Trial Outcomes & Findings for The Use of 3D Printing in Orbital Fractures (NCT NCT03673865)

NCT ID: NCT03673865

Last Updated: 2022-07-27

Results Overview

The Primary Investigator will evaluate the orbital volume using OsiriX (medical software). Orbital volume measurements will be obtained to compare the injured and uninjured (contralateral) orbital volumes. OsiriX MD offers advanced processing techniques and has the ability to precisely measure orbital volume. It also utilizes the DICOM data from the immediate postoperative CT scans.

Recruitment status

TERMINATED

Study phase

NA

Target enrollment

25 participants

Primary outcome timeframe

1 hour post operatively

Results posted on

2022-07-27

Participant Flow

Participant milestones

Participant milestones
Measure
Treatment Group
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Overall Study
STARTED
13
12
Overall Study
COMPLETED
13
12
Overall Study
NOT COMPLETED
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

The Use of 3D Printing in Orbital Fractures

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Total
n=25 Participants
Total of all reporting groups
Age, Continuous
41.5 years
n=93 Participants
38.2 years
n=4 Participants
39.9 years
n=27 Participants
Sex: Female, Male
Female
6 Participants
n=93 Participants
4 Participants
n=4 Participants
10 Participants
n=27 Participants
Sex: Female, Male
Male
7 Participants
n=93 Participants
8 Participants
n=4 Participants
15 Participants
n=27 Participants
Race/Ethnicity, Customized
Caucasian
3 Participants
n=93 Participants
1 Participants
n=4 Participants
4 Participants
n=27 Participants
Race/Ethnicity, Customized
Other
1 Participants
n=93 Participants
0 Participants
n=4 Participants
1 Participants
n=27 Participants
Race/Ethnicity, Customized
African-American
9 Participants
n=93 Participants
11 Participants
n=4 Participants
20 Participants
n=27 Participants
Region of Enrollment
United States
13 participants
n=93 Participants
12 participants
n=4 Participants
25 participants
n=27 Participants
Medical Comorbidities
Hypertension
6 Participants
n=93 Participants
4 Participants
n=4 Participants
10 Participants
n=27 Participants
Medical Comorbidities
Diabetes
2 Participants
n=93 Participants
1 Participants
n=4 Participants
3 Participants
n=27 Participants
Medical Comorbidities
Migraines
2 Participants
n=93 Participants
0 Participants
n=4 Participants
2 Participants
n=27 Participants
Medical Comorbidities
Asthma
2 Participants
n=93 Participants
0 Participants
n=4 Participants
2 Participants
n=27 Participants
Medical Comorbidities
Depression
1 Participants
n=93 Participants
1 Participants
n=4 Participants
2 Participants
n=27 Participants
Etiology
MVC
1 Participants
n=93 Participants
4 Participants
n=4 Participants
5 Participants
n=27 Participants
Etiology
Fall
3 Participants
n=93 Participants
1 Participants
n=4 Participants
4 Participants
n=27 Participants
Etiology
Assault
8 Participants
n=93 Participants
3 Participants
n=4 Participants
11 Participants
n=27 Participants
Etiology
Other
1 Participants
n=93 Participants
4 Participants
n=4 Participants
5 Participants
n=27 Participants
Laterality
Left
6 Participants
n=93 Participants
8 Participants
n=4 Participants
14 Participants
n=27 Participants
Laterality
Right
7 Participants
n=93 Participants
4 Participants
n=4 Participants
11 Participants
n=27 Participants
Location of fracture
Orbital floor fracture
11 Participants
n=93 Participants
12 Participants
n=4 Participants
23 Participants
n=27 Participants
Location of fracture
Medial wall fracture
6 Participants
n=93 Participants
5 Participants
n=4 Participants
11 Participants
n=27 Participants

PRIMARY outcome

Timeframe: 1 hour post operatively

The Primary Investigator will evaluate the orbital volume using OsiriX (medical software). Orbital volume measurements will be obtained to compare the injured and uninjured (contralateral) orbital volumes. OsiriX MD offers advanced processing techniques and has the ability to precisely measure orbital volume. It also utilizes the DICOM data from the immediate postoperative CT scans.

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Orbital Volume of the Injured Orbit Compared to the Contralateral Uninjured Orbit as Assessed by CT Scan Between the Treatment and Control Groups
Uninjured Orbit
23 Cm^3
Standard Deviation 3.5
22.8 Cm^3
Standard Deviation 2.6
Orbital Volume of the Injured Orbit Compared to the Contralateral Uninjured Orbit as Assessed by CT Scan Between the Treatment and Control Groups
Reconstructed Orbit
23.5 Cm^3
Standard Deviation 3.2
28.6 Cm^3
Standard Deviation 3.6

SECONDARY outcome

Timeframe: 1 week, 3 weeks, and 6 weeks postoperatively.

