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Zhang Y, Bi Q, Zhang L, Zhu D. Preoperative Simulation and Three-Dimensional Model for the Operative Treatment of Tibiofibular Diaphyseal Fracture: A Randomized Controlled Clinical Trial. J INVEST SURG 2025; 38:2463351. [PMID: 39956543 DOI: 10.1080/08941939.2025.2463351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 02/01/2025] [Indexed: 02/18/2025]
Abstract
BACKGROUND In order to ascertain the safety and therapeutic efficacy of preoperative simulation in conjunction with three-dimensional (3D) printing modalities for the surgical management of tibiofibular diaphyseal fractures. We postulate that preoperative simulation and three-dimensional (3D) printing techniques have a significant impact on reducing the mean operative time, diminishing intraoperative blood loss, and decreasing the frequency of fluoroscopic. MATERIAL AND METHODS Sixty patients with tibiofibular diaphyseal fracture were divided into the conventional surgery group (n = 30) and the 3D printing group (n = 30). In the 3D printing group, preoperative equal-ratio fracture models prepared using the 3D printing technique were used to perform preoperative simulation, guide the real surgical operation, examine implant reduction and placement as well as preoperative plate/screw size. The operation time, intraoperative bleeding, frequency of fluoroscopies, Visual Analog Scale (VAS), and Johner-Wruhs Scale were recorded. RESULTS The operation time, blood loss, and the frequency of fluoroscopy during operation in the group with preoperative simulation and 3D printing were less than that in the conventional surgery group (p < 0.001). Meanwhile, the Visual Analog Scale (VAS) and Johner-Wruhs Scale were also improved in both groups. CONCLUSION The findings indicated that preoperative simulation and three-dimensional (3D) printing may facilitate the treatment of tibiofibular diaphyseal fractures, potentially enhancing preoperative planning and contributing to the precision and personalization of the surgical procedure. Thus, the application of this technology possesses considerable promise for future utilization in clinical practice. TRIAL REGISTRY Name of the registry: This study was registered in the Chinese Clinical Trial Registry; Trial registration number: ChiCTR2100052379.
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Affiliation(s)
- Yin Zhang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Qing Bi
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Li Zhang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Danjie Zhu
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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Reyniers P, Verrewaere D, van Es E, Colaris J, Schweizer A, Verstreken F. The Role of 3D technology in corrective osteotomy for forearm malunion. J Hand Surg Eur Vol 2025:17531934251327286. [PMID: 40145427 DOI: 10.1177/17531934251327286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2025]
Abstract
Forearm malunion affects upper limb function, impairing rotation, grip strength, and dexterity. Traditional osteotomies, based on two-dimensional imaging and intraoperative adjustments, may fail to address the intricate three-dimensional aspects of forearm deformities. Advances in 3D technology, including imaging, virtual surgical planning and 3D-printed patient-specific guides, have transformed corrective osteotomy by enhancing precision and predictability. This paper discusses the limitations of traditional methods, the role of 3D imaging in detailed deformity analysis, the benefits of virtual planning and the use of 3D surgical guides to improve outcomes. The use of 3D technology in both paediatric and adult cases is illustrated in a supplementary series of case reports. Future improvements in artificial intelligence, robotics and augmented reality are expected to enhance 3D-guided osteotomies further, making them more accessible and cost-effective.
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Affiliation(s)
| | | | - Eline van Es
- Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Colaris
- Erasmus University Medical Centre, Rotterdam, The Netherlands
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Wirth MA, Maniglio M, Jochum BC, Mania S, Nagy L, Schweizer A, Reissner L. Three-Dimensional-Planned Patient-Specific Guides for Scaphoid Reconstruction: A Comparative Study of Primary and Revision Nonunion Cases. J Clin Med 2025; 14:2082. [PMID: 40142890 PMCID: PMC11943166 DOI: 10.3390/jcm14062082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/13/2025] [Accepted: 03/15/2025] [Indexed: 03/28/2025] Open
Abstract
Background: Scaphoid reconstruction after an established non- or malunion is challenging and recent developments have shown the feasibility to reconstruct it with 3D-planned and -printed patient-specific instrumentation. Methods: Our study compared the clinical outcome of computer assisted 3D-reconstructions of the scaphoid using patient-specific guides for primary and revision reconstructions of scaphoid nonunion regarding clinical outcome. Therefore, 39 patients with primary scaphoid nonunion or malunion and 15 patients with nonunion or malunion after a previous operative treatment were treated with patient-specific guides and followed up for a mean of 10.5 months. The consolidation was assessed with a CT-scan, and the time to consolidation was recorded. Pain level, satisfaction, wrist range of motion, and grip strength were measured and compared. Results: The wrist range of motion and grip strength of the two groups were similar, except for the wrist extension, which was significantly reduced in the revision group. Consolidation was observed in 36/39 patients (92%) in the primary group and in 13/15 patients (87%) in the revision group. Our results showed similar clinical results postoperatively between primary reconstructions and revision surgery. Conclusions: The use of 3D-planned and -printed patient-specific instrumentation proves to be similarly effective in revision surgeries for the reconstruction of the scaphoid as it is in primary surgeries.
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Affiliation(s)
- Michael A. Wirth
- Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland (L.N.); (A.S.); (L.R.)
| | - Mauro Maniglio
- Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland (L.N.); (A.S.); (L.R.)
| | - Benedikt C. Jochum
- Department of Hand Surgery, Kantonsspital St. Gallen (KSSG), Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland
| | - Sylvano Mania
- Department of Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital, 1005 Lausanne, Switzerland
| | - Ladislav Nagy
- Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland (L.N.); (A.S.); (L.R.)
| | - Andreas Schweizer
- Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland (L.N.); (A.S.); (L.R.)
| | - Lisa Reissner
- Department of Hand Surgery, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland (L.N.); (A.S.); (L.R.)
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4
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Betschart J, Estermann L, Götschi T, Schweizer A. Computed-tomography-based three-dimensional analysis of bilateral differences in phalanges. HAND SURGERY & REHABILITATION 2025; 44:102065. [PMID: 39672510 DOI: 10.1016/j.hansur.2024.102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/30/2024] [Accepted: 12/02/2024] [Indexed: 12/15/2024]
Abstract
Three-dimensional analysis of bones, especially for preoperative planning of corrective osteotomy in fracture malunion, assumes that the bilateral extremities exhibit a symmetrical mirror image when projected onto each other. No studies are available for phalanges. Three-dimensional bone models of all phalanges of 20 healthy participants (40 hands) were created from computed tomography data. For each phalanx, the difference between the left and right sides were assessed with respect to axis of rotation, ulnoradial deviation, flexion-extension and bone length. The average absolute side difference was small, but with significant differences of extension-flexion (mean 1.1°), supination-pronation (mean 1.8°), ulnoradial deviation (mean 0.9°) and translation (mean 0.2 mm). All left proximal phalanges were significantly pronated in comparison to the right side. The differences are likely unimportant, especially in corrective osteotomy using advanced 3D techniques.
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Affiliation(s)
- Jana Betschart
- Department of Orthopaedics, Hand Surgery Division, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lea Estermann
- Department of Orthopaedics, Hand Surgery Division, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Tobias Götschi
- Department of Orthopaedics, Balgrist University Hospital; Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Hand Surgery Division, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Oyama S, Iwase H, Yoneda H, Yokota H, Hirata H, Yamamoto M. Insights and trends review: Use of extended reality (xR) in hand surgery. J Hand Surg Eur Vol 2025:17531934241313208. [PMID: 39852555 DOI: 10.1177/17531934241313208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2025]
Abstract
Digital transformation through extended reality (xR)-comprising virtual, augmented, mixed, and substitutional reality-has become an integral part of the future of clinical and surgical practice. xR technologies facilitate advanced surgical planning, training, therapies and education, reshaping both personal and institutional healthcare. This paper examines the potential changes that xR has introduced into the field of hand surgery, exploring how xR enhances patient-centric care, increases medical service efficiency and revolutionizes surgical training, planning and therapeutic interventions. Key areas such as surgical assistance, telemedicine, therapies and rehabilitation, medical training and education, and improving patient understanding are highlighted. By synthesizing the current literature, this narrative review articulates the theoretical and practical implications of xR, offering insights into its transformative potential and supporting continuous educational advancement in medical practice.
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Affiliation(s)
- Shintaro Oyama
- Innovative Research Center for Preventive Medical Engineering, Institute of Innovation for Future Society, Nagoya University, Tokai National Higher Education and Research System, NIC#5, Furo-cho, Chikusa-ku, Nagoya 4648601, Aichi, Japan
| | - Hiroaki Iwase
- Medical IT Center, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Hidemasa Yoneda
- Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan
| | - Hideo Yokota
- Image Processing Research Team, RIKEN Center for Advanced Photonics, Wako, Saitama, Japan
| | - Hitoshi Hirata
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michiro Yamamoto
- Department of Human Enhancement and Hand Surgery, Nagoya University, Nagoya, Aichi, Japan
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Yuichi Y, Kohyama S, Ikumi A, Yanagisawa Y, Nakatani T, Morita J, Ogawa T. A review of novel methods to assist digital planning and execution of osteotomy for upper limb deformities. Biomed Eng Online 2025; 24:2. [PMID: 39815270 PMCID: PMC11736953 DOI: 10.1186/s12938-025-01332-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 01/06/2025] [Indexed: 01/18/2025] Open
Abstract
Corrective osteotomy for upper limb deformities caused by fractures, trauma, or degeneration necessitates detailed preoperative planning to ensure accurate anatomical alignment, restore limb length, and correct angular deformities. This review evaluates the effectiveness of a three-dimensional (3D) preoperative planning program and an image fusion system designed for intraoperative guidance during corrective osteotomy procedures. The application processes and clinical outcomes observed with these technologies in various surgical scenarios involving the upper extremities were summarized. The systems proved beneficial in allowing surgeons to visualize surgical steps and optimize implant placement. However, despite these technological advancements, we found no significant impact on clinical outcomes compared to conventional methods. This indicates a need for further enhancements in system efficiency and user-friendliness to significantly improve patient results. Future developments should focus on addressing these limitations to enhance the practical utility of such advanced systems.
