Where Are 3D-Printed Casts?

Years ago, I met Scott Summit , Design Director of 3DSystems . At that time, he was wearing a cast due to ongoing issues with his wrist. He told me it was a cast specific for himself; and one that his physician could open and close in seconds. He even told me he could shower with it, without the need to wrap it in plastic bags. That was, of course, no ordinary cast as it was a 3D-printed cast.

However, since that time, I haven't come across any medical practitioners who offer 3D-printed casts as part of normal care. Nor have I seen people with casts wearing 3D-printed ones. There are companies that do produce these peripherals, but it’s the same old gypsum casts that prevail.

So what happened to those promising 3D-printed casts? Were they a fad that will remain only a fantasy for tech enthusiasts? It was challenging to find the exact reason so we tried to speculate why. We also asked insights of an expert, namely Juan Monzón Fabregat. Fabregat is the ex-CEO of Exovite, a company that used to manufacture 3D-printed casts itself.

Finding out what happened to 3D-printed casts and why they haven’t broken into healthcare might provide valuable insights into what we can expect from other seemingly-exciting and advanced technologies. Companies and startups investing in such solutions could thus learn where to improve where 3D-printed casts failed.

Cast from the past

The appeal for 3D-printed casts isn’t based on hype alone. They are thin, breathable, customisable, waterproof, easily removable, and prevent infection and muscle atrophy. In short, they outperform traditional casts in many ways. For in many ways, 3D-printed casts represent the natural evolution in casts.

To separate the hype from the fact, researchers investigated this technique’s advantages over traditional casts. A study, conducted in 2017 , found that 3D-printed casts “increased patient comfort and satisfaction.” Another one in 2018 also found superior “patient satisfaction, comfort, and perceived functions" with 3D printed casts.?

But the same study added that both conventional and 3D-printed casting techniques “demonstrate similar objective function” based on their functions and the dexterity they provide the wearer. Juan Monzón Fabregat shared a similar opinion. “The traditional splints are not that bad,” he commented. “Of course, the personalised 3D-printed splint is a better product but is not better than the traditional ones to take a chance to change.”

An example in practice

We recently interviewed Diana Hall, President/CEO of ActivArmor to ask her opinion about this. Her company designs 3D printed, waterproof, plastic casts that allow patients to practice basic hygiene like showering and hand washing, and allow for customizations in device thickness, coverage areas, offsets for pins or incisions, exposures for wound or skin observation or adaptation with advanced healing technologies like bone stimulators.

When asked why we still don't see 3D printed casts everywhere in healthcare despite its value having been shown multiple times, she answered this:

"We are definitely seeing them in mainstream practice more and more, thanks to ActivArmor! Our system is easy to implement in any clinical setting - we have taken the pain points of digital design and 3D printing, and made them turnkey. They're now covered by Medicaid, Medicare and private insurers which helps as well! As the 3D printing technology gets faster, from hours to minutes, we have no doubt that it will take over as the standard of care."

Lack of evidence?

But then again, the evidence is rather lacking . Most of the literature about 3D-printed casts is around the cast’s design and material properties rather than their effectiveness. The few that focused on the latter did show promise. But to convince a larger subset of traumatologists, more of such studies would be needed. These deficiencies in the literature itself attest to the limited adoption of 3D-printed casts by the medical community and patients alike.?

Even if the medical 3D-printing market is projected to be valued at $1.2 billion by 2024 , it remains to be seen how much 3D-printed casts will add to this market. The COVID-19 pandemic could accelerate this growth in 3D-printing. Indeed, the current public health crisis highlighted the importance of 3D-printers in the medical industry . They enable healthcare institutions to bypass the supply chain and help meet demand with supplies made in-house. Despite the potential that 3D-printed casts hold, the technology still seems niche facing several challenges before its mass adoption.