Adequate orbital volume reduction, defined as a reduction of orbital volume to less than 2 cm3. The Primary Investigator will evaluate the orbital volume using OsiriX (medical software). Number of subjects with reduction of orbital volume to less than 2 cm3 between the treatment and control groups are recorded

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Number of Subjects With Reduction of Orbital Volume to Less Than 2 cm3 Between the Treatment and Control Groups
1 week postoperatively.
13 Participants
12 Participants
Number of Subjects With Reduction of Orbital Volume to Less Than 2 cm3 Between the Treatment and Control Groups
3 weeks postoperatively.
13 Participants
12 Participants
Number of Subjects With Reduction of Orbital Volume to Less Than 2 cm3 Between the Treatment and Control Groups
6 weeks postoperatively
13 Participants
12 Participants

SECONDARY outcome

Timeframe: 1 week, 3 weeks, and 6 weeks postoperatively.

A difference of more than 2 mm between the two orbits is diagnostic for enophthalmos. Enophthalmos is assessed by clinical examination using a Hertel exophthalmometer. The measurement is taken from the lateral orbital rim to the corneal apex. The normal range is 12-21 mm. Upper normal limit for people of African origin is a little higher, about 23-24 mm. A difference greater than 2 mm between the eyes is significant.

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Number of Subjects With a Difference of More Than 2 mm Between the Two Orbits Between the Treatment and Control Groups
1 week postoperatively.
0 Participants
0 Participants
Number of Subjects With a Difference of More Than 2 mm Between the Two Orbits Between the Treatment and Control Groups
3 weeks postoperatively.
0 Participants
0 Participants
Number of Subjects With a Difference of More Than 2 mm Between the Two Orbits Between the Treatment and Control Groups
6 weeks postoperatively.
0 Participants
0 Participants

SECONDARY outcome

Timeframe: 1 week, 3 weeks, and 6 weeks postoperatively.

Infection is defined by the presence of postoperative pus in the wound, a sinus tract or fistula, or elevated white blood cell count (WBC) \>11.0x109/L combined with erythematous skin and swelling on the operated side more than on the un-operated side. WBC is measured with a blood draw test. Infection will be confirmed with clinical examination along with blood tests.

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Number of Subjects With Infection Between the Treatment and Control Groups
1 week postoperatively.
0 Participants
0 Participants
Number of Subjects With Infection Between the Treatment and Control Groups
3 weeks postoperatively.
0 Participants
0 Participants
Number of Subjects With Infection Between the Treatment and Control Groups
6 weeks postoperatively.
0 Participants
0 Participants

SECONDARY outcome

Timeframe: 1 week, 3 weeks, and 6 weeks postoperatively.

Infraorbital nerve injury is assessed by clinical examination using neurosensory testing (NST). NST is a standardized methodology designed to objectively evaluate sensory nerve function. The sensory impairment is determined by 3 levels of testing; each level classifies a specific type of sensory nerve injury.

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Number of Subjects With Infraorbital Nerve Injury Between the Treatment and Control Groups
1 week postoperatively.
0 Participants
0 Participants
Number of Subjects With Infraorbital Nerve Injury Between the Treatment and Control Groups
3 weeks postoperatively.
0 Participants
0 Participants
Number of Subjects With Infraorbital Nerve Injury Between the Treatment and Control Groups
6 weeks postoperatively.
0 Participants
0 Participants

SECONDARY outcome

Timeframe: 1 week, 3 weeks, and 6 weeks postoperatively.

Intraocular pressure (IOP) \> 40 mmHg is diagnostic of orbital compartment syndrome. Orbital compartment syndrome is assessed through clinical examination using tonometry test. Tonometry is a diagnostic test that measures the pressure inside your eye, which is called intraocular pressure (IOP). The normal pressure range is 12 to 22 mm Hg.

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Number of Subjects With Intraocular Pressure (IOP) > 40 mmHg Between the Treatment and Control Groups
1 week postoperatively.
0 Participants
0 Participants
Number of Subjects With Intraocular Pressure (IOP) > 40 mmHg Between the Treatment and Control Groups
3 weeks postoperatively.
0 Participants
0 Participants
Number of Subjects With Intraocular Pressure (IOP) > 40 mmHg Between the Treatment and Control Groups
6 weeks postoperatively.
0 Participants
0 Participants

SECONDARY outcome

Timeframe: Intraoperative time period

Operating time will be calculated from fracture exposure and identification to the final implant placement and fixation and will be recorded in minutes. This will be compared between the two treatment groups. To record and compare the operative time between the two groups, a stopwatch will be utilized.