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Affiliation(s)
- Yoshii Yuichi
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Inashiki, Ami, Ibaraki, 300-0395, Japan.
| | - Sho Kohyama
- Department of Orthopaedic Surgery, Kikkoman General Hospital, Noda, Chiba, 278-0005, Japan
| | - Akira Ikumi
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Yohei Yanagisawa
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Takushi Nakatani
- Department of Orthopedic Surgery, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Junichiro Morita
- Department of Orthopaedic Surgery, NHO Mito Medical Center Hospital, Ibaraki, Ibaraki, 311-3193, Japan
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, NHO Mito Medical Center Hospital, Ibaraki, Ibaraki, 311-3193, Japan
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Meisterhans M, Zindel C, Sigrist B, Fucentese SF, Vlachopoulos L. Optimizing Reduction Guide Stability in Osteotomy Using Patient-Specific Instrumentation: A Basic Guideline. Orthop J Sports Med 2024; 12:23259671241275124. [PMID: 39664255 PMCID: PMC11632856 DOI: 10.1177/23259671241275124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 12/13/2024] Open
Abstract
Background The use of patient-specific instruments (PSIs) for osteotomies is becoming more popular in orthopaedic surgery for correcting mechanical axis and posttraumatic deformities. However, the PSI reduction guides have great potential for intraoperative deformation, which adversely affects the accuracy of the procedure. Purpose To conduct a finite element analysis (FEA) to analyze different design parameters to improve the intraoperative stability of the reduction guides. Study Design Descriptive laboratory study. Methods A reduction guide with a rectangular cross section and four 4-mm K-wire slots was simplified, and the following parameters were modified: width, height, profile design, K-wire thickness, and positions. Bending and torsional moments were applied to the guide construct and guide deformation and equivalent stress were determined using FEA. Results Increasing the profile height by 25% resulted in a 44% reduction in guide deformation for bending (37% for torsion). A 25% increase in profile width led to an 18% deformation reduction for bending (22% for torsion). Transverse K-wire slots resulted in 51% less deformation in torsion compared with longitudinally oriented slots. Placing the central K-wire slots 25% closer to the osteotomy reduced guide deformation by 20% for bending and 11% for torsion. Conclusion The most effective methods to increase reduction guide stability are to increase the guide height and reduce the central K-wire distance to the osteotomy. Clinical Relevance When performing opening or closing wedge osteotomies, which mainly involve bending of the guide, a high-profile guide and longitudinally oriented K-wire slots should be used. When torque is expected as in rotational osteotomies, the K-wire holes in guides should be oriented transversely to reduce intraoperative deformation.
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Affiliation(s)
- Michel Meisterhans
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Zindel
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Bastian Sigrist
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro F. Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Zou M, He Y, Xu Y, Shi Q, Zeng H. Design and application of a novel 3D printing digital navigation template for cubitus varus deformity in children. Front Pediatr 2024; 12:1342980. [PMID: 39170604 PMCID: PMC11335522 DOI: 10.3389/fped.2024.1342980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 07/24/2024] [Indexed: 08/23/2024] Open
Abstract
Background This study was aimed to assess the feasibility and efficacy of 3D printing digital template for treatment of cubitus varus deformity. Methods 32 patients who underwent lateral closing osteotomy were evaluated between January 2018 and January 2020 in this retrospective study. Navigation templates were used in 17 cases, while conventional surgery in 15 cases. The carrying angles before and after surgery, operation time and elbow joint function were compared. Results Navigation templates matched well with the anatomical markers of the lateral humerus. More accurate osteotomy degrees, shorter operation time and less radiation exposure were achieved in the navigation template group (p < 0.05). At the last follow-up time, significant difference was found based on the Bellemore criteria (p = 0.0288). Conclusions The novel navigation template can shorten operation time, improve the lateral closing osteotomy accuracy and improve postoperative elbow joint function.
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Affiliation(s)
- Ming Zou
- Department of Sport Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Youzhi He
- Department of Spine Surgery Zone 2, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Yuxia Xu
- Department of Spine Surgery Zone 2, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Qiang Shi
- Department of Spine Surgery Zone 2, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hao Zeng
- Department of Spine Surgery Zone 2, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Zindel C, Hodel S, Fürnstahl P, Schweizer A, Fucentese SF, Vlachopoulos L. Dome versus single-cut osteotomies for correction of long bone deformities-technical considerations. Sci Rep 2024; 14:12839. [PMID: 38834604 DOI: 10.1038/s41598-024-62410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/16/2024] [Indexed: 06/06/2024] Open
Abstract
Corrective osteotomy allows to improve joint loading, pain and function. In complex deformities, the biggest challenge is to define the optimal surgical solution, while considering anatomical, technical and biomechanical factors. While the single-cut osteotomy (SCOT) and focal dome osteotomy (FDO) are well-established treatment options, their mathematical relationship remain largely unclear. The aim of the study was (1) to describe the close mathematical relationship between the SCOT and FDO and (2) to analyze and introduce a novel technique-the stepped FDO-as a modification of the classic FDO. The mathematical background and relationship of SCOT and FDO are described for the example of a femoral deformity correction and visualized using a 3D surface model taking into account the benefits for the clinical application. The novel modifications of the stepped FDO are introduced and its technical and clinical feasibility demonstrated. Both, SCOT and FDO, rely on the same deformity axis that defines the rotation axis k for a 3D deformity correction. To achieve the desired correction using a SCOT, the resulting cutting plane is perpendicular to k, while using a FDO will result in a cylindrical cut with a central axis parallel to k. The SCOT and FDO demonstrate a strong mathematical relation, as both methods rely on the same deformity axis, however, resulting in different cutting planes. These characteristics enable a complementary use when defining the optimal type of osteotomy. This understanding enables a more versatile planning approach when considering factors as the surgical approach, biomechanical characteristics of fixation or soft tissue conditions. The newly introduced stepped FDO facilitates an exact reduction of the bone fragments and potentially expands the clinical applicability of the FDO.
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Affiliation(s)
- Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Sandro Hodel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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10
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Huo Z, Hao K, Fan C, Niu Y, Bai H, Bai W. Derotational distal femur osteotomy with medial patellofemoral ligament reconstruction can get good outcomes in the treatment of recurrent patellar dislocation with excessive TT-TG and increased femoral anteversion. Front Surg 2024; 11:1392947. [PMID: 38660587 PMCID: PMC11039896 DOI: 10.3389/fsurg.2024.1392947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
Background Surgery is the main treatment for recurrent patellar dislocation (PD). However, due to the complexity of anatomical factors, there is still a lack of consensus on the choice of combined surgical methods. This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament reconstruction combined with derotational distal femur osteotomies (MPFLR + DDFO) and combined with tibial tubercle osteotomies (MPFLR + TTO) for recurrent PD with increased femoral anteversion angles (FAA) and excessive tibial tubercle-trochlear groove (TT-TG) distance. Methods In this retrospective analysis, MPFLR + DDFO and MPFLR + TTO patients from 2015 to 2020 were included. Group A (MPFLR + DDFO, n = 42) and B (MPFLR + TTO, n = 46) were formed. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), visual analog scale (VAS) and intermittent and persistent osteoarthritis pain scale (ICOAP), Tegner scores), and complications. The Caton-Deschamps index (CD-I), patellar title angle, patellar congruence angle, patella-trochlear groove distance, TT-TG distance, and FAA were used to assess radiological outcomes. Results All clinical outcomes improved significantly in both groups, but Group A had significantly better postoperative scores than Group B (Kujala: 89.8 ± 6.4 vs. 82.9 ± 7.4, P < 0.01; Lysholm: 90.9 ± 5.1 vs. 81.3 ± 6.3, P = 0.02; IKDC: 87.3 ± 9.0 vs. 82.7 ± 8.0, P < 0.01; Tegner: 6.0 (5.0, 9.0) vs. 5.0 (4.0, 8.0), P = 0.01). However, there was no significant difference in the VAS and ICOAP scores between the two groups. No dislocation recurrences occurred. Radiological outcomes improved significantly in both groups, but Group A had better outcomes. After surgery, the patellar height of 88.5% (23/26) patients in Group A and 82.8% (24/29) patients in Group B was restored to normal (the Caton-Deschamps index <1.2). Conclusions Both MPFLR + TTO and MPFLR + DDFO obtained satisfactory clinical and radiological outcomes in the treatment of recurrent PD with increased FAA and excessive TT-TG. However, the outcomes of MPFLR + DDFO were better and should be considered a priority. MPFLR + TTO may be not necessary for such patients.
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Affiliation(s)
- Zhenhui Huo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kuo Hao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chongyi Fan
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Haotian Bai
- School of Basic Medical Science, Hebei University, Baoding, Hebei, China
| | - Weixia Bai
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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11
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Boe CC, Kennedy SA. Managing the Intra-articular Distal Radius Malunion. Hand Clin 2024; 40:79-87. [PMID: 37979992 DOI: 10.1016/j.hcl.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Intra-articular malunion of the distal radius represents a difficult clinical problem. While not all patients require treatment, corrective osteotomy may significantly improve motion, grip strength, and patient-reported outcome measures. Meticulous planning and technical precision are required with the possible need for multiple surgical approaches and both volar and dorsal implants. Arthroscopic assistance may be used to visualize the joint and articular reduction. Custom 3-dimensional planning guides are helpful in addressing complex multiplanar deformities. Regardless, intervention may not change the natural history of these injuries and post-traumatic arthritis is to be expected.
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Affiliation(s)
- Chelsea C Boe
- Department of Orthopaedics and Sports Medicine, University of Washington, Box 359798, 325 9th Avenue, Seattle, WA 98104, USA.
| | - Stephen A Kennedy
- Department of Orthopaedics and Sports Medicine, University of Washington, Box 359798, 325 9th Avenue, Seattle, WA 98104, USA
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12
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Konda S, Ishibashi T, Tamaki M, Tomita T. A preoperative simulation of medial open-wedge high tibial osteotomy for predicting postoperative realignment. Front Bioeng Biotechnol 2023; 11:1278912. [PMID: 38188494 PMCID: PMC10771312 DOI: 10.3389/fbioe.2023.1278912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
Three-dimensional preoperative surgical simulation of the medial open-wedge high tibial osteotomy (OWHTO), simplified as the rigid rotation around the hinge axis, has been performed to predict postoperative realignment. However, the practicality of this highly simplified simulation method has not been verified. This study aimed to investigate the validity of realignment simulation simplified as a rotation around a hinge axis compared with a postoperative CT model. A three-dimensional surface model of the tibia and femur was created from preoperative computed tomography (CT) images (preoperative model) of three patients. The simulation of medial OWHTO created sixty computer simulation models in each patient simplified as the rigid rotation of the proximal part of the tibia relative to the distal part from 1° to 20° around three types of hinge axes. The simulation models were compared with the actual postoperative model created from postoperative CT images to assess the reality of the simulation model. The average surface distance between the two models was calculated as an index representing the similarity of the simulation model to the postoperative model. The minimum value of average surface distances between the simulation and postoperative CT models was almost 1 mm in each patient. The rotation angles at which the minimum value of average surface distances was represented were almost identical to the actual correction angles. We found that the posterior tibial tilt and the axial rotation of the proximal tibia of the simulation model well represented those of the postoperative CT model, as well as the valgus correction. Therefore, the realignment simulation of medial OWHTO can generate realistic candidates for postoperative realignment that includes the actual postoperative realignment, suggesting the efficacy of the preoperative simulation method.
