UB Schools Help Med Student Solve Hypermobility Issue

By Bill Bruton

A collaboration between the Jacobs School 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 affect connective tissues; in this case her joints.

Cottone has hypermobility in her joints, which means she has an unusually large range of movements. That leaves her 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 (like dissection tools) in conventional ways, because of the hypermobility — specifically in my thumbs,” says Cottone, a Buffalo native and Amherst High School graduate.

Not willing to give up on her dream, 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 school student without a lot of extra spending money, she got creative.   

“I went to Michaels (an arts and crafts store) and got a ring sizer and some copper wire, and thought, maybe I can make these myself,” Cottone says. “They worked for a little bit. Unfortunately, they ripped through the surgical gloves.”

Stuart D. Inglis, PhD, instructor of pathology and anatomical sciences and her gross anatomy class professor, could see she was struggling.

“When she was dissecting, she was very meticulous in being able to clean around the structures. 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.

They figured 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.

“From my perspective, I work with some biomedical engineering students. They were creating synthetic prosthetic hands that could be used during surgical simulation for getting a lifelike, realistic hand developed. In talking with them about the project, they said ‘yes, that sounds interesting. It’s something we could probably do.’ So, they started exploring different designs and getting materials that could be brought in and put on in an actual surgical suite, and be completely sterile,” Inglis says.

“I saw working with the engineering students as an opportunity to create a novel design specifically to optimize fine motor stability and functionality,’ Cottone says.

She created the 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, who earned her bachelor’s degree in biology from SUNY Geneseo. “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, PhD, instructor of pathology and anatomical sciences, who manages the 3D printing operation on the seventh floor of the Jacobs School building.

“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).

“With the chemical properties of the substance, and the high-resolution capabilities of the printer, I think we have a good combination,” Costa says.

“What’s really cool is that this material can be autoclaved. 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,” Cottone says.

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 in the Department of Biological Sciences, were brought into the project in the fall of 2022. They are being mentored by Filip Stefanovic, PhD, teaching assistant professor of biomedical engineering,

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, as well as 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 Blender (a 3D software tool) 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 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.”

“I have a lot of hypermobility in my thumbs, but I have them in other joints too, so it could work in two joints on the same aperture,” Cottone says.

The prototypes could be a game-changer.

“Surgeons are very dedicated to their job. 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. It can also be used as a preventive measure,” McLaughlin-Kelly says. “This can make a huge difference in terms of medicine.”

“It started as a small personal thing where I said ‘I’m not letting this stop me,’ and then it grew from there. Now we are thinking of how can we make these available to other people who work in health care who have hypermobility, that can’t afford several hundred dollars on metal splints,” Cottone says.

She’s excited about how the project has progressed.

“I think it’s wonderful. When I first started anatomy, I knew I wanted to go into procedural medicine, but I had a little bit of doubt. ‘Is this something my body will allow me to do?’ Even though I’m extremely dexterous — I come from an art background and do hyperrealistic art — I didn’t see any other surgeons with different types of anatomy or deficits,” Cottone says. “Who knows, there could be other potential surgeons out there with hypermobility who are putting themselves down thinking they can’t become what they want to become. And who knows, even outside of surgeons, health care workers and other people who want to do dexterous things but their hypermobility is holding them back, they’re missing out. Now maybe they won’t have to.”

Cottone says the group is working with the Jacobs Institute on getting a patent for the prototypes. The prototypes 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 schools.

“As this was developing, 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,” Inglis says.

It’s been quite a journey for Cottone and the others  — and it’s not over yet.

“We’ll see where this takes us. We’re hoping to make this as accessible as we can to as many people as possible,” Cottone says. “It would have saved me a lot of time and energy if I had these available to me when I started.”