Out on a (broken) limb

One of those challenges can be because of the state of the technology itself, leading to traumatologists favouring traditional casts over its simplicity and availability, even if 3D-printed casts have superior potential. Take the Osteoid prototype from 2014 for example. It doesn't only keep the limb’s bone in place but can also help in the bone’s healing. With its pulsed ultrasound bone stimulator system, it fastens bone healing via ultrasonic vibrations . With traditional plaster casts, doctors couldn’t apply the vibrational therapy, but 3D-printed casts do allow it. But Osteoid went off the radar, with no news since 2014 and seemed destined to stay as a prototype.

“The technology used for all this matter sometimes is excessive compared with a normal cast and the setup needs too much time and preparation,” Fabregat told The Medical Futurist. For instance, the Spanish startup Xkelet takes about two hours to 3D-print its casts. “Obviously, that's about two hours too long. But eventually, the goal with these new printers is to print in 12 to 30 minutes,” said Tim Dobrinich, COO and co-founder of TriMed , a partner of Xkelet. Fabregat told us that the whole procedure should be even shorter, less than 5 minutes, for the adoption to take off.

Another aspect to consider is that not all hospitals have a 3D-printer and scanner to make personalised casts. A way to circumvent this would be for 3D-printing companies to partner with healthcare institutions and offer the equipment required. That’s the approach of Latvian startup CastPrint . They provide clinics with their 3D-scanner where physicians scan the injury and forward the 3D-image to the company.

Dead-end solutions

Xkelet offers yet another solution that does not require an expensive scanner but an iPad scanner attachment that can even be used at home and send the information obtained for printing. But the whole logistics behind getting the cast from the manufacturer to the wearer and the price itself (a CastPrint cast costs around €100 ) are potential deterrents.?

Fabregat also pointed out another issue. “The surface of the limb during the inflammatory phase after the injury and the phases just after it change too much and even if you use the most accurate 3D-scanner, it is not going to fit,” he explained. “The time between 3D-scanning and 3D-printing is too long today and the patient limb surface changes too much.”

These persisting issues show that maybe the technology behind 3D-printed casts is still not ready yet. Medical professionals might rightly think why they would need to go through all those hoops when the conventional method works anyway.

The return of the 3D-printed casts: a new hope?

It's also possible that 3D-printed casts haven't been widely adopted simply because patients and physicians don't know about this option. But not if you are in Latvia, according to Janis Olins, one of CastPrint’s founders. "You can go in any clinic or hospital in Latvia and ask the traumatologist about CastPrint, and they would've already used it, or at least know there is a viable alternative to the traditional plaster cast," Olins says . The company has partnered with Latvian clinics and even expanded to the U.K., with plans to branch out further into Europe.

Xkelet’s casts are also commercially available in the United States for wrist and arm injuries, with more in the pipeline. “We're going to come out with [a cast for] the whole arm, where it comes up past the elbow into the bicep, also the foot and ankle, and then we're looking at a full leg brace as well,” Tim Dobrinich said .

CastPrint saw a fourfold year-on-year growth. The founders further said that they are confident that their startup would be successful. They are also exploring other fields such as 3D-printing in orthodontics and collaborating with healthcare professionals and businesses.?

Maybe their approach might prove fruitful and expand the adoption of 3D-printed casts. This could drive competition and investment in the field, leading to reduced costs of equipment and eventually an accepted alternative to conventional cast.

Go Big Tech or go home?

As for Juan Monzón Fabregat, he believes that the task is up to Big Tech to tackle. “[It] needs to come from a big company that believes this is the way; otherwise is too complicated to have a chance because of the risks and factors related to investment and regulatory requirements,” he told us.

The case of 3D-printed casts is an interesting one for techno-optimists like us at The Medical Futurist. It shows that certain elements of healthcare cannot be replaced by advanced technologies; or simply that it takes too much time and investment to make it happen. If this is the case, then the story of how 3D-printing casts couldn't make it to healthcare practice should be a cautionary tale for everyone else in the industry.

Eventually, only time will tell if 3D-printed casts are indeed the evolution of casts. I just hope that Scott Summit wasn’t one of the few people that I have seen using such casts.