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Mean Operating Time in Minutes Between the Treatment and Control Groups
Length of surgery
32.6 minutes
Standard Deviation 13.7
53.3 minutes
Standard Deviation 12.8
Mean Operating Time in Minutes Between the Treatment and Control Groups
Time interval from plate insertion to fixation
15.8 minutes
Standard Deviation 14.4
41.4 minutes
Standard Deviation 9.4

SECONDARY outcome

Timeframe: up to 2 weeks

Isolated orbital floor fracture patients do not require a pre-operative hospital stay. Length of stay will be calculated in terms of postoperative hospital stay (days). Length of stay in cases of complex orbital fracture will be calculated in terms of pre-operative and postoperative hospital stay (days). The number of days subject stays in the hospital are measured and compared

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Mean Length of Stay in Hospital Measured in Days Between the Treatment and Control Groups
1.4 days
Interval 0.0 to 5.0
2.1 days
Interval 0.0 to 7.0

SECONDARY outcome

Timeframe: up to 2 weeks

Treatment charges will be calculated with consideration of the following: 1. Facility operating room charges, which include anesthesia time (surgical time multiplied by the facility rate of $33/ minute). 2. Hardware charges (plates and screws). 3. Length Of Stay charges (LOS multiplied by the facility daily rate of $1,690/ day). 4. The cost of the 3D printed model including the cost of the 3D printer and filaments ($1.5). All treatment charge variables will be provided by the Grady Memorial Hospital Financial Planning and Analysis center. Total treatment charges facility operating room charges, hardware charges, LOS, and the 3D printed model cost will be compared between groups in a manner similar to that outlined in previous studies by our group.

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Mean Treatment Amount in Dollars Between the Treatment and Control Groups
Total Cost
3602.54 US Dollars
Standard Deviation 524.63
4287.25 US Dollars
Standard Deviation 422.64
Mean Treatment Amount in Dollars Between the Treatment and Control Groups
Cost of Operation Room
992.54 US Dollars
Standard Deviation 524.63
1,757.25 US Dollars
Standard Deviation 422.64
Mean Treatment Amount in Dollars Between the Treatment and Control Groups
3D Cost
80 US Dollars
Standard Deviation 0
0 US Dollars
Standard Deviation 0
Mean Treatment Amount in Dollars Between the Treatment and Control Groups
Length of Stay, Cost
1690 US Dollars
Standard Deviation 0
1690 US Dollars
Standard Deviation 0
Mean Treatment Amount in Dollars Between the Treatment and Control Groups
Cost of plate and screws
840 US Dollars
Standard Deviation 0
840 US Dollars
Standard Deviation 0

SECONDARY outcome

Timeframe: 1 week, 3 weeks, and 6 weeks postoperatively.

Extra-ocular motility is assessed through clinical examination. The patient should be able to move the eyes through the six cardinal positions of gaze (left, right, up and right, up and left, down and right, down and left). All patients will be examined for the following: 1. Development of restricted extraocular motility that was not present prior to the surgery. 2. Persistent restriction of extraocular motility after the surgery

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Number of Subjects That Develop Restricted Extraocular Motility That Was Not Present Before Between the Treatment and Control Groups
1 week postoperatively.
0 Participants
0 Participants
Number of Subjects That Develop Restricted Extraocular Motility That Was Not Present Before Between the Treatment and Control Groups
3 weeks postoperatively.
0 Participants
0 Participants
Number of Subjects That Develop Restricted Extraocular Motility That Was Not Present Before Between the Treatment and Control Groups
6 weeks postoperatively.
0 Participants
0 Participants

SECONDARY outcome

Timeframe: Up to 6 hours postoperatively

Inability to achieve the normal orbital contour as assessed in the immediate post-operative Computerized Tomography (CT) scan. Maxillofacial non-contrast CT scans according to the protocol will be obtained as part of the standard of care in managing orbital fractures and will be obtained for all subjects post operatively.

Outcome measures

Outcome measures
Measure
Treatment Group
n=13 Participants
Patients undergo orbital reconstruction using pre-adjusted patient-specific orbital implants with office-based 3-dimensional printers (OB3DP) office-based 3-dimensional printers (OB3DP): In this treatment group subjects, using office-based 3-dimensional printers (OB3DP) a patient-specific pre-adjusted (pre-bend) orbital plates will be made using over-the-counter titanium plates that are manually adjusted according to the printed model. The plates are then send to sterilization for preparation.
Control Group
n=12 Participants
Patients undergo orbital reconstruction with non-patient-specific orbital implants (traditional approach, Control Group) which is a standard stock orbital plate standard stock orbital plate: In this control group subjects will receive non-patient-specific orbital implants which is standard stock orbital plate that is adapted intraoperatively to the fractured orbit
Number of Subjects With Inability to Achieve the Normal Orbital Contour Between the Treatment and Control Groups
0 Participants
0 Participants

Adverse Events

Treatment Group

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Control Group

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dina Amin

Emory University

Phone: 404-251-8895

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place