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Affiliation(s)
- Shoji Konda
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Toyonaka, Japan
| | - Teruya Ishibashi
- Department of Orthopaedic Biomaterial Science, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masashi Tamaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Graduate School of Medicine, Osaka University, Suita, Japan
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
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Hochreiter B, Saager LV, Zindel C, Calek AK, Stern C, Wieser K, Gerber C. Computer-assisted planning vs. conventional surgery for the correction of symptomatic mid-shaft clavicular nonunion and malunion. JSES Int 2023; 7:2321-2329. [PMID: 37969529 PMCID: PMC10638583 DOI: 10.1016/j.jseint.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The aim of this study was to compare the clinical and radiographic outcomes of treatment of symptomatic mal- and/or nonunion of midshaft clavicle fractures using radiographically based free-hand open reduction and internal fixation (ORIF) or computer-assisted 3D-planned, personalized corrective osteotomies performed using patient-specific instrumentation (PSI) and ORIF. The hypotheses were that (1) patients treated with computer-assisted planning and PSI would have a better clinical outcome, and (2) computer-assisted surgical planning would achieve a more accurate restoration of anatomy compared to the free-hand technique. Methods Between 1998 and 2020, 13 patients underwent PSI, and 34 patients underwent free-hand ORIF and/or corrective osteotomy. After application of exclusion criteria, 12/13 and 11/34 patients were included in the study. The clinical examination included measurement of the active range of motion and assessment of the absolute and relative Constant-Murley Scores and the subjective shoulder value. Subjective satisfaction with the cosmetic result was assessed on a Likert scale from 0 to 100 (subjective aesthetic value). 11/13 and 6/11 patients underwent postoperative computed tomography evaluation of both clavicles. Computed tomography scans were segmented to generate 3D surface models. After projection onto the mirrored contralateral side, displacement analysis was performed. Finally, bony union was documented. The average follow-up time was 43 months in the PSI and 50 months in the free-hand cohort. Results The clinical outcomes of both groups did not differ significantly. Median subjective shoulder value was 97.5% (70; 100) in the PSI group vs. 90% (0; 100) in the free-hand group; subjective aesthetic value was 86.4% (±10.7) vs. 75% (±18.7); aCS was 82.3 (±10.3) points vs. 74.9 (±26) points; and rCS was 86.7 (±11.3) points vs. 81.9 (±28.1) points. In the free-hand group, 2/11 patients had a postoperative neurological complication. In the PSI cohort, the 3D angle deviation was significantly smaller (PSI/planned vs. free-hand/contralateral: 10.8° (3.1; 23.8) vs. 17.4° (11.6; 42.4); P = .020)). There was also a trend toward a smaller 3D shift, which was not statistically significant (PSI/planned vs. free-hand/contralateral: 6 mm (3.4; 18.3) vs. 9.3 mm (5.1; 18.1); P = .342). There were no other significant differences. A bony union was achieved in all cases. Conclusion Surgical treatment of nonunion and malunions of the clavicle was associated with very good clinical results and a 100% union rate. This study, albeit in a relatively small cohort with a follow-up of 4 years, could not document any clinically relevant advantage of 3D planning and personalized operative templating over conventional radiographic planning and free-hand surgical fixation performed by experienced surgeons.
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Affiliation(s)
- Bettina Hochreiter
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Laura Victoria Saager
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Balgrist Campus, Orthopaedic Research Center, Zürich, Switzerland
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14
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Labèr R, Schweizer A. [Malunion of the distal radius: 3D planning and performance of intra- and extra-articular corrective osteotomy]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:258-269. [PMID: 37129610 PMCID: PMC10520186 DOI: 10.1007/s00064-023-00808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Restoration of the original anatomy with reduction of both current symptoms and risk of posttraumatic osteoarthritis. INDICATIONS Symptomatic intra- or extra-articular malunion due to limitation of movement and/or painful function, intra-articular step of > 1 mm, instability of the distal radioulnar joint. CONTRAINDICATIONS Minimal deformity. Pre-existing osteoarthritis Knirk and Jupiter II or higher. Simpler surgical alternative, e.g., ulna shortening osteotomy. Smoking or advanced age are not contraindications. SURGICAL TECHNIQUE Preoperative assessment and performance of a bilateral computed tomography (CT). Three-dimensional (3D) malposition analysis and calculation of the correction. Planning of the corrective osteotomy on the 3D model and creation of patient-specific drilling and sawing guides. Performing the 3D-guided osteotomy. POSTOPERATIVE MANAGEMENT Early functional unloaded mobilization with the splint for 8 weeks until consolidation control with CT. RESULTS Significant reduction of the step to < 1 mm (p ≤ 0.05) can be achieved with intra-articular corrections. In extra-articular corrective osteotomies, a mean residual rotational malalignment error of 2.0° (± 2.2°) and a translational malalignment error of 0.6 mm (± 0.2 mm) is achieved. Single-cut osteotomies in the shaft region can be performed to within a few degrees for rotation (e.g., pronation/supination 4.9°) and for translation (e.g., proximal/distal, 0.8 mm). After surgery, a mean residual 3D angle of 5.8° (SD 3.6°) was measured. Furthermore, surgical time for 3D-assisted surgery is significantly reduced compared to the conventional technique (140 ± 37 vs 108 ± 26 min; p < 0.05). Thus, the progression of osteoarthritis can be reduced in the medium term and improved mobility and grip strength are achieved. The clinical outcome parameters based on patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) scores are roughly comparable.
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Affiliation(s)
- Raffael Labèr
- Handchirurgie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
| | - Andreas Schweizer
- Handchirurgie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz
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15
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Hananouchi T, Satake S, Sakao K, Katsuda H, Shimada N, Dorthe EW, D’Lima DD. Determining the Relationship between Mechanical Properties and Quantitative Magnetic Resonance Imaging of Joint Soft Tissues Using Patient-Specific Templates. Bioengineering (Basel) 2023; 10:1050. [PMID: 37760152 PMCID: PMC10525776 DOI: 10.3390/bioengineering10091050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/11/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
To determine whether the mechanical properties of joint soft tissues such as cartilage can be calculated from quantitative magnetic resonance imaging (MRI) data, we investigated whether the mechanical properties of articular cartilage and meniscus scheduled to be resected during arthroplasty are correlated with the T2 relaxation time on quantitative MRI at the same location. Six patients who had undergone knee arthroplasty and seven who had undergone hip arthroplasty were examined. For the knee joint, the articular cartilage and lateral meniscus of the distal lateral condyle of the femur and proximal lateral tibia were examined, while for the hip joint, the articular cartilage above the femoral head was studied. We investigated the relationship between T2 relaxation time by quantitative MRI and stiffness using a hand-made compression tester at 235 locations. The patient-individualized template technique was used to align the two measurement sites. The results showed a negative correlation (from -0.30 to -0.35) in the less severely damaged articular cartilage and meniscus. This indicates that tissue mechanical properties can be calculated from T2 relaxation time, suggesting that quantitative MRI is useful in determining when to start loading after interventional surgery on cartilage tissue and in managing the health of elderly patients.
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Affiliation(s)
- Takehito Hananouchi
- Biodesign Division, Department of Academia-Government-Industry Collaboration, Hiroshima University, Hiroshima, Hiroshima 734-8551, Japan
- Department of Mechanical Engineering, Faculty of Engineering, Osaka Sangyo University, Daito, Osaka 574-8530, Japan
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, Osaka 583-0875, Japan (K.S.)
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA 92037, USA
| | - Shinji Satake
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, Osaka 583-0875, Japan (K.S.)
| | - Kei Sakao
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, Osaka 583-0875, Japan (K.S.)
| | - Hiroshi Katsuda
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, Osaka 583-0875, Japan (K.S.)
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, Osaka 583-0875, Japan (K.S.)
| | - Erik W. Dorthe
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA 92037, USA
| | - Darryl D. D’Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA 92037, USA
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16
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Wu W, Sabharwal S, Bunker M, Sabharwal S. 3D Printing Technology in Pediatric Orthopedics: a Primer for the Clinician. Curr Rev Musculoskelet Med 2023; 16:398-409. [PMID: 37335502 PMCID: PMC10427603 DOI: 10.1007/s12178-023-09847-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE OF REVIEW This article reviews the basics of 3D printing and provides an overview of current and future applications of this emerging technology in pediatric orthopedic surgery. RECENT FINDINGS Both preoperative and intraoperative utilization of 3D printing technology have enhanced clinical care. Potential benefits include more accurate surgical planning, shortening of a surgical learning curve, decrease in intraoperative blood loss, less operative time, and fluoroscopic time. Furthermore, patient-specific instrumentation can be used to improve the safety and accuracy of surgical care. Patient-physician communication can also benefit from 3D printing technology. 3D printing is rapidly advancing in the field of pediatric orthopedic surgery. It has the potential to increase the value of several pediatric orthopedic procedures by enhancing safety and accuracy while saving time. Future efforts in cost reduction strategies, making patient-specific implants including biologic substitutes and scaffolds, will further increase the relevance of 3D technology in the field of pediatric orthopedic surgery.
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Affiliation(s)
- Wei Wu
- Department of Orthopedic Surgery, UCSF Benioff Children’s Hospital, 747 52Nd Street, OPC 1St Floor, Oakland, CA 94609 USA
- University of California, San Francisco, San Francisco, CA USA
| | - Samir Sabharwal
- Department of Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, MD USA
| | - Michael Bunker
- Center for Advanced 3D+ Technologies, San Francisco Medical Center, University of California, San Francisco, CA USA
| | - Sanjeev Sabharwal
- Department of Orthopedic Surgery, UCSF Benioff Children’s Hospital, 747 52Nd Street, OPC 1St Floor, Oakland, CA 94609 USA
- University of California, San Francisco, San Francisco, CA USA
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17
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Xue KX, Zheng XG, Qiao C, Fang JH. Preoperative simulated surgery on 3D model assists osteotomy feasibility verification and surgical guidance for patients with cubitus valgus/varus deformity: a retrospective observational study. J Orthop Surg Res 2023; 18:470. [PMID: 37386477 PMCID: PMC10308635 DOI: 10.1186/s13018-023-03939-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND As the common delayed complication of supracondylar fractures in children, cubitus valgus/varus deformity might lead to pain and loss of motion of the elbow. The current corrective treatment might not be accurate enough and even contribute to postoperative deformity. This study retrospectively analyzed the clinical value of preoperative simulated surgery on 3D model-assisted osteotomy feasibility verification and surgical guidance for cubitus valgus/varus deformity. METHODS Seventeen patients were selected from October 2016 to November 2019. Deformities were analyzed from imaging data and 3D models and corrected after the simulated operations. The radiographic evaluation comprised osseous union, carrying angle, and anteversion angle of the distal humerus. The clinical evaluation was performed according to the Hospital for Special Surgery (HSS) scoring system. RESULTS All patients underwent the operation successfully and had no postoperative deformity. The carrying angle was significantly improved postoperatively (P < 0.001). The anteversion angle of the distal humerus did not change significantly (P > 0.05). The HSS score rose after surgery (P < 0.001). The function of the elbow joint was excellent in seven cases and good in ten cases. CONCLUSION Simulated surgery on 3D model plays an important role in osteotomy plan and surgical guidance, contributing to good surgical efficacy.
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Affiliation(s)
- Kai-Xiao Xue
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China
| | - Xing-Guo Zheng
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China
| | - Chang Qiao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China
| | - Jia-Hu Fang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, People's Republic of China.
