The Victoria Hand Project recently trained two clinics in Ukraine to design, print and produce upper limb prosthetics using additive manufacturing.
Since 2014, the Victoria Hand Project (VHP) has aimed to provide affordable, easy-to-use prosthetics to underserved communities globally. The organization emerged from a University of Victoria research project and is now a not-for-profit that trains clinicians to design, produce and fit 3D-printed prosthetic devices.
Following the onset of the war, VHP was approached by several prosthetic clinics and Ukrainian organizations interested in bringing their services to the country. Since the start of the Russian invasion, much of the Ukrainian infrastructure that makes prosthetic components has been destroyed or remains inaccessible.
As of January 2023, an estimated 40,000 Ukrainians have been injured in the ongoing conflict. Current estimates predict that 25 to 33 percent of those injured in the war will lose limbs, but the actual number could be significantly higher. This adds to the existing 400,000 Ukrainians with amputations, many of whom can no longer access appropriate prosthetic resources.
With the “Hands for Ukraine” project, VHP has so far provided 3D printers and training for two clinics in the country. One program was launched at a public hospital, the Vinnytsia State Experimental Prosthetic and Orthopedic Enterprise, while a second program was set up at a private clinic, Arol Plus, in Lviv.
With this training, the clinics can now measure, design, and print custom prosthetics on-site at low cost and with a short turnaround times. The “Hands for Ukraine” project began in the summer of 2022 with initial conversations and a pilot project was launched in January 2023. In June, a team of VHP engineers traveled to Ukraine to expand the pilot project, providing training and printers and increasing the capacity of clinics to 3D print their prosthetic designs. As a result, Ukrainian clinicians are now capable of making upper limb prosthetics for local patients.
Making an Accessible and Low-Cost 3D Printed Prosthetic
The Victoria Hand is designed for printing on Ultimaker devices. In the early design stages, the engineering team tried multiple FDM and PLA printers but ultimately landed on Ultimaker, for its ease of use and ability to create a prints that are sturdy enough for robust prosthetic devices. By standardizing their use of Ultimaker globally, VHP ensures that they can provide consistent print instructions and custom software using a Fusion360 API to make designing and printing the devices straightforward for clinicians. It also means that any modification to their workflow can automatically be updated in all their international partnership clinics.
For most of their clinical partners, VHP uses the Ultimaker 2 Extended +, as it’s the largest printer currently available from the manufacturer. In conversation with the VHP team, they noted that printer size is one of the biggest limitations to their design and printing workflow.
To continue to improve their workflow, VHP would like to see even larger format printers become available in the future, as it would be especially handy for their larger prosthetic devices that currently require two separate printing stages. A larger build volume would also simplify the process for clinicians.
For materials, VHP uses PLA as it is easy to print, compatible with long-term contact with human skin and creates a strong, waterproof product. They currently use the BASF PRO1 PLA due to its reliable durability for making a prosthetic that can realistically handle everyday use. According to the VHP team, the BASF PRO1 PLA creates ideal layered adhesion for a strong, tough prosthetic.
For each prosthetic device, the palm and the fingers are 3D printed with PLA, the fingertips are made of silicone to improve grip and utility, and the inside of the hand includes stainless steel springs, bolts, and other small mechanical parts to improve durability.
Altogether, the 3D printing and assembly process can take between 30 to 40 hours, depending on the prosthetic size. It also takes about 12 hours of work with prosthetists and technicians to build the hand and fit the patient. If the hand components are prepared in advance, some patients can have their prosthetic the next day, with up to a 3- to 4-day turnaround.
Since our last discussion in 2021, VHP has expanded their prosthetic offerings to include both a trans-radial and trans-humeral model. This means they have upper limb prosthetics for patients with amputations either above or below the elbow.
An End-to-End Workflow, Courtesy of Fusion360
Most clinicians do not have experience or advanced training in additive manufacturing. To make their prosthetics as accessible as possible, VHP aims to provide the equipment and training necessary for clinicians to become self-sufficient when it comes to delivering custom prosthetic care. When VHP expands to a new site, including at the new partner sites in Ukraine, their engineering team provides technical training in the use and maintenance of Ultimaker printers as well as strategies to troubleshoot common problems.
To make the process as straightforward as possible for clinicians, the VHP team designed a custom software program in Python that integrates with Fusion360. Using the Fusion360 API, the VHP software automates most of the steps required for the prosthetic design workflow, requiring minimal user input or CAD expertise. Overall, the interface tool makes the process simpler, faster and reduces the amount of potential variability and errors.
Clinicians can utilize the interface to select the type of hand, whether it is left or right, along with several other inputs like size. The automation process then assists with aligning the scan of the patient’s arm for the custom socket. Most importantly, the software automatically exports all the necessary print files for 3D printing.
After the device is printed, VHP then trains clinicians on how to assemble the final prosthetic device. All the 3D-printed prosthetics are body-powered, making it easier to design, fit, and 3D print the component parts. The device does not require any advanced electronics, charging, or waterproofing. It keeps the cost low and makes it easier for patients to learn how to use the prosthetic. VHP has designs for hands that either close when you pull the internal cable or open when the cable is pulled, depending on the patient.
Expanding Access to Low-Cost Prosthetics
VHP has countless stories from patients transformed through access to the Victoria Hand prosthetic. In Ukraine alone, VHP has already fitted more than a dozen patients with prosthetics, and the two clinics are continuing to provide care to veterans and civilians in their communities. Beyond Ukraine, VHP also currently supports clinics in Nepal, Cambodia, Guatemala, Egypt, Kenya and Uganda.
Looking toward the future, in addition to their current above-elbow and below-elbow prosthetics, the VHP team is hoping to provide solutions for patients experiencing partial hand or finger loss. Although they have no plans to expand into lower limb devices, they are interested in potentially developing orthotic devices, too.
Beyond new devices, the engineering team is excited by the possibility of swapping the Victoria Hand for other tools that could be useful for patients. For example, they are interested in designing 3D printed devices that can fit into the ball and socket wrist design but may be specialized for gardening, cooking or other applications.
The goal is to improve independence and improve the quality of life for those experiencing limb loss. By continuing to empower local clinics to create and distribute their prosthetics, VHP is supporting an international community of clinics capable of ensuring their prosthetics reach those who will most benefit from the technology.
