Additively manufactured wrist–hand orthoses (3DP-WHOs) offer several advantages over traditional splints and casts, but their development based on a patient’s 3D scans currently requires advanced engineering skills, while also recording long manufacturing times as they are commonly built in a vertical position. A proposed alternative involves 3D printing the orthoses as a flat model base and then thermoforming them to fit the patient’s forearm. This manufacturing approach is faster, cost-effective and allows easier integration of flexible sensors as an example. However, it is unknown whether these flat-shaped 3DP-WHOs offer similar mechanical resistance as the 3D-printed hand-shaped orthoses, with a lack of research in this area being revealed by the literature review. To evaluate the mechanical properties of 3DP-WHOs produced using the two approaches, three-point bending tests and flexural fatigue tests were conducted. The results showed that both types of orthoses had similar stiffness up to 50 N, but the vertically built orthoses failed at a maximum load of 120 N, while the thermoformed orthoses could withstand up to 300 N with no damages observed. The integrity of the thermoformed orthoses was maintained after 2000 cycles at 0.5 Hz and ±2.5 mm displacement. It was observed that the minimum force occurring during fatigue tests was approximately −95 N. After 1100–1200 cycles, it reached −110 N and remained constant. The outcomes of this study are expected to enhance the trust that hand therapists, orthopedists, and patients have in using thermoformable 3DP-WHOs.

This article proposes the integration of two novel aspects into the production of 3D-printed customized wrist-hand orthoses. One aspect involves the material, particularly Colorfabb varioShore thermoplastic polyurethane (TPU) filament with an active foaming agent, which allows adjusting the 3D-printed orthoses’ mechanical properties via process parameters such as printing temperature. Consequently, within the same printing process, by using a single extrusion nozzle, orthoses with varying stiffness levels can be produced, aiming at both immobilization rigidity and skin-comfortable softness. This capability is harnessed by 3D-printing the orthosis in a flat shape via material extrusion-based additive manufacturing, which represents the other novel aspect. Subsequently, the orthosis conforms to the user’s upper limb shape after secure attachment, or by thermoforming in the case of a bi-material solution. A dedicated design web app, which relies on key patient hand measurement input, is also proposed, differing from the 3D scanning and modeling approach that requires engineering expertise and 3D scan data processing. The evaluation of varioShore TPU orthoses with diverse designs was conducted considering printing time, cost, maximum flexion angle, comfort, and perceived wrist stability as criteria. As some of the produced TPU orthoses lacked the necessary stiffness around the wrist or did not properly fit the palm shape, bi-material orthoses including polylactic acid (PLA) inserts of varying sizes were 3D-printed and assessed, showing an improved stiffness around the wrist and a better hand shape conformity. The findings demonstrated the potential of this innovative approach in creating bi-material upper limb orthoses, capitalizing on various characteristics such as varioShore properties, PLA thermoforming capabilities, and the design flexibility provided by additive manufacturing technology.

This paper investigated the feasibility of using 3D printing processes, specifically material extrusion (MEX) and vat photopolymerization (DLP—Digital Light Processing), to produce customized wrist–hand orthoses. Design, printability, and usability aspects were addressed. It was found that minimizing printing time for orthoses with intricate shapes, ventilation pockets, and minimal thickness is difficult. The influence of build orientation and process parameters, such as infill density, pattern, layer thickness, and wall thickness, on printing time for ten parameter configurations of orthoses in both ready-to-use and flat thermoformed shapes was examined. The findings revealed that the optimized orientations suggested by Meshmixer and Cura (Auto-orient option) did not reliably yield reduced printing times for each analyzed orthoses. The shortest printing time was achieved with a horizontal orientation (for orthoses manufactured in their ready-to-use form, starting from 3D scanning upper limb data) at the expense of surface quality in contact with the hand. For tall and thin orthoses, 100% infill density is recommended to ensure mechanical stability and layer fill, with caution required when reducing the support volume. Flat and thermoformed orthoses had the shortest printing times and could be produced with lower infill densities without defects. For the same design, the shortest printing time for an orthosis 3D-printed in its ready-to-use form was 8 h and 24 min at 60% infill, while the same orthosis produced as flat took 4 h and 37 min for the MEX process and half of this time for DLP. Usability criteria, including perceived immobilization strength, aesthetics, comfort, and weight, were evaluated for seven orthoses. Two healthy users, with previous experience with traditional plaster splints, tested the orthoses and expressed satisfaction with the 3D-printed designs. While the Voronoi design of DLP orthoses was visually more appealing, it was perceived as less stiff compared to those produced by MEX.

In recent years, the application of 3D-printed implant cages or trusses for foot arthrodesis has emerged as a personalized approach to address complex bone defects and deformities. Twenty studies involving different regions of the foot, such as the ankle and subtalar joints, were reviewed to document the 3D-printed custom solutions. The design of these implants is also discussed, including custom titanium trusses and lattice structures, which can promote osseointegration and fit the bone geometries. From a mechanical perspective, these implants proved to be stable and compatible with natural bone, aiming to reduce stress shielding while offering the mechanical strength needed for optimal outcomes. This systematic survey also addresses the additive manufacturing processes involved, namely EBM, SLM, or DMLS. Clinical cases were focused on patients with large bone loss, failed prior fusions, and deformity corrections, with the follow-up results showing high rates of fusion and functional improvement. Of the analyzed studies, three provide level III evidence, while the rest provide level IV or V, consisting of case series or reports. Since 2015, 148 patients have been reported to receive such implants. This review addresses the question, “how effective are 3D-printed titanium cage implants in foot arthrodesis in addressing large bone defects and deformities?” It is the first review to gather data on the use of such customized implants in foot arthrodesis, providing critical insights to enhance their application, including amputation avoidance. This study highlights the advantages of personalized 3D-printed implants in achieving a better anatomical fit, improving clinical outcomes, and ensuring faster recovery times, while also addressing considerations such as the cost and the need for long-term clinical data.