Project title:
Design for Medicine
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Project name:
Velos - Reducing Zygomatic Fractures Ergonomically
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Project leader:
Dr. Yen Ching Chiuan
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Collaborators:
NUH Plastic, Reconstructive
& Aesthetic Surgery
Assoc. Prof. Dr. Lim Thiam Chye
Dr. Elijah Cai Zhengyang
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Team members:
Vanessa Ong Hui Xin
Phan Mai
Brief:
Design is often neglected in the medical inventory.
Why would one need aesthetically pleasing instruments when technology is the fundamental key to surgical success? Why would one need a sculptural piece of patient aid when technology restores health?
This studio acts as a platform to discover a multitude of opportunities for innovation in medicine through the process of design, with exposure to Human-Centric Design Approach to harness a good problem scenario and an opportunity for design to intervene. The types of project may range from surgical instruments, physical simulators, rehabilitation tools, smart phone applications and others.
Project descriptions:
Facial injuries from high-impact trauma often result in fractures of the zygomatic complex, which reaches from the cheekbone to the temple. During reconstructive surgery, the doctor often uses the Carroll-Girard T-bar screw, a surgical instrument used specifically to grip and control the broken fragment of the zygoma.
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Though the Carroll-Girard screw is functional, its design is not ergonomically sound nor optimised. Through this project, we explored in-depth the issues faced by the surgical team while handling this instrument, and then provided potential solutions to address these issues.
The basics:
This is a zygomatic fracture, the Carroll-Girard T-bar screw, and how it's commonly used (together with some other tools).
The standard procedure:
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A small hole is drilled onto the bone fragment. The screw bit is screwed down tightly into the hole. The T-bar handle then catches onto the screw.
The doctor manipulates the fragment into position and fix it with plates and screws.
The actual procedure:
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Similar to the standard procedure up until the T-bar handle catching onto the screw.
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While manipulating the device, the doctor's wrist get strained easily from awkward angles. Slippage also regularly occurs from forceful maneuvering.
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More holes are drilled, more screws used to properly control the bone fragment. As the fragment is held in place, another doctor secures it with plates and screws.
The problems:
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The T-bar handle doesn't provide triple-axis control of the screw, so the doctor's wrist is often placed in strenuous awkward position for long periods of time, possibly throughout much of the surgery.
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Being a single screw, it slips out easily, forcing doctors to restart the procedure and drill more holes, wasting time and energy.
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Sometimes, 2 screws are required for better control and maneuver. This is cumbersome and tiring for the assistant surgeon(s) holding the screw and obstructive to the surgeon's view.
The insights:
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There's a need to restrict movements of the screw bit to prevent it from widening the hole and slipping out.
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The handle needs to accommodate 3D control and allow for more flexibility in wrist position.
The proposed solution:
The benefits:
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3 screw bits provide stabilisation and establish 3D control of the bone fragment,
preventing the screws from moving about, widening the hole and slipping out.
Rotating handle allows for a wider range of angle of wrist position.
The strap provides additional support for the wrist in awkward angles, avoiding unnecessary strain.
Evaluation:
by Dr. Elijah Cai Zhengyang