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18
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Tarabishi MM, Almigdad AK, Ganger R, Farr S. Distal humeral corrective osteotomy for treatment of supracondylar fracture malunions in children. J Child Orthop 2023; 17:232-238. [PMID: 37288044 PMCID: PMC10242378 DOI: 10.1177/18632521231156942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/26/2023] [Indexed: 06/09/2023] Open
Abstract
Purpose This study aimed to determine the functional and radiographic outcomes following corrective distal humeral osteotomies for the treatment of supracondylar fracture malunions in children. We hypothesized that such secondary reconstructive procedures could restore a reasonable and near-normal amount of functionality in a large patient cohort at a tertiary referral center. Methods We retrospectively reviewed the clinical and radiological records of 38 children who underwent corrective osteotomy for posttraumatic supracondylar humeral malunion using K-wire fixation. All clinical data were extracted after chart review, including age, sex, dominant side whenever available, follow-up duration, and elbow range of motion preoperatively and at the final visit. Radiographic parameters, including Baumann's angle, humeroulnar angle, humerocondylar angle, and elbow range of motion were evaluated preoperatively, postoperatively, and at the final visit to identify the surgical correction outcomes. Results The mean age of the patients at fracture was 5.6 (±2.7) years, and the mean age at surgical intervention was 8.6 (±2.6) years. The mean follow-up period of the current series was 28.2 (±31.1) months. Baumann's angle, humeroulnar angle, and humerocondylar angle were successfully restored to physiological ranges (72.6°, 5.4°, and 36.1°, respectively). Postoperatively, elbow extension improved from -22° (±5.7) to -2.7° (±7.2) versus flexion from 115° (±13.2) to 128.2° (±11.1). Three revision surgeries (8%) were encountered. Conclusions Corrective osteotomy of the distal humerus with K-wire fixation is a reliable method to efficiently correct malunion of the distal humerus in different planes, thereby improving elbow range of motion and appearance. Level of evidence level IV: Retrospective therapeutic study.
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Affiliation(s)
| | - Ahmed K Almigdad
- Department of Orthopedic Surgery, Royal Medical Services, Amman, Jordan
| | - Rudolf Ganger
- Department of Pediatric Orthopedics and Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
| | - Sebastian Farr
- Department of Pediatric Orthopedics and Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
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19
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Mania S, Zindel C, Götschi T, Carrillo F, Fürnstahl P, Schweizer A. Malunion deformity of the forearm: Three-dimensional length variation of interosseous membrane and bone collision. J Orthop Res 2023; 41:727-736. [PMID: 35953296 DOI: 10.1002/jor.25428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 06/27/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
It remains unclear to what extent the interosseous membrane (IOM) is affected through the whole range of motion (ROM) in posttraumatic deformities of the forearm. The purpose of this study is to describe the ligament- and bone-related factors involved in rotational deficit of the forearm. Through three-dimensional (3D) kinematic simulations on one cadaveric forearm, angular deformities of 5° in four directions (flexion, extension, valgus, varus) were produced at two locations of the radius and the ulna (proximal and distal third). The occurrence of bone collision in pronation and the linear length variation of six parts of the IOM through the whole ROM were compared between the 32 types of forearm deformities. Similar patterns could be observed among four groups: 12 types of deformity presented increased bone collision in pronation, 8 presented an improvement of bone collision with an increase of the mean linear lengthening of the IOM in neutral rotation, 6 had an increased linear lengthening of the IOM in supination with nearly unchanged bone collision in pronation and 6 types presented nearly unchanged bone collision in pronation with a shortening of the mean linear length of IOM in supination or neutral rotation. This kinematic analysis provides a better understanding of the ligament- and bone-related factors expected to cause rotational deficit in forearm deformity and may help to refine the surgical indications of patient-specific corrective osteotomy.
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Affiliation(s)
- Sylvano Mania
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christoph Zindel
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Tobias Götschi
- Research in Orthopaedic Computer Science Group, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Fabio Carrillo
- Research in Orthopaedic Computer Science Group, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science Group, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Tsutsui S, Okano I, Kuroda T, Kawasaki K, Inagaki K. Corrective Osteotomy of Malunited Forearm Fractures for Volar Distal Radioulnar Joint Instability: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00039. [PMID: 37235707 DOI: 10.2106/jbjs.cc.22.00800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CASE A 6-year-old girl who had midshaft forearm fractures treated conservatively had volar distal radioulnar joint (DRUJ) instability caused by radial malunion at the 1-year follow-up. Corrective osteotomy was planned using computer-aided design (CAD) software based on computed tomography images. According to the analysis, the radial bone had an 8° apex volar deformation in the sagittal plane. Corrective osteotomy was performed based on preoperative planning. After surgery, the patient regained full function of her right forearm without volar DRUJ instability. CONCLUSION This case report shows that corrective osteotomy with 3D CAD analysis can help surgeons plan and accurately correct malunion.
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Affiliation(s)
- Sadaaki Tsutsui
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Takuma Kuroda
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Keikichi Kawasaki
- Department of Orthopaedic Surgery, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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The Flipping-Wedge Osteotomy: How 3D Virtual Surgical Planning (VSP) Suggested a Simple and Promising Type of Osteotomy in Pediatric Post-Traumatic Forearm Deformity. J Pers Med 2023; 13:jpm13030549. [PMID: 36983730 PMCID: PMC10058750 DOI: 10.3390/jpm13030549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
(1) Background: The application of computer-aided planning in the surgical treatment of post-traumatic forearm deformities has been increasingly widening the range of techniques over the last two decades. We present the “flipping-wedge osteotomy”, a promising geometrical approach to correct uniapical deformities defined during our experience with virtual surgical planning (VSP); (2) Methods: a case of post-traumatic distal radius deformity (magnitude 43°) treated with a flipping-wedge osteotomy in an 11-year-old girl is reported, presenting the planning rationale, its geometrical demonstration, and the outcome of the procedure; (3) Results: surgery achieved correction of both the angular and rotational deformities with a neutral ulnar variance; (4) Conclusions: flipping-wedge osteotomy may be a viable option to achieve correction in forearm deformities, and it deserves further clinical investigation.
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22
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Accuracy of 3D Corrective Osteotomy for Pediatric Malunited Both-Bone Forearm Fractures. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010021. [PMID: 36670572 PMCID: PMC9856311 DOI: 10.3390/children10010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Re-displacement of a pediatric diaphyseal forearm fracture can lead to a malunion with symptomatic impairment in forearm rotation, which may require a corrective osteotomy. Corrective osteotomy with two-dimensional (2D) radiographic planning for malunited pediatric forearm fractures can be a complex procedure due to multiplanar deformities. Three-dimensional (3D) corrective osteotomy can aid the surgeon in planning and obtaining a more accurate correction and better forearm rotation. This prospective study aimed to assess the accuracy of correction after 3D corrective osteotomy for pediatric forearm malunion and if anatomic correction influences the functional outcome. Our primary outcome measures were the residual maximum deformity angle (MDA) and malrotation after 3D corrective osteotomy. Post-operative MDA > 5° or residual malrotation > 15° were defined as non-anatomic corrections. Our secondary outcome measure was the gain in pro-supination. Between 2016−2018, fifteen patients underwent 3D corrective osteotomies for pediatric malunited diaphyseal both-bone fractures. Three-dimensional corrective osteotomies provided anatomic correction in 10 out of 15 patients. Anatomic corrections resulted in a greater gain in pro-supination than non-anatomic corrections: 70° versus 46° (p = 0.04, ANOVA). Residual malrotation of the radius was associated with inferior gain in pro-supination (p = 0.03, multi-variate linear regression). Three-dimensional corrective osteotomy for pediatric forearm malunion reliably provided an accurate correction, which led to a close-to-normal forearm rotation. Non-anatomic correction, especially residual malrotation of the radius, leads to inferior functional outcomes.
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23
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Patient-Specific Instruments for Forearm Sarcoma Resection and Allograft Reconstruction in Children: Results in 4 Cases. Sarcoma 2022; 2022:7005629. [PMID: 36353598 PMCID: PMC9640240 DOI: 10.1155/2022/7005629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/18/2022] [Accepted: 10/17/2022] [Indexed: 12/02/2022] Open
Abstract
For pediatric malignant bone tumors located in the limbs, limb salvage surgery is the gold standard, but it requires adequate resection margins to avoid local recurrence. Primitive bone sarcomas of the forearm (radius or ulna) are very rare and the reconstruction remains challenging. We describe a method to ensure minimal but adequate resection bone margins with precision in four consecutive patients with primitive bone sarcomas of the forearm. During the preoperative planning, magnetic resonance imaging (MRI) was used to delineate the tumor and the tumor volume was transferred to computerized tomography (CT) by image fusion. A patient-specific instrument (PSI) was manufactured by 3D printing to allow the surgeon to perform the surgical cuts precisely according to the preoperative planning. The first PSI was used for the resection of the tumor, which adopted a unique position at the bony surface. A second PSI was intended for the cutting of the bone allograft so that it fitted perfectly with the bone defect. In all four cases, the safe margin obtained into the bone was free of tumor (R0: microscopically margin-negative resection). The functional result was very good in all four patients. This limb salvage surgical technique can be applied in forearm bone sarcoma and improves surgical precision while maintaining satisfactory local tumor control. It can also reduce the surgical time and allow a stable osteosynthesis.
