Feasibility and Mechanical Performance of 3D-Printed Polymer Composite External Fixators for Tibial Fractures

Abstract

Featured Application: This study quantitatively evaluated the use of 3D-printed polymer composite fixator rings as a cost-effective alternative to traditional metal counterparts. Their reduced cost and accessibility make them particularly suitable for use in trauma surgery, especially in low-resource settings, conflict zones, and remote areas where traditional fixators are less readily available. This study evaluates the feasibility of 3D-printed polymer composite external fixator (EF) rings as a cost-effective alternative to stainless steel fixators, focusing on hybrid fixators for complex tibial fractures. Mechanical performance was assessed in three stages: (1) evaluating the initial EF–tibia configuration under axial loading and wire pre-tension conditions; (2) analyzing the stiffness evolution and weight-bearing capacity during early healing with progressive callus formation; and (3) optimizing ring designs through numerical analysis to improve structural performance under increased pre-tension. The results showed that, for the metallic EF, the axial displacement under one-leg stance reached 8.41 mm without pre-tension, reducing to 6.83 mm at 500 N pre-tension, though transverse displacement remained significant, suggesting the need for higher wire tension. Callus formation enhanced the load-bearing capacity, as expected. However, excessive displacements persisted under the one-leg stance, indicating that full weight-bearing should be delayed beyond two weeks for a fracture gap of 3 mm. A ring design assessment showed that full-ring configurations with two wires per ring improved performance. The 3D-printed full-ring design made of carbon-fiber-reinforced polylactic acid (PLA-CF) reduced stress by 85% at 500 N pre-tension compared to the initial configuration, remaining within allowable limits. While confirming feasibility, the study highlights the need for geometric refinements to accommodate higher preloads and improve transverse stiffness.