RALEIGH, N.C. (Ivanhoe Newswire) — Imagine surviving a car crash- only to be told by doctors that while your life was saved, you’d lose your leg. For one woman, the news was devastating, but then she learned of a new technology that could put her back on her feet again.
Ruth Smith-Leigh is finally feeling no pain after a car accident last year crushed her leg, breaking her shin, ankle and multiple bones in her foot.
Ruth was referred to Samuel B. Adams, MD, Orthopedic Surgeon at Duke University Medical Center.
Dr. Adams told Ivanhoe, “It’s very, very serious. Most people do end up losing their leg from this type of injury.”
Smith-Leigh said, “It was a very frightening situation for me to be in at that point; frightening and almost hopeless.”
In the past, amputation would have been the likely outcome. But thanks to a new custom 3-D printed bone implant, her leg repaired itself.
“This is a tremendous breakthrough. It gives us so many more options that we didn’t have. We can make any shape and size that we want, and the 3-D implant, the truss technology that’s used is actually stronger than the native bone,” Dr. Adams explained.
Using CT scans, Ruth’s anatomy was recreated with an implant made of titanium to fit the bone.
Dr. Adams said, “Your body’s bone cells love to grow into this material both on a microscopic level and because of these open pores, the bone can grow around and through it.”
Eight months after surgery, Smith-Leigh told Ivanhoe, “I returned back to work. I am now back to being a basketball and a soccer mom and just getting things back to normal,” and back on her feet.
Only a handful of patients have received 3-D printed bone implants in the U.S. Dr. Adams says the new technology can be used to help save the limbs of those with bone cancer or any trauma or accident, without the risk of rejection seen with traditional methods like bone grafting.
BACKGROUND: Car crashes, falling from a jungle gym and falling down stairs can all cause broken bones or fractures. When too much pressure is placed on the bone, it will split or break. Sometimes the break will be visible or accompanied by bleeding, bruising, or swelling. Intense pain and limited mobility also usually accompany broken bones. It’s important to limit mobility and stay calm until medical personnel arrive at the scene. Applying ice may reduce swelling, and sometimes splints can be used to immobilize the broken bone. A break in the bone of any size is called a fracture. An open fracture occurs if the bone punctures the skin. While most fractures occur as the result of trauma, a stress fracture occurs when a hairline crack forms in the bone from repeated or extended forces or pressure on the bone. (Source: http://www.nlm.nih.gov/medlineplus/ency/article/000001.htm)
TREATMENT: After a bone is fractured, it has to be set in the right place. This process is called reduction. Sometimes the reduction is done without surgery, called a closed reduction, and other times it can be done with surgery, called open reduction. Sometimes, devices must be placed to make sure the bone stays in place. After the bone is set, casts or splints are used to immobilize the bone. Painkillers may also be recommended to reduce pain. After the cast or splint is removed, the area may still be stiff or swollen. Then, it is recommended to gradually begin using the area again. While there may be difficulties at first, such as a noticeable limp, but they should disappear. It may take four to six weeks for the bone to regain strength. (Source: http://www.webmd.com/a-to-z-guides/understanding-fractures-treatment?page=2)
NEW TECHNOLOGY: Now, 3-D printing is helping doctors find new treatments for more serious cases. The first commercial 3-D printer was invented in 1986 by Charles Hull. Now, these printers are finding uses in the medical field. A viral video earlier this year showed Robert Downey Jr. presenting a 3-D-printed mechanical arm to a boy with a partially developed right arm. “I think yours might be better than mine,” the Iron Man star quipped. After Ruth Smith-Leigh broke almost every bone in her foot from a car accident, she could look to 3-D-printed bone implants to save her leg. CT scans helped doctors recreate Smith-Leigh’s anatomy in the form of a titanium implant that fits into the bone. The bone then grows in and around the implanted device. Only a handful of people have received bone transplants in the U.S. (Source: http://www.livescience.com/34551-3d-printing.html, http://variety.com/2015/film/news/robert-downey-jr-gifts-bionic-iron-man-arm-to-7-year-old-fan-1201451880/, Samuel B. Adams, MD, Duke University Medical Center)
FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Sarah Avery
919-660-1306
Sarah.avery@duke.edu
If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com
Samuel B. Adams, M.D., Orthopedic Surgeon at Duke University Medical Center discusses a new procedure involving a 3-D bone implant.
Interview conducted by Ivanhoe Broadcast News in February 2014.
Can you take us through Ruth’s case?