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3D accuracy and clinical outcomes of corrective osteotomies with patient-specific instruments in complex upper extremity deformities: an approach for investigation and correlation. Eur J Med Res 2022; 27:197. [PMID: 36209123 PMCID: PMC9548141 DOI: 10.1186/s40001-022-00830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Corrective osteotomies of the upper extremities with patient-specific instruments (PSIs) are increasingly used. In this context, the concordance between planning and postoperative 3D radiographs as well as the association between 3D accuracy and clinical outcome has rarely been evaluated. In this pilot study, we aimed to investigate our clinical mid-term outcome and 3D accuracy as well as their possible correlation, including identifying aspects critical to reaching optimal correction results. Methods From October 2018 to January 2020, we used PSIs for 12 corrective osteotomies of the upper extremity in 11 bones of 8 patients (congenital or posttraumatic deformities in 2 elbows, 3 forearms, 3 distal radii). In follow-up examination (10–25 months postoperatively), patient satisfaction, grip strength, ROM, VAS, and DASH were evaluated. Three-dimensional radiological accuracy was determined with 3D-reconstructed postoperative CT scans. With the software tool “Part Comparison” of Mimics® Innovation Suite Software/Materialise, surface differences of pre-planned and postoperative 3D models were compared. Results Compared to the preoperative situation pain and function were better at follow-up: The average VAS score significantly decreased from 6.5 ± 4.1 cm preoperatively to 2.3 ± 2.6 cm at the follow-up time point (p = 0.008). The average DASH score significantly improved, from 48.4 ± 30.9 to 27.0 ± 25.2 (p = 0.015). In the part comparison analysis “planned vs postoperative comparison”, significantly more points in percent (= 3D accuracy) were in a −3 mm to 3 mm interval than in the “preoperative vs planned comparison” (87.3 ± 13.8% vs 48.9 ± 16.6%, p = 0.004). After surgery, the maximum deviation value over all cases was 4.5 ± 1.1 mm, and the minimum deviation value was − 4.5 ± 1.2 mm vs preoperatively 12.9 ± 6.2 mm (p = 0.004) and − 7.2 ± 2.1 mm (p = 0.02), respectively. Clinically, in all cases with higher accuracy (> 90%), an improvement of either DASH or VAS or both of > 60% to the preoperative values occurred. There was a significant correlation between accuracy (%) and ΔVAS (p = 0.004). There were no method-related complications. Conclusions Our data after PSI-based corrective osteotomy in complex deformities of the upper extremity in a limited number of cases indicate a positive correlation between 3D accuracy and clinical outcomes. Examination of 3D accuracy to analyse sources of error in the hole procedure from initial CT scan to end of surgery even in patients with not fully satisfactory clinical results is required for further development of the method to achieve optimal correction results with nearly 100% congruence between the planned and postoperative 3D bone position. Trial registration This retrospective study was registered in the Center for Translational & Clinical Research Aachen (CTC-A) with the number 20-514 on November 20, 2021
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Benayoun M, Langlais T, Laurent R, Le Hanneur M, Vialle R, Bachy M, Fitoussi F. 3D planning and patient-specific surgical guides in forearm osteotomy in children: Radiographic accuracy and clinical morbidity. Orthop Traumatol Surg Res 2022; 108:102925. [PMID: 33845175 DOI: 10.1016/j.otsr.2021.102925] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Three-dimensional (3D) planning and patient-specific surgical guides are increasingly used in the treatment of skeletal deformities. The present study hypothesis was that they are reliable in forearm osteotomy in children, with low morbidity. MATERIAL AND METHODS Twenty-there children with one or several osteotomies to correct forearm deformities were retrospectively included: 9 (20 osteotomies) with surgical guide (G+), and 14 (28 osteotomies) without (G-). Etiologies comprised 8 cases of Madelung disease (3G+, 5G-) and 15 of post-traumatic malunion (6G+, 9G-). Mean age at surgery was 14.8±1.9 years. The patient-specific 3D-printed polyamide guides were produced from 3D virtual models based on 3D CT reconstruction. Mean follow-up was 22.1±13.6 months. RESULTS Mean correction error was 5.3°±4.1 and 4.2°±4.1 in the frontal and sagittal planes respectively in G+ (p=0.6). Surgery time was significantly shorter in G+, by a mean 42min (p=0.02). Mean total radiation dose (preoperative CT+intraoperative fluoroscopy) was significantly higher in G+ (p<0.0001). Complications rates were similar between groups. Improvement in PRWE score was significantly greater in G+. CONCLUSION The present preliminary results were encouraging. 3D planning and patient-specific surgical guides can be used in the treatment of forearm deformity in children. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Marie Benayoun
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Tristan Langlais
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France; Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants Purpan, Université de Toulouse, Toulouse, France.
| | - Romain Laurent
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Malo Le Hanneur
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Raphaël Vialle
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France; Département des Maladies Musculo-Squelettiques et Innovations Thérapeutiques, Sorbonne Université, Paris, France
| | - Manon Bachy
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Franck Fitoussi
- Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand-Trousseau, Sorbonne Université, 26, Avenue du Dr Arnold-Netter, 75012 Paris, France; Département des Maladies Musculo-Squelettiques et Innovations Thérapeutiques, Sorbonne Université, Paris, France
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Shi Q, Yan H, Chen S, Cao Q, Xu Y. Effect of a functional brace in combination with physical therapy for early correction of cubitus varus in young children. BMC Pediatr 2022; 22:523. [PMID: 36057568 PMCID: PMC9440591 DOI: 10.1186/s12887-022-03578-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to assess the clinical and radiologic outcomes of a functional brace in combination with physical therapy (FBPT) for early correction of cubitus varus in young children. Methods Eighteen consecutive patients with cubitus varus secondary to supracondylar fractures were enrolled between July 2017 and March 2019. We used the FBPT technique to correct varus and sagittal plane deformity for early cubitus varus in young children. The clinical evaluation included measurement of varus angulation, sagittal plane, and range of motion at three, six, and twelve months post-intervention. The clinical and radiographic results were assessed according to the Bellemore criteria. Results Pre-treatment humerus-elbow-wrist (HEW) angle measured on the affected side (varus deformity) ranged between -38° and -12° (average, -23.2°) while the post-treatment HEW angle ranged between -10° and + 15° (average, 8.8°). Compared with the unaffected side, no statistically significant difference was found in the affected side post-intervention (P > 0.05). According to the Bellemore criteria, we got excellent results in fourteen patients (77.8%), good results in three patients (16.7%), and poor result in one patient (5.5%). All patients and their parents (except one patient with residual varus deformities) were satisfied with the functional and cosmetic outcomes. Conclusions The FBPT is effective for the treatment of cubitus varus in children, especially for young children within 6 months of the injury.
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Affiliation(s)
- Qiang Shi
- Department of Spine Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410018, People's Republic of China
| | - Hua Yan
- Department of Pediatric Orthopedics, Shantou University Guangzhou Huaxin Orthopedic Hospital, Guangzhou, 510507, People's Republic of China
| | - Shu Chen
- Department of Pediatric Orthopedics, Shantou University Guangzhou Huaxin Orthopedic Hospital, Guangzhou, 510507, People's Republic of China
| | - Qian Cao
- Department of Orthopedics, Xiangtan Chinese Medicine Hospital, Xiangtan, 411100, People's Republic of China.
| | - Yuxia Xu
- Department of Spine Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, 410018, People's Republic of China.
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Li TP, Wollstein A, Sabharwal S, Nayar SK, Sabharwal S. Malunion of Pediatric Forearm Shaft Fractures: Management Principles and Techniques. Curr Rev Musculoskelet Med 2022; 15:427-437. [PMID: 35876970 PMCID: PMC9789287 DOI: 10.1007/s12178-022-09783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Clinically significant malunion of forearm diaphyseal fractures is an uncommon but potentially disabling condition amongst children and adolescents. We present the preoperative evaluation, including imaging, and discuss surgical indications and contemporary approaches to manage such patients, including an illustrative case. RECENT FINDINGS While advances in three-dimensional (3D) simulation, modeling, and patient-specific instrumentation have expanded the surgical armamentarium, their impact on long-term outcomes compared to traditional methods remains unknown. Successful outcome following surgical correction of malunion following a both-bone forearm fracture can be achieved with careful patient selection, appropriate indications, and a well-planned surgical execution.
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Affiliation(s)
- T. Peter Li
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Adi Wollstein
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Samir Sabharwal
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Suresh K. Nayar
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Sanjeev Sabharwal
- Department of Orthopaedic Surgery, University of California San Francisco, Benioff Children’s Hospital, Oakland, CA USA
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Zhang H, Zhu Y, Fu F, Gou L, Zhu Y, Zhang Z, Zhou C, Yao S, Yue M, Li X, Tong P, Ruan H, Wu C. Corrective Osteotomy with Volar and Dorsal Fixation for Malunion of Intra-Articular Fracture of the Distal Radius: A Retrospective Study. Orthop Surg 2022; 14:1751-1758. [PMID: 35866348 PMCID: PMC9363726 DOI: 10.1111/os.13409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/24/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Although corrective osteotomy with volar or dorsal plate fixation can treat malunion of distal radius fractures, each has its own disadvantages. Little is currently known on whether dorsal fixation combined with volar fixation may further improve recovery. This study aimed to evaluate the clinical value of corrective osteotomy combined with volar and dorsal plate fixation in patients with malunion of intra-articular fractures of the distal radius. METHODS Seventeen patients with malunion of intra-articular fractures of the distal radius treated with corrective osteotomy with volar and dorsal plate fixation from 1 January 2016 to 31 November 2018 were retrospectively analyzed. The enrolled patients included seven males and 10 females with an average age of 54.9 years (range: 36-70 years). The radiographic parameters, including the radial length, the radial inclination angle, the ulnar variance, and the volar tilt, as well as clinical outcomes, including wrist and forearm range of motion (ROM), grip strength, the Mayo Modified Wrist Score (MMWS), and the disabilities of the Arm, Shoulder, and Hand (DASH) score, were examined at 3 months and 18 months after operation and compared with the preoperative state. The paired t-test was used for statistical analysis. RESULTS After corrective osteotomy combined with volar and dorsal plate fixation, all included patients were followed up for 18 months, and there was no surgical site infection. Patients reported postoperative pain due to the irritation of extensor tendon (two cases) and wrist arthritis (two cases). The radial length increased from 1.34 ± 2.34 mm to 9.25 ± 2.65 mm and 9.03 ± 2.47 mm at 3 months and 18 months postoperatively (t = 8.257, 7.954, all p < 0.05). The radial inclination angle increased from 6.45° ± 0.76° to 19.35° ± 3.43° and 19.03° ± 3.63° at 3 and 18 months (t = 12.517, 12.122, all p < 0.05). The ulnar variance decreased from 5.11 ± 0.23 mm to 1.32 ± 0.31 mm and 1.54 ± 0.62 mm at 3 and 18 months (t = 4.214, 4.895, all p < 0.05). The volar tilt was corrected from 4.47° ± 3.46° to 15.51° ± 2.72° and 14.12° ± 2.41°, respectively (t = 11.247, 10.432, all p < 0.05). Moreover, wrist ROM increased from 42.53° ± 8.99° to 98.70° ± 7.61° and 101.24° ± 7.66° (t = 41.433, 46.627, all p < 0.05), while forearm ROM was increased from 94.82° ± 6.54° to 134.47° ± 5.06° and 137.24° ± 5.52°, respectively (t = 31.507, 32.584, all p < 0.05). Similarly, grip strength, MMWS, and DASH were also remarkably improved. There were no significant differences in the wrist and forearm ROM, grip strength, MMWS, and DASH scores between follow-up at 3 and 18 months (all p > 0.05). CONCLUSIONS Corrective osteotomy with volar and dorsal fixation can improve recovery of volar tilt, relieve wrist pain, restore wrist and forearm function, and increase grip strength of patients with malunion of intra-articular fractures of the distal radius.
