Prototyping A Novel Foot And Ankle External Fixator To Improve Rehabilitation Outcomes In Patients Following Closed Reduction; Healthcare or Wealthcare? The Hidden Economics of Medicine

Sociotechnical Synthesis

The general problem that unites my technical and STS research is the challenge of optimizing orthopedic intervention to balance patient outcomes, healthcare costs, and hospital incentives. This problem is particularly significant in the context of lower extremity fractures, where traditional surgical interventions may not always be necessary but are often favored due to institutional preferences and financial incentives. My research addresses both the technical development of a novel non-invasive external fixator and the broader socio technical factors that influence medical decision-making, particularly the tension between surgical and non-surgical treatment pathways. By examining both the engineering feasibility and the systemic influences on treatment choices, my work highlights the multifaceted nature of innovation in biomedical engineering and healthcare delivery.

My technical research focused on designing and prototyping a non-invasive external fixator for treating Type A and B ankle fractures based on the Weber classification. Our goal was to create a device that provides relative stability while allowing controlled micromovement to facilitate natural bone healing without the need for surgery. We conducted material testing, finite element analysis, and iterative prototyping to assess the device’s mechanical stability and usability. The findings demonstrated that our fixator could achieve adequate stabilization comparable to traditional surgical methods, supporting the potential for non-invasive treatment as a viable alternative. However, limitations in material selection and patient-specific variability indicate that further testing is required before clinical implementation.

My STS research examined the sociotechnical factors influencing hospital preferences for surgical interventions over non-invasive alternatives, particularly in the context of value-based care. Using Actor-Network Theory, I analyzed how financial incentives, institutional norms, and physician training contribute to the predominance of surgical treatments, even when non-invasive options may be equally effective. By reviewing hospital policy documents, interviewing healthcare professionals, and analyzing reimbursement structures, I found that economic incentives and surgical training pathways strongly reinforce the prioritization of operative care. My research also highlighted that shifts toward value-based care models, which emphasize cost-effectiveness and patient outcomes, could create opportunities for increased adoption of non-invasive technologies like our external fixator.

Through my research, I have contributed to a deeper understanding of both the technical feasibility of non-invasive orthopedic treatments and the systemic barriers to their adoption. While my technical work provides evidence that non-invasive fixation is a promising alternative, my STS research underscores the need for systemic change in hospital policies and physician training to encourage its implementation. Future researchers should focus on clinical trials to validate the efficacy of non-invasive fixation methods and further investigate policy reforms that incentivize the adoption of cost-effective, patient-centered treatments. Additionally, engaging with stakeholders such as insurance companies, hospital administrators, and orthopedic societies will be critical in shifting treatment paradigms.

I would like to express my sincere gratitude to my technical advisors, Dr. Ali Bajwa and Isi Azeke, for their guidance and expertise throughout the design process. I also appreciate the insights and support from my capstone teammates, Remy Brettell and Breanna Donahue, whose collaboration was instrumental in the success of our project. Special thanks to my STS professor, whose feedback and mentorship helped shape my analysis of the broader socio technical factors influencing healthcare decision-making. Finally, I am deeply grateful to my family and friends for their unwavering encouragement throughout my undergraduate journey.

School of Engineering and Applied Science

Bachelor of Science in Biomedical Engineering

Technical Advisor: Isi Azeke, Ali Bajwa

STS Advisor: Caitlin Wylie

Technical Team Members: Remy Brettell, Breanna Donahue