What’s the procedure for making a metal plate for someone with a severely fractured skull?
How long does it take to manufacture the plate?
Does the doctor take a mold and send that to a machine shop the next business day?
It seems the patient would be laying there with an exposed brain until then. Or are skull fractures that exposed the brain rarely survivable with or without a plate?
Are the plates manufactured in the hospital somehow? Are they not custom made?
In summary, how is the delay between deciding a patient needs a plate and manufacturing the plate handled?
They have “blanks” of approximate sizes they use. Once one is chosen they are attached to the skull at 3-4 points with stainless steel screws. Then the blank is hammered into the desired shape “on skull” until a proper fit is achieved. After that it’s a few more screws then sew it up.:smack:
You get the ship’s armorer to hammer out a three shilling piece into a dome to fit the skull, then you affix it over the hole with screws and sew the scalp flap back into place.
How long until a CAT and/or MRI is wired to a computer whichis wired to a 3D printer loaded with heat-fusible plastic.
Here’s an image of the skull (such as it is) - push/pull at various points to indicate the critical clearances and click “smooth contours”. Click “save”. Click print… Select “prototype”.
Make sure the cartridge is full, open the skull, prep area, trial fit prototype. mark up design to get final contours, then Print => Final.
The 3D printing has been done. I know of one case from at least 10 years ago that was fabricated in just this manner.
A woman working in a shop was found by the owner on the floor with a fractured skull. She was carted off to hospital where they removed the fragments of skull and sewed her up. So long as you are careful this isn’t a huge risk. But obviously she was going to need a solid skull in order to lead a normal life.
So, she was scanned on a helical CT scanner, and a 3D model of her skull created. They then printed a full scale model of her skull on a laser sintering plastic printer. This was given to the the fabrication guys who hand crafted a titanium plate that exactly fitted. Then it was a simple operation to lift the scalp and screw the plate in place.
The same guys used this process to fabricate a new lower jaw section for somone. Again a perfectly fitting titanium component was ready to fit.
However I have not heard of much more of this, and I moved on from being in touch with some of the people involved. So, whilst very cool, I don’t know how much of a real difference the technology made.
[QUOTE=Willcross]
This is what shocked me as well!
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(About hammering on skulls)
You really don’t want to see how orthopedic surgery is done.
That said, most skull plates aren’t quarter-inch thick steel or titanium. Here’s a picof one, and it appears to be not much thicker than what heating ducts or car bodies are made of, so any final fitting would be more tapping than bashing.
As briefly mentioned, if there is a delay in making a skullplate the brain can be covered by pulling the skin/scalp over the wound and stitching it in place. You just have to make sure nothing whacks the unprotected-by-bone area. This may be done with some sort of helmet.
Actually, in some types of brain injury that involves swelling, part of the skull is deliberately removed to allow that sort of swelling to occur. Ideally, they try to preserve that piece of skull alive but if that is not successful then a replacement is made.
mrAru’s stepfather Frank had a broken nose and deviated septum, and some other assorted nasaly problems so he went to get them fixed. he popped awake with the surgeon pretty much sitting on his chest grinding away with some sort of dremel tool and cracking jokes with the nurses.
I have to admit, I am thinking of asking to watch when they get around to replacing my knees. Can’t be any worse than being awake when I had my endo rummaging around in my throat while awake. [granted I was on versed while they shot up my throat with a set of locals but I was awake for the first incision. Cutting skin sounds sort of like velcro through bone induction.]
Which reminds me, I am assuming that I was also pretty much wide awake under the versed - so why can’t they do the painful parts of the nerve induction test for carpal or cubital tunnel? I would guess that even though I wouldn’t remember the painful parts, my body would be able to comment on the pain level or whatever they need you awake for.
I’m not so sure about this hammering on the skull business – it may be that’s how it’s done in most cases, I don’t know, I’m not a doctor. But I did find this abstract for a study from 1999 that compared the effectiveness of CT imaging to make cranioplasty molds vs. the previous method of physically taking a mold of someone’s head over the skin and flesh.
Bolding mine. No information on who actually stamps the titanium plate or how long it takes. I imagine that nowadays, 15 years after that study was done, they don’t do much physical molding anymore. For a look at a CT model, watch this video of Malala Yousafzai’s reconstruction. She’s the one who was shot in the head by the Taliban. They have her entire skull modeled, and made a mold from that.
Although, I also found this product (pdf), which is a kit for cranial reconstruction. It comes with a bunch of screws/hardware and some standard plates, which do appear to be of the “hammer this down on the skull” sort. But they’re also mesh plates, which would be a little bit easier to shape than sheet titanium.