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Affiliation(s)
- Huihao Zhang
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Department of Orthopaedic Surgery, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Yong Zhu
- Department of Orthopaedic Surgery, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Fangda Fu
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lingyun Gou
- Department of Orthopaedic Surgery, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Yonglin Zhu
- Department of Orthopaedic Surgery, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Zhiguo Zhang
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengcong Zhou
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Sai Yao
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ming Yue
- Department of Physiology, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaofeng Li
- Department of Orthopedics and Traumatology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Peijian Tong
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongfeng Ruan
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengliang Wu
- Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Singh S, Jud L, Fürnstahl P, Nagy L, Schweizer A, Roner S. Intermediate-Term Outcome of 3-Dimensional Corrective Osteotomy for Malunited Distal Radius Fractures With a Mean Follow-Up of 6 Years. J Hand Surg Am 2022; 47:691.e1-691.e10. [PMID: 34507869 DOI: 10.1016/j.jhsa.2021.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/15/2021] [Accepted: 07/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Our study aimed to analyze the functional and radiological intermediate-term outcome of 3-dimensional-guided corrective osteotomies for malunited distal radius fractures and to evaluate the progression of osteoarthritis after this intervention. METHODS All patients with malunited distal radius fractures who underwent 3-dimensional-guided corrective osteotomies from October 2008 to January 2015 were included. Pre- and postoperative range of motion, grip strength, and postoperative patient-reported outcomes were assessed. Pre- and postoperative osteoarthritis grading was performed using conventional radiographs and the osteoarthritis grading system described by Knirk and Jupiter. Additionally, the evaluation of articular stepoff was performed using pre- and postoperative computed tomography. RESULTS Fifteen patients, with a mean follow-up of 6 years (range, 4.1-10.4 years), were included. According to rater 1, 8 cases had no postoperative osteoarthritis progression, 6 cases had progression of 1 grade, and 1 case had progression of 2 grades. According to rater 2, there was no progression in 11 cases, and there was progression of 1 grade in 2 cases and progression of 2 grades in 2 cases. Compared with before the surgery, the patients demonstrated a mean improvement of 14.8 kg (±12.6 kg) in grip strength after the surgery. At the last follow-up, the mean Patient-Rated Wrist Evaluation score was 11.8 (±12.0), the mean Disabilities of the Arm, Shoulder and Hand score was 11.1 (±11.4), and the mean residual pain score on the visual analog scale was 0.8 (±1.0). CONCLUSIONS The intermediate-term outcome of 3-dimensional-guided corrective osteotomies for distal radius intra-articular malunions showed excellent patient-reported outcomes and no clinically relevant progression of osteoarthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Sarvpreet Singh
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.
| | - Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Ladislav Nagy
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Simon Roner
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland; Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zürich, Zürich, Switzerland
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Three-Dimensional Planning and Patient-Specific Instrumentation for the Fixation of Distal Radius Fractures. Medicina (B Aires) 2022; 58:medicina58060744. [PMID: 35744007 PMCID: PMC9227146 DOI: 10.3390/medicina58060744] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Three-dimensional planning and guided osteotomy utilizing patient-specific instrumentation (PSI) with the contralateral side used as a reference have been proven as effective in the treatment of malunions following complex fractures of the distal radius. However, this approach has not yet been described in relation to fracture reduction of the distal radius. The aim of this study was to assess the technical and logistical feasibility of computer-assisted surgery in a clinical setting using PSI for fracture reduction and fixation. Materials and Methods: Five patients with varied fracture patterns of the distal radius underwent operative treatment with using PSI. The first applied PSI guide allowed specific and accurate placement of Kirschner wires inside the multiple fragments, with subsequent concurrent reduction using a second guide. Results: Planning, printing of the guides, and operations were performed within 5.6 days on average (range of 1–10 days). All patients could be treated within a reasonable period of time, demonstrating good outcomes, and were able to return to work after a follow-up of three months. Mean wrist movements (°) were 58 (standard deviation (SD) 21) in flexion, 62 (SD 15) in extension, 73 (SD 4) in pronation and 74 (SD 10) in supination at a minimum follow-up of 6 months. Conclusions: Three-dimensional planned osteosynthesis using PSI for treatment of distal radius fractures is feasible and facilitates reduction of multiple fracture fragments. However, higher costs must be taken into consideration for this treatment.
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Shi Q, Yan H, Yang M, Chen S, Lu B. Comparative evaluation of pinning and cast fixation vs. external fixation after lateral closing-wedge osteotomy for cubitus varus in children. J Shoulder Elbow Surg 2022; 31:481-487. [PMID: 34052443 DOI: 10.1016/j.jse.2021.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cubitus varus has been regarded as a poor functional and cosmetic consequence of supracondylar humerus fracture in children. The aim of this study was to assess the clinical and radiologic outcomes of cubitus varus treatments based on fixation methods: Kirschner (K)-wire and cast fixation or external fixation. METHODS Forty consecutive patients with cubitus varus secondary to supracondylar fractures were retrospectively enrolled between October 2015 and December 2018. Following lateral closing-wedge osteotomy, those undergoing K-wire and cast fixation were included in group A (n = 21) and those who were treated with external fixation comprised group B (n = 19). We measured the bony union, elbow joint range of motion, and carrying angle. The clinical and radiographic results were assessed according to the Bellemore criteria. RESULTS No significant difference was found between the 2 groups in terms of age, gender, operation duration, union time, and postoperative elbow range of motion (P > .05). A significant difference was noted, however, in postoperative carrying angle and results according to Bellemore criteria in group B (P < .05). No nonunion, myositis ossificans, or neurovascular injury was found at follow-up in the 2 groups. In group A, revision surgery was needed for residual varus in 1 patient and lateral condylar prominence was found in 2 patients. In group B, a superficial pin-site infection occurred in 2 patients, who were treated successfully with oral antibiotics. CONCLUSIONS Both K-wire and external fixation after lateral closing-wedge osteotomy are reliable and effective for the treatment of cubitus varus in children. Compared with the K-wire method, external fixation achieves better functional and cosmetic results with a shorter learning curve.
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Affiliation(s)
- Qiang Shi
- Department of Spine Surgery, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hua Yan
- Department of Pediatric Orthopedics, Women and Children's Hospital of Guangdong Province, Guangzhou, China
| | - Ming Yang
- Department of Pediatric Orthopedics, Shantou University Guangzhou Huaxin Orthopedic Hospital, Guangzhou, China
| | - Shu Chen
- Department of Pediatric Orthopedics, Women and Children's Hospital of Guangdong Province, Guangzhou, China
| | - Bangbao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China.
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Roth KC, van Es EM, Kraan GA, Verhaar JAN, Stockmans F, Colaris JW. Outcomes of 3-D corrective osteotomies for paediatric malunited both-bone forearm fractures. J Hand Surg Eur Vol 2022; 47:164-171. [PMID: 34260312 PMCID: PMC8801669 DOI: 10.1177/17531934211029511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Closed treatment of paediatric diaphyseal forearm fractures carries the risk of re-displacement, which can lead to symptomatic malunions. This is because growth will not correct angulation deformity as it does in metaphyseal fractures. The purpose of this prospective cohort study was to evaluate the outcomes after 3-D-planned corrective osteotomy with patient-specific surgical guides for paediatric malunited forearm fractures causing impaired pro-supination. Our primary outcome measure was the gain in pro-supination at 12 months follow-up. Fifteen patients with a mean age at trauma of 9.6 years and time until osteotomy of 5.9 years were included. Preoperatively, patients displayed a mean pro-supination of 67° corresponding to 44% of the contralateral forearm. At final follow-up, this improved to 128°, achieving 85% of the contralateral side. Multivariate linear regression analysis revealed that predictors of greater functional gain after 3-D corrective osteotomy are severe preoperative impairment in pro-supination, shorter interval until 3-D corrective osteotomy and greater angulation of the radius.Level of evidence: III.
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Affiliation(s)
- Kasper C. Roth
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands,Kasper C. Roth, Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Eline M. van Es
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gerald A. Kraan
- Department of Orthopaedics, Reinier HAGA Orthopaedic Centre, Zoetermeer, The Netherlands
| | - Jan A. N. Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Joost W. Colaris
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Zhang Y, Luo J, Cao L, Zhang S, Tong Y, Bi Q, Zhang Q. Preoperative Simulation and Three-Dimensional Model for the Operative Treatment of Forearm Double Fracture: A Randomized Controlled Clinical Trial. J INVEST SURG 2022; 35:1231-1238. [PMID: 34983284 DOI: 10.1080/08941939.2021.2024305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To assess the safety and efficacy of preoperative simulation and three-dimensional (3D) models in the treatment of ulnoradial diaphyses fracture. It was hypothesized that preoperative simulation and 3D printing might significantly shorten the mean operative time, intraoperative bleeding, and intraoperative fluoroscopy. MATERIAL AND METHODS Forty patients with forearm double fracture were divided into 3D printing group and conventional surgery group. Preoperative simulation and 3D printing were performed on patients in the 3D printing group to examine implant reduction and placement as well as preoperative plate/screw size. The operation time, intraoperative bleeding, and frequency of fluoroscopies were recorded. RESULTS In the conventional surgery group, the operative time, intraoperative bleeding, and the frequency of fluoroscopy were 106.2 ± 15.92 min, 61.45 ± 11.33 ml and 5.65 ± 1.23 times, whereas in the 3D printing group, values of all the three parameters were better than those of the conventional surgery group (91.3 ± 14.85 min, 48.6 ± 10.39 ml and 3.85 ± 1.04 times, respectively). The forearm pronation and supination of the 3D printing group improved to 79.55 ± 5.12° and 76.80 ± 3.96°, respectively. In the conventional surgery group, patients also had significant improvement in these indicators, which improved to 78.60 ± 5.18° and 75.4 ± 5.30°. CONCLUSIONS The results showed that preoperative simulation and 3D printing can enhance the safety as well as personalization of the surgical process during the treatment of forearm double fracture and therefore holds potential for future application in clinical practice. TRIAL REGISTRY Name of the registry: This study was registered in the Chinese Clinical Trial Registry; Trial registration number: ChiCTR2100045790.
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Affiliation(s)
- Yin Zhang
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.,The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
| | - Junchao Luo
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.,The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Li Cao
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shuijun Zhang
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yu Tong
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qing Bi
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qiong Zhang
- Department of Orthopedic Surgery, Zhejiang Provincial People's Hospital and People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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Borbas P, Loucas R, Loucas M, Vetter M, Hofstede S, Ernstbrunner L, Wieser K. Biomechanical stability of complex coronal plane fracture fixation of the capitellum. Arch Orthop Trauma Surg 2022; 142:3239-3246. [PMID: 34424387 PMCID: PMC9522805 DOI: 10.1007/s00402-021-04126-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Coronal plane fractures of the distal humerus are relatively rare and can be challenging to treat due to their complexity and intra-articular nature. There is no gold standard for surgical management of these complex fractures. The purpose of this study was to compare the biomechanical stability and strength of two different internal fixation techniques for complex coronal plane fractures of the capitellum with posterior comminution. MATERIALS AND METHODS Fourteen fresh frozen, age- and gender-matched cadaveric elbows were 3D-navigated osteotomized simulating a Dubberley type IIB fracture. Specimens were randomized into one of two treatment groups and stabilized with an anterior antiglide plate with additional anteroposterior cannulated headless compression screws (group antiGP + HCS) or a posterolateral distal humerus locking plate with lateral extension (group PLP). Cyclic testing was performed with 75 N over 2000 cycles and ultimately until construct failure. Data were analyzed for displacement, construct stiffness, and ultimate load to failure. RESULTS There was no significant difference in displacement during 2000 cycles (p = 0.291), stiffness (310 vs. 347 N/mm; p = 0.612) or ultimate load to failure (649 ± 351 vs. 887 ± 187 N; p = 0.140) between the two groups. CONCLUSIONS Posterolateral distal humerus locking plate achieves equal biomechanical fixation strength as an anterior antiglide plate with additional anteroposterior cannulated headless compression screws for fracture fixation of complex coronal plane fractures of the capitellum. These results support the use of a posterolateral distal humerus locking plate considering the clinical advantages of less invasive surgery and extraarticular metalware. LEVEL OF EVIDENCE Biomechanical study.
