Collaboration keeps medical student’s dream alive

First-year UB medical student Chloe Cottone had a problem that could have quickly derailed her dream of becoming a surgeon. But a collaboration between the Jacobs School of Medicine and Biomedical Sciences and the School of Engineering and Applied Sciences is keeping that dream alive.

Cottone deals with Ehlers-Danlos syndrome, a group of inherited disorders that affects connective tissues — in this case, her joints. She has hypermobility in her joints, which means she has an unusually large range of movement and is at risk of injury because her joints are too flexible.

“When I was in gross anatomy lab, I struggled to use some of the surgical instruments in conventional ways because of the hypermobility — specifically in my thumbs,” she explains. She tried swan splints, which can be worn on the fingers or thumb and are designed to block hyperextension without limiting flexion.

“There are some companies that make metal ones, but they’re extremely expensive. They were like $100 a pop. And I couldn’t find anything online that did what I needed and could be used under a surgical glove,” Cottone says.

As a medical student without a lot of extra spending money, she got creative. She went to Michaels, an arts and crafts store, and bought a ring sizer and some copper wire to make something herself. “They worked for a little bit. Unfortunately, they ripped through the surgical gloves,” she says.

Her gross anatomy instructor, Stuart D. Inglis, instructor in the Department of Pathology and Anatomical Sciences, saw she was struggling. “What she was finding was that when she was holding the scalpel, her fingers would bend in an awkward sort of way and pop out of joint and pop back in, causing her a great deal of pain,” Inglis says.

There had to be a solution.

“She was asking me about it, and she showed me some of the braces that were commercially available — pretty expensive things. But it did get us to talking that we could probably create a 3D digital print of these joint braces for her fingers,” Inglis says.

At the time, he was working with some biomedical engineering students who were creating synthetic prosthetic hands that could be used during surgical simulation. He brought Cottone’s project to the students, and they thought it was something they could take on.

Cottone created a new design and showed it to the engineering students, who made tweaks along the way. 

“After meeting with the engineering students, we took the traditional swan-splint design for inspiration and then made an entirely new kind of splint that’s lighter, more functional and cheap — because you can 3D print them — and they do the same thing,” says Cottone. “We worked together to make this design that was going to be optimal in function with a material that doesn’t abrade gloves.”

They brought in Joseph A. Costa, instructor of pathology and anatomical sciences, who manages the 3D printing operation at the Jacobs School.

“One of the key factors in terms of what we want these braces to do — not only their functionality, but if she’s going to be using these in the gross anatomy lab or surgery — we want these to be able to go through autoclave (steam sterilizing typically used for health care or industrial applications) to be sanitized. We want them to be temperature-resistant,” Costa says. “Through my contacts and what we know about 3D printing, we figured out what material would work, and what wouldn’t work.”

They came up with a plastic material, VisiJet M2S–HT250, a product of 3D Systems Inc. that is resistant to temperatures up to 104 degrees Celsius (219 degrees Fahrenheit).

“What’s really cool is that this material can be autoclaved,” Cottone says. “This is a silicone-based material that can be sterilized. The prototypes are soft, they don’t hurt the skin, they don’t break through gloves. It’s hard to describe because it’s a very unique shape.”

Mathew Fiel and Cianna Currie, who are pursuing master’s degrees in the Department of Biomedical Engineering — a joint collaboration between the Jacobs School and the School of Engineering and Applied Sciences — and Lauren McLaughlin-Kelly, who is pursuing a master’s degree in biological sciences, were brought into the project last fall.

McLaughlin-Kelly — who does research with Inglis — and Currie set up meetings with orthopaedic surgeons for design feedback; research on existing models, patents and medical feasibility; and project planning and coordination.  

“Based on Chloe’s feedback, we made tweaks to the model. We wanted to make sure it can survive the autoclave and later we’re going to contact the proper surgical associations to see if it will be able to be implemented in the operating room,” Currie says.

Fiel spent a few weeks working on the prototype. He used the 3D software tool Blender to print the prototype, which was adjusted to better fit Cottone’s fingers.

“Each one of the original red plastic braces only takes two or three grams of material. And you can buy a kilogram of this material for like $20, so it’s just a few cents for each finger brace,” Fiel says.

The stronger material needed to survive being autoclaved costs more, but is still much less expensive than anything already on the market.

And he’s not stopping there.

“Mathew’s working on prototypes that have multiple interlocking parts to be able to create something that is sturdy, that captures all the small moving parts effectively, and allows for a final product that can move smoothly along with her (Cottone’s) thumbs,” Costa says.

“The next step is to attempt to print Mathew’s new prototype that has interlocking parts and see if that accommodates Chloe’s thumb movements a little bit more naturally and comfortably. Right now, we’re just working our way through prototypes.”

The prototypes could be a game-changer.

“Surgeons are very dedicated to their job,” McLaughlin-Kelly notes. "They don’t want to give up the operating room, so they operate right up until they can’t. But if they have braces like this that allow them to work longer — the same with people out in the work force in other occupations — this can help prolong their careers,” she says. “It can also be used as a preventive measure. This can make a huge difference in terms of medicine.”

Cottone says that what started as a small personal project is now something that can have a much larger impact. “Now we are thinking of how we can make these available to other people who work in health care who have hypermobility, who can’t afford several hundred dollars on metal splints.”

Cottone says the group is working with the Jacobs Institute on getting a patent for the prototypes, which could have uses beyond the operating room. For instance, people suffering from other joint problems — specifically arthritis — may find these finger braces particularly useful.

It’s the type of collaborative effort UB has been encouraging throughout its units.

“As this was developing,” Inglis says, “I was thinking that this is a situation of someone who has a particular need reaching out to a faculty member in one department who can then reach out to someone in a separate department, so all these individuals in these different silos in the university come together to create an effective product that can really have a significant role in changing someone’s life.”