3D-Printed Casts Improve Patient-Reported Function and Satisfaction in Children With Stable Fracture Patterns.

Background: Three-dimensional (3D) printing is an emerging technology with unclear roles in the care of pediatric orthopaedic fractures. The purpose of this study was to compare patient-reported impressions of custom 3D-printed casts (3DC) versus traditional fiberglass casts (TFC) after short arm immobilization of stable fracture patterns.

Methods: Patients aged 18 years or younger with stable fracture patterns (per detailed criteria) treated with a short arm 3DC or TFC during a 2-year period were reviewed. Patients with less stable fracture patterns, <2 weeks of immobilization, or incomplete follow-up or outcomes assessments were excluded. Clinical outcomes were recorded. Patient-reported function and satisfaction outcomes were evaluated with a standardized patient activity survey and patient valuations of each immobilization device were compared using the validated Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 (QUEST 2.0) assessment. Institutional charge estimates per distinct clinical scenarios were computed.

Results: Among 106 included patients (49 3DC, 57 TFC), the average age was 10.0±3.2 (range: 2 to 18), and the average cast duration was 4.4±1.5 (2 to 10) weeks. Patients with 3D-printed casts reported it was easier to shower (1.2 vs. 2.6, P<0.001), swim (1.1 vs. 3.2, P<0.001), play sports (1.5 vs. 3.2, P<0.001), participate in family vacations (1.0 vs. 1.3, P=0.028), and they reported less overall functional limitations (1.5 vs. 2.3, P<0.001). Regarding satisfaction, 3D-printed casts were considered more durable (5.0 vs. 4.7, P=0.012). Skin irritation rates were equivalent between cohorts (12.2% 3DC vs. 8.8% TFC, P=0.559). There was 1 unplanned visit in the 3DC group versus 5 in the TFC group (2% vs. 9%, P=0.411). One patient lost alignment in a 3DC while violating activity restrictions. The most common difference in estimated institutional charges was $48 more for a 3DC (ranged from -$252 to $48).

Conclusion: 3D-printed casts outperformed TFCs in durability, a pediatric patient's ability to participate in common activities, and overall patient satisfaction in exchange for sometimes slightly higher estimated charges. In appropriate patients, 3D-printed casts offer a reasonable alternative to traditional fiberglass casts.

Level Of Evidence: Level III.