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Affiliation(s)
- Paul Borbas
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Rafael Loucas
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Marios Loucas
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Maximilian Vetter
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Simon Hofstede
- grid.5801.c0000 0001 2156 2780Institute of Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Lukas Ernstbrunner
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Karl Wieser
- grid.412373.00000 0004 0518 9682Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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You C, Zhou Y, Han J. Loss of correction in cubitus varus deformity after osteotomy. Medicine (Baltimore) 2021; 100:e27848. [PMID: 34889234 PMCID: PMC8663885 DOI: 10.1097/md.0000000000027848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022] Open
Abstract
We aimed to investigate the rate of loss of correction and the factors thereof in pediatric patients undergoing osteotomy for treatment of cubitus varus deformity.Between July 2008 and July 2017, we treated 30 patients who underwent osteotomy for cubital varus. We compared the preoperative and postoperative clinical and imaging findings, including the H-Cobb and Baumman angles, in all patients. Postoperative evaluation was performed by telephonic interviews.Our patients consisted of 17 males and 13 females. The mean age was 75 months. At the first follow-up, approximately 80% of patients had experienced a loss of correction of the humerus-cobb angle (H-Cobb angle); at the second follow-up, the incidence was 83%. Meanwhile, 57% and 43% of patients experienced a loss of correction of the Baumman angle at the first and second follow-ups, respectively. The average interval between the first and second follow-ups was 24 days, and the mean loss in the H-Cobb angle was 2.4°. There was a significant difference between the H-Cobb angles as measured before and after surgery (P < .05). There was no significant difference between the H-Cobb angles of the affected side and the contralateral healthy elbow at the third postoperative follow-up; however, there was a significant difference between the Baumman angle between before and after surgery (P < .05). The Baumman angles as measured at the second and third postoperative follow-ups differed significantly from those of the contralateral healthy elbow joint. According to the survival curve analysis, the median survival times of the H-Cobb and Baumman angles were 27 and 34 months, respectively.The postoperative loss of the 2 angles occurred mainly during the first and second follow-up periods. Therefore, patient follow-up is particularly important in the period directly following the operation. Additional measures may be necessary to avoid rapid angle loss.
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Shah NV, Gold R, Dar QA, Diebo BG, Paulino CB, Naziri Q. Smart Technology and Orthopaedic Surgery: Current Concepts Regarding the Impact of Smartphones and Wearable Technology on Our Patients and Practice. Curr Rev Musculoskelet Med 2021; 14:378-391. [PMID: 34729710 PMCID: PMC8733100 DOI: 10.1007/s12178-021-09723-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW While limited to case reports or small case series, emerging evidence advocates the inclusion of smartphone-interfacing mobile platforms and wearable technologies, consisting of internet-powered mobile and wearable devices that interface with smartphones, in the orthopaedic surgery practice. The purpose of this review is to investigate the relevance and impact of this technology in orthopaedic surgery. RECENT FINDINGS Smartphone-interfacing mobile platforms and wearable technologies are capable of improving the patients' quality of life as well as the extent of their therapeutic engagement, while promoting the orthopaedic surgeons' abilities and level of care. Offered advantages include improvements in diagnosis and examination, preoperative templating and planning, and intraoperative assistance, as well as postoperative monitoring and rehabilitation. Supplemental surgical exposure, through haptic feedback and realism of audio and video, may add another perspective to these innovations by simulating the operative environment and potentially adding a virtual tactile feature to the operator's visual experience. Although encouraging in the field of orthopaedic surgery, surgeons should be cautious when using smartphone-interfacing mobile platforms and wearable technologies, given the lack of a current academic governing board certification and clinical practice validation processes.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
| | - Richard Gold
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- School of Medicine, Saint George's University, True Blue, West Indies, Grenada
| | - Qurratul-Ain Dar
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- Department of Orthopaedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
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Hong E, Kwak DS, Kim IB. Morphological symmetry of the radius and ulna-Can contralateral forearm bones utilize as a reliable template for the opposite side? PLoS One 2021; 16:e0258232. [PMID: 34613996 PMCID: PMC8494372 DOI: 10.1371/journal.pone.0258232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
The most important precondition for correction of the affected forearm using data from the contralateral side is that the left and right bone features must be similar, in order to develop patient-specific instruments (PSIs) and/or utilize computer-assisted orthopedic surgery (CAOS). The forearm has complex anatomical structure, and most people use their dominant hand more than their less dominant hand, sometimes resulting in asymmetry of the upper limbs. The aim of this study is to investigate differences of the bilateral forearm bones through a quantitative comparison of whole bone parameters including length, volume, bowing, and twisting parameters, and regional shape differences of the forearm bones. In total, 132 bilateral 3D radii and ulnae 3D models were obtained from CT images, whole bone parameters and regional shape were analyzed. Statistically significant differences in whole bone parameters were not shown. Regionally, the radius shows asymmetry in the upper section of the central part to the upper section of the distal part. The ulna shows asymmetry in the lower section of the proximal part to the lower section of the central part. Utilizing contralateral side forearm bones to correct the affected side may be feasible despite regional differences in the forearm bones of around 0.5 mm.
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Affiliation(s)
- Eunah Hong
- Department of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- Department of Anatomy / Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail: (IBK); (DSK)
| | - In-Beom Kim
- Department of Biomedicine & Health Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Anatomy / Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail: (IBK); (DSK)
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Shiode R, Kabashima M, Hiasa Y, Oka K, Murase T, Sato Y, Otake Y. 2D-3D reconstruction of distal forearm bone from actual X-ray images of the wrist using convolutional neural networks. Sci Rep 2021; 11:15249. [PMID: 34315946 PMCID: PMC8316567 DOI: 10.1038/s41598-021-94634-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/06/2021] [Indexed: 01/08/2023] Open
Abstract
The purpose of the study was to develop a deep learning network for estimating and constructing highly accurate 3D bone models directly from actual X-ray images and to verify its accuracy. The data used were 173 computed tomography (CT) images and 105 actual X-ray images of a healthy wrist joint. To compensate for the small size of the dataset, digitally reconstructed radiography (DRR) images generated from CT were used as training data instead of actual X-ray images. The DRR-like images were generated from actual X-ray images in the test and adapted to the network, and high-accuracy estimation of a 3D bone model from a small data set was possible. The 3D shape of the radius and ulna were estimated from actual X-ray images with accuracies of 1.05 ± 0.36 and 1.45 ± 0.41 mm, respectively.
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Affiliation(s)
- Ryoya Shiode
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. .,Division of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, 630-0192, Japan.
| | - Mototaka Kabashima
- Division of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, 630-0192, Japan
| | - Yuta Hiasa
- Division of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, 630-0192, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshinobu Sato
- Division of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, 630-0192, Japan
| | - Yoshito Otake
- Division of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, 630-0192, Japan.
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Dobbe JGG, Kloen P, Strackee SD, Streekstra GJ. Comparison of an oblique single cut rotation osteotomy with a novel 3D computer-assisted oblique double cut alignment approach. Sci Rep 2021; 11:14731. [PMID: 34282242 PMCID: PMC8290026 DOI: 10.1038/s41598-021-94141-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/06/2021] [Indexed: 11/09/2022] Open
Abstract
An oblique double-cut rotation osteotomy (ODCRO) enables correcting a complex bone deformation by aligning, in 3D, the distal, middle and proximal bone segments with a target bone, without intersegmental gaps. We propose virtual preoperative planning of an ODCRO. To minimize a residual translation error, we use an optimization algorithm and optimize towards bone length, alignment in the transverse direction, or a balanced reconstruction. We compare the residual alignment error with an oblique single-cut rotation osteotomy using 15 complex bone deformations. The single-cut approach was not feasible in 5 cases, whereas the ODCRO procedure was feasible in all cases. The residual alignment error was smaller for the ODCRO than for the single-cut approach except for one case. In a subset for length reconstruction, the length error of 7.3-21.3 mm was restored to 0.0 mm in 4 of 5 cases, although at the cost of an increased transverse translation. The proposed method renders planning an ODCRO feasible and helps restoring bone alignment and lengthening better than an oblique single-cut rotation osteotomy. Awareness of the challenges and possibilities in preoperative planning of an ODCRO will be of value for future alignment surgery and for patients.
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Affiliation(s)
- Johannes G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room no L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Peter Kloen
- Department of Orthopedic Trauma Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room no L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Yoshii Y, Ogawa T, Hara Y, Totoki Y, Ishii T. An image fusion system for corrective osteotomy of distal radius malunion. Biomed Eng Online 2021; 20:66. [PMID: 34193171 PMCID: PMC8244167 DOI: 10.1186/s12938-021-00901-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background To provide surgical support for corrective osteotomy, we developed an image fusion system for three-dimensional (3D) preoperative planning and fluoroscopy. To assess the utility of this image fusion system, we evaluated the reproducibility of preoperative planning for corrective osteotomy of dorsally angulated distal radius malunion using the system and compared reproducibility without using the system. Methods Ten wrists from 10 distal radius malunion patients who underwent corrective osteotomy were evaluated. 3D preoperative planning and the image fusion system were used for the image fusion group (n = 5). Only 3D preoperative planning was used for the control group (n = 5). 3D preoperative planning was performed for both groups in order to assess reduction, placement, and the choice of implants. In the image fusion group, the outline of the planned image was displayed on a monitor and overlapped with fluoroscopy images during surgery. Reproducibility was evaluated using preoperative plan and postoperative 3D images. Images were compared with the 3D coordinates of the radial styloid process (1), the volar and dorsal edges of the sigmoid notch (2) (3), and the barycentric coordinates of the three reference points. The reproducibility of the preoperative plan was evaluated by the distance of the coordinates between the plan and postoperative images for the reference points. Results The distances between preoperative planning and postoperative reduction in the image fusion group were 2.1 ± 1.1 mm, 1.8 ± 0.7 mm, 1.9 ± 0.9 mm, and 1.4 ± 0.7 mm for reference points (1), (2), (3), and the barycenter, respectively. The distances between preoperative planning and postoperative reduction in the control group were 3.7 ± 1.0 mm, 2.8 ± 2.0 mm, 1.7 ± 0.8 mm, and 1.8 ± 1.2 mm for reference points (1), (2), (3), and the barycenter, respectively. The difference in reference point (1) was significantly smaller in the image fusion group than in the control group (P < 0.05). Conclusion Corrective osteotomy using an image fusion system will become a new surgical support method for fracture malunion. Trial registration Registered as NCT03764501 at ClinicalTrials.gov.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan.
| | - Takeshi Ogawa
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Yasukazu Totoki
- Department of Orthopaedic Surgery, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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Efficacy Evaluation of 3D Navigational Template for Salter Osteotomy of DDH in Children. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8832617. [PMID: 34124261 PMCID: PMC8166498 DOI: 10.1155/2021/8832617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
Background The aim of this study is to retrospectively evaluate the efficacy of 3D navigational template for Salter osteotomy of DDH in children. Methods Thirty-two consecutive patients with DDH who underwent Salter osteotomy were evaluated between July 2014 and August 2017, and they were divided into the conventional group (n = 16) and navigation template group (n = 16) according to different surgical methods. The corrective acetabular degrees, radiation exposure, and operation time were compared between the two groups. Results No nerve palsy or redislocation was reported in the navigation template group. Compared with the conventional group, the navigation template group had the advantages of more accurate acetabular degrees, less radiation exposure, and shorter operation time (P < 0.05). Meanwhile, the navigation template group achieved a better surgical outcome than the conventional group (McKay, P = 0.0293; Severin, P = 0.0949). Conclusions The 3D navigational template for Salter osteotomy of DDH is simple and effective, which could be an alternative approach to improve the Salter osteotomy accuracy and optimize the efficacy.