Dr. Adams: Ruth came to our emergency room after being involved in a rollover motor vehicle collision. She swerved to miss a drunk driver. She sustained an open fracture which means the bones came through her skin and multiple fractures of her lower extremity, including her tibia bone, her talus, her calcaneus and multiple additional foot fractures. She underwent multiple surgeries to temporize her fractures and clean out her open wounds. She then saw some physicians who recommended an amputation. That is when they recommended she come and see me to see if there were any salvage options.
She was in very bad shape, correct?
Dr. Adams: Correct. She underwent multiple surgeries to clean those open wounds and also temporize the fractures, which means to help stabilize until we could figure out a long term plan. She did see multiple surgeons who recommended amputation. She was then sent to me for a limb salvage option, which means is there any way that we can allow her to keep her foot.
Before you had this implant, what would be the option besides amputation?
Dr. Adams: We used to use cadaver bones to try to fill the defect. However, this was such a large defect of bone that it wouldn’t have been an option.
Where does the 3-D bone implant come in?
Dr. Adams: The idea of the 3-D bone implant is that we can make any shape and size that we want. The Truss technology that’s used is actually stronger than the native bone. We can make any shape and any size and provide a structural integrity to her leg that’s stronger than what she would have with either her own bone or if we had used a cadaver bone.
Is this something that would be almost personalized?
Dr. Adams: It is personalized. She had a CT scan and that scan was sent to the company. They recreated her anatomy and then made an implant to fit the bone that she had lost in the accident.
What is it made of?
Dr. Adams: Titanium. Its electron beam melted titanium, which basically means that there’s powder titanium that’s melted and then 3-D printed into any shape and size.
Is this actually stronger than her bone because of the body’s ability to kind of mold into that titanium?
Dr. Adams: That is true as well as the truss technology that this particular company uses. If you look at the implant, it’s basically triangles. If you’re driving by a bridge, you’ll start to notice various triangles being used in engineering. That’s what this company has employed in to the human body. And, that’s what makes it strong.
Can you talk about how the body’s bone actually will grow into that?
Dr. Adams: The basic science, or the laboratory data that we have, indicates that your body’s bone cells love to grow in to this material on a microscopic level. Because of these open pores, the bone can grow around and through it allowing the patient’s bone to really interdigitate with the implant.
Where is Ruth now?
Dr. Adams: This was done last April. Around Thanksgiving, she came to see me and had shopped fourteen hours in one day. The last visit in January when she came in to see me, she pulled out her pedometer and had already walked eight thousand steps that day. She’s also back to teaching a full work day.
How big of a breakthrough would you say that this is?
Dr. Adams: This is a tremendous breakthrough. It gives us so many more options that we didn’t have. There are so many people out there that have these severe accidents that lose part or all of their bones and we’re now able to reconstruct those.
Is there any kind of disease, like bone cancer, that you would use this for?
Dr. Adams: Certainly. This could also be used in bone cancer. There are a lot of procedures where we have to resect a large portion of somebody’s bone and this can fill that void.
When Ruth came to you, explain the dire circumstance she was in and where she is now?
Dr. Adams: She was not able to walk on this leg. Many people had told her that she was going to lose her leg. She did not want that of course. She’s a mother of several children and she wanted to do anything she could to preserve her leg. I was able to provide that for her.
How exciting was that for you?
Dr. Adams: Tremendous excitement. It’s proof of concept and hopefully I can help many more patients in her same situation.
Is there any chance of somebody having an allergic reaction to the metal?
Dr. Adams: There are people with metal allergies. Typically, they do not have an allergy to titanium. This is pure titanium. Most people that have metal allergies, the allergy is to nickel.
What is the recovery like?
Dr. Adams: In this instance, I was very conservative in her recovery and kept her non weight bearing for about three months. However, I have done this since her surgery and I was able to weight bear one patient at two weeks. So, we’ve become more comfortable with the technology and we’ll be able to weight bear people and they’re recovery time will be shorter.
By that, you mean you didn’t want her to walk for three months?
Dr. Adams: She was able to get up, just not allowed to put weight on this leg. That was mainly because it was new technology and the first time being used. I was concerned about how her bones would really grow in to the implant.
What is the time difference with the 3-D and cadaver? You can pretty much get one of these printed up right away, correct?
Dr. Adams: Correct. This may be several years off, but the future is that this could be in-house and you’re in surgery and need a custom-shaped implant. You can send the specifications downstairs and could have one printed while you’re in the operating room.
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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