A hospital in Jordan is trialing the use of 3D-printed prosthetic limbs to treat refugees injured in the ongoing war in Syria. The technology allows an artificial limb to be designed and built within 24 hours, and at a fraction of the cost of conventional prostheses. The trial appears to be a success story for the practical use of 3D-printed prosthetic limbs, and in a part of the world where the need is greatest.

Médecins Sans Frontières (MSF, also known as Doctors Without Borders) has been working with five volunteer patients, including children, since the beginning of 2017. The trial's taking place at the MSF Reconstructive Surgery Hospital at the Al-Mowasah Hospital in Amman, Jordan, which works with those injured during the conflicts in Syria, Iraq and Yemen.

"Rather than exploring electronic solutions or very complicated solutions, we want to keep things as simple as possible but also durable," says Safa Herfat, a biomedical engineer at MSF. A printed prosthesis can cost around US$20, "rather than the hundreds of dollars a normal upper limb prosthesis would cost."

There are benefits beyond speed and expense. For example, the printed prosthesis can be tailored to the patient's specific needs. This might involve designing the prosthesis according to the corresponding limb, or to the particular work the patient hopes to perform, from driving a car to day-to-day tasks around the home. It's also possible for the prosthesis to be designed remotely, since only the scanning and printing needs to be done on site.

The printed prostheses also tend to be much lighter than the conventional kind. "That can be a huge factor in the adoption rate of upper-limb prostheses," explains Herfat. "If it's really heavy and cumbersome to wear, then the patient will likely not adopt it in the long term and set it aside."

But perhaps most significantly, the technology is bringing the benefits of prosthetic limbs to those who would otherwise be unable to access it. The trial is capable of printing prostheses for upper-limb amputees, for whom the options with conventional prostheses are fewer. However, this trial aside, it's doubtful that patients in the region would have access to prosthetic limbs at all.

The team is using an Ultimaker 3, the latest version in the Ultimaker line previously reviewed by New Atlas. This is a high-end 3D printer costing around £2,800 (US $3,900), and capable of printing in a variety of materials.

A typical trial prosthesis is made up of several parts and plastics. The first is a socket where the prosthesis is attached to the upper limb. This is printed in thermoplastic polyurethane, a flexible plastic which can be made to fit the patient comfortably, based on a scan of the stump. The forearm part is made from a firmer plastic, while the hand is made from polyurethane, as some degree of give in the hand and fingers is useful. The team is also exploring interchangeable and task-specific attachments which can replace the hand if needed.

The clinicians work closely with the patients to make sure the prostheses are comfortable and meet their needs, often working through a number of prototypes to this end. But they're also designed with cosmetic sensitivity in mind, being designed to match the patient's body. The prosthesis can also be painted to match skin tone.

The trial is reminiscent of the research work from the University of Michigan into rapid proesthetic prototyping, though perhaps all the more remarkable given the context. We've also seen low-cost 3D-printed hands trialed with amputees in Ecuador.

Since the war in Syria began, some 100,000 civilians have been killed according to officially documented figures compiled by The Syrian Observatory For Human Rights. With undocumented deaths included, the real figure may be much higher. In 2016, the UN put the figure of external refugees from the Syria conflict at 5 million. Thousands of civilians have lost limbs as a result of the conflict.

MSF hopes to expand the program to other places in need around the world. You can see a video about its work with 3D-printed prostheses below.

Sources: Médecins Sans Frontières, MSF Reconstructive Surgery Hospital

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