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Sri-utenchai N, Pengrung N, Srikong K, Puncreobutr C, Lohwongwatana B, Sa-ngasoongsong P. Three-dimensional printing technology for patient-matched instrument in treatment of cubitus varus deformity: A case report. World J Orthop 2021; 12:338-345. [PMID: 34055591 PMCID: PMC8152442 DOI: 10.5312/wjo.v12.i5.338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recently, medical three-dimensional printing technology (3DPT) has demonstrated potential benefits for the treatment of cubitus varus deformity (CVD) by improving accuracy of the osteotomy through the use of an osteotomy guide, with or without a patient-mated plate. Here, we present an interesting CVD case, involving a patient who was treated with corrective biplanar chevron osteotomy using an innovative customized osteotomy guide and a newly designed patient-matched monoblock crosslink plate created with 3DPT.
CASE SUMMARY A 32-year-old female presented with a significant CVD from childhood injury. A computer simulation was processed using images from computerized tomography scans of both upper extremities. The biplanar chevron osteotomy was designed to create identical anatomy between the mirror image of the contralateral distal humerus and the osteotomized distal humerus. Next, the customized osteotomy guide and patient-matched monoblock crosslink plate were designed and printed. A simulation osteotomy was created for the real-sized bone model, and the operation was performed using the posterior paratricipital approach with k-wire positioning from the customized osteotomy guide as a predrilled hole for screw fixation to achieve immediate control of the reduction after osteotomy. Our method allowed for successful treatment of the CVD case, significantly improving the patient’s radiographic and clinical outcomes, with satisfactory result.
CONCLUSION 3DPT-created patient-matched osteotomy guide and instrumentation provides accurate control during CVD correction.
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Affiliation(s)
- Nithid Sri-utenchai
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Nachapan Pengrung
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Korakod Srikong
- Biomechanic Research Center, Meticuly Co Ltd., Chulalongkorn University, Bangkok 10330, Thailand
| | - Chedtha Puncreobutr
- Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand
| | - Boonrat Lohwongwatana
- Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand
| | - Paphon Sa-ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Shigi A, Oka K, Tanaka H, Shiode R, Murase T. Utility of a 3-dimensionally printed color-coded bone model to visualize impinging osteophytes for arthroscopic débridement arthroplasty in elbow osteoarthritis. J Shoulder Elbow Surg 2021; 30:1152-1158. [PMID: 33486060 DOI: 10.1016/j.jse.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The identification and precise removal of bony impingement lesions during arthroscopic débridement arthroplasty for elbow osteoarthritis require a high level of experience and surgical skill. We have developed a new technique to identify impinging osteophytes on a computer display by simulating elbow motion using the multiple positions of 3-dimensional (3D) elbow models created from computed tomography data. Moreover, an actual color-coded 3D model indicating the impinging osteophytes was created with a 3D printer and was used as an intraoperative reference tool. This study aimed to verify the efficacy of these new technologies in arthroscopic débridement for elbow osteoarthritis. METHODS We retrospectively studied 16 patients treated with arthroscopic débridement for elbow osteoarthritis after a preoperative computer simulation. Patients who underwent surgery with only the preoperative simulation were assigned to group 1 (n = 8), whereas those on whom we operated using a color-coded 3D bone model created from the preoperative simulation were assigned to group 2 (n = 8). Elbow extension and flexion range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the severity of osteoarthritis were compared between the groups. RESULTS Although preoperative elbow flexion and MEPS values were not significantly different between the groups, preoperative extension was significantly more restricted in group 2 than in group 1 (P = .0131). Group 2 tended to include more severe cases according to the Hastings-Rettig classification (P = .0693). ROM and MEPS values were improved in all cases. No significant differences in postoperative ROM or MEPS values were observed between the groups. There were no significant differences in the improvement in ROM or MEPS values between the 2 groups. CONCLUSIONS The use of preoperative simulation and a color-coded bone model could help to achieve as good postoperative ROM and MEPS values for advanced elbow osteoarthritis as those for early and intermediate stages.
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Affiliation(s)
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryoya Shiode
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Broos M, Berardo S, Dobbe JGG, Maas M, Streekstra GJ, Wellenberg RHH. Geometric 3D analyses of the foot and ankle using weight-bearing and non weight-bearing cone-beam CT images: The new standard? Eur J Radiol 2021; 138:109674. [PMID: 33798932 DOI: 10.1016/j.ejrad.2021.109674] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/13/2021] [Accepted: 03/18/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We hypothesize that three-dimensional (3D) geometric analyses in weight bearing CT-images of the foot and ankle are more reproducible compared to two-dimensional (2D) analyses. Therefore, we compared 2D and 3D analyses on bones of weight-bearing and non weight-bearing cone-beam CT images of healthy volunteers. METHODS Twenty healthy volunteers (10 male, 10 female, mean age 37.5 years) underwent weight-bearing and non weight-bearing cone-beam CT imaging of both feet. Clinically relevant height and angle measurements were performed in 2D and 3D (for example: cuboid height, calcaneal pitch, talo-calcaneal angle, Meary's angle, intermetatarsal angle). Three-dimensional measurements were obtained using automated software. Intra-observer and inter-observer agreement were evaluated for all 2D measurements. RESULTS Overall intraclass correlation coefficients (ICC's) were higher than 0.750 for most 2D measurements, ranging from 0.352 to 0.995. Calcaneal pitch, angle between the first metatarsal (MT1) and proximal phalange 1, between the fifth metatarsal (MT5) and the calcaneus and heights of the sesamoid bones, navicular, cuboid and talus decreased during weight-bearing in both 2D and 3D results (p < 0.01). Meary's angle was not statistically different in 2D (p = 0.627) and 3D (p = 0.765). Higher coefficients of variation in 2D geometric analysis parameters (0.27 versus 0.16) indicate that 3D analyses are more precise compared to 2D (p < 0.01). Results of left and right feet are comparable for 2D and 3D analyses. CONCLUSION Although 2D and 3D geometrical analyses are fundamentally different, automated 3D analyses are more reproducible and precise compared to 2D analyses. In addition, 3D evaluation better demonstrates differences in bone configurations between weight-bearing and non weight-bearing conditions, which may be of value to demonstrate pathology.
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Affiliation(s)
- M Broos
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - S Berardo
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Novara, Italy.
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
| | - M Maas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - G J Streekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
| | - R H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
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Zindel C, Fürnstahl P, Hoch A, Götschi T, Schweizer A, Nagy L, Roner S. Inter-rater variability of three-dimensional fracture reduction planning according to the educational background. J Orthop Surg Res 2021; 16:159. [PMID: 33632251 PMCID: PMC7905543 DOI: 10.1186/s13018-021-02312-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Computer-assisted three-dimensional (3D) planning is increasingly delegated to biomedical engineers. So far, the described fracture reduction approaches rely strongly on the performance of the users. The goal of our study was to analyze the influence of the two different professional backgrounds (technical and medical) and skill levels regarding the reliability of the proposed planning method. Finally, a new fragment displacement measurement method was introduced due to the lack of consistent methods in the literature. Methods 3D bone models of 20 distal radius fractures were presented to nine raters with different educational backgrounds (medical and technical) and various levels of experience in 3D operation planning (0 to 10 years) and clinical experience (1.5 to 24 years). Each rater was asked to perform the fracture reduction on 3D planning software. Results No difference was demonstrated in reduction accuracy regarding rotational (p = 1.000) and translational (p = 0.263) misalignment of the fragments between biomedical engineers and senior orthopedic residents. However, a significantly more accurate planning was performed in these two groups compared with junior orthopedic residents with less clinical experience and no 3D planning experience (p < 0.05). Conclusion Experience in 3D operation planning and clinical experience are relevant factors to plan an intra-articular fragment reduction of the distal radius. However, no difference was observed regarding the educational background (medical vs. technical) between biomedical engineers and senior orthopedic residents. Therefore, our results support the further development of computer-assisted surgery planning by biomedical engineers. Additionally, the introduced fragment displacement measure proves to be a feasible and reliable method. Level of Evidence Diagnostic Level II
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Affiliation(s)
- Christoph Zindel
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland. .,Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland
| | - Armando Hoch
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland.,Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ladislav Nagy
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Simon Roner
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Balgrist CAMPUS, Zurich, Switzerland.,Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Dobbe JGG, Peymani A, Roos HAL, Beerens M, Streekstra GJ, Strackee SD. Patient-specific plate for navigation and fixation of the distal radius: a case series. Int J Comput Assist Radiol Surg 2021; 16:515-524. [PMID: 33575933 PMCID: PMC7946677 DOI: 10.1007/s11548-021-02320-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
Purpose Corrective osteotomy of a malunited distal radius conventionally relies on 2D imaging techniques for alignment planning and evaluation. However, this approach results in suboptimal bone repositioning, which is associated with poor patient outcomes. In this case series, we evaluate the use of novel patient-specific plates (PSPs), which feature navigation and fixation of bone segments as preoperatively planned in 3D. Methods Ten participants with distal radius malunion underwent CT scans for preoperative alignment planning. Patient-specific guides and plates were designed, 3D-printed, and sterilized for use in corrective surgery of the distal radius. Pre- and postoperative results were compared in regard to clinical, functional, and radiographic outcomes. Results The application of a PSP was successful in 7 of the 10 cases. After treatment, the residual alignment error was reduced by approximately 50% compared with conventional treatment. The use of PSPs reduced pain significantly. Pre- and postoperative results were pooled and demonstrated significant correlations between: (1) pain and malpositioning, (2) the range of pro- and supination motion, the MHOQ score, the EQ-5D-5L score and dorsovolar angulation, and (3) MHOQ score and proximodistal translation. Conclusion The correlation between malalignment and MHOQ score, EQ-5D-5L score, pain, and range of motion shows that alignment should be restored as well as possible. Compared to the conventional approach, which relies on 2D imaging techniques, corrective osteotomy based on 3D preoperative planning and intraoperative fixation with a PSP has been shown to improve bone alignment and reduce pain. Level of evidence IV.
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Affiliation(s)
- Johannes G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room No L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Abbas Peymani
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Hendrika A L Roos
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maikel Beerens
- Xilloc Medical, Urmonderbaan 22, Sittard-Geleen, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Room No L0-113-3, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Saravi B, Lang G, Steger R, Vollmer A, Zwingmann J. Corrective Osteotomy of Upper Extremity Malunions Using Three