulky/cumbersome around the palm/thumb area as traditional thumb spica casts. It fit well and required very little-to-no adjustments for comfort.

Follow-Up and Rehabilitation (4 Weeks Post-Application)

• Symptoms: The patient exhibited an improvement in symptoms, including a decrease in pain and swelling.

• Impacts: The 3D printed cast allowed for the ability to monitor surgical site healing as well as the ability to get cast wet, which was necessary for the patient to return to work without sacrificing immobilization of the healing scaphoid.

• Cast Assessment: The cast remained intact with no signs of wear or discomfort.

• Imaging: In follow-up X-ray, bridging bone could be clearly visualized across the nonunion site.

• Cast Removal: The cast was quickly removed without a saw, and the patient was provided with a volar cock-up brace to use for heavier activities for an additional four weeks. There was no sign of skin breakdown.

• Patient Feedback: Patient reported increase quality in life both occupationally and personally due to the "cool factor” and the ability to return to work

Outcome

The patient returned to his pre-injury activities. He expressed a high level of satisfaction with the 3D printed cast, reporting improved freedom, hygiene, comfort and mobility compared to traditional casting methods. Healing time and outcomes were equal-to or better-than expected when using a traditional cast.

Discussion

This case illustrates the effective use of a 3D printed cast for the treatment of a scaphoid fracture repair. Benefits included:

• Waterproof and hygienic

• Ventilation properties, allowing for skin observation and reducing irritation

• Custom, low-profile fit

• Improved compliance due to comfort, lifestyle freedom, and social “cool factor”

Conclusion

3D printed casts represent a promising advancement in orthopedic treatment and return-to-duty, particularly for patients whose daily activities or jobs require the ability to get wet or dirty, or with longer healing phases, as with scaphoid fractures or other related injuries. The custom fit and design process allows for lower-profile immobilization, giving patients improved function and mobility of the hand, where traditional casts can be bulky or cumbersome, especially useful for athletes or occupational functions. Further studies with larger sample sizes will be necessary to validate these findings and explore how the clinical flow process with 3D printing can be incorporated into the clinical flow process.

References

1. Pan, J. et al. "The role of 3D printing in orthopedic surgery." Orthopedic Clinics of North America, 2022.

2. Smith, R. et al. "Innovations in fracture management: The impact of 3D printing." Journal of Hand Surgery, 2023.

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This case study exemplifies the integration of modern technology into orthopedic care, enhancing both patient outcomes and satisfaction.

*All 3D imaging, design and print equipment, software and services were provided by ActivArmor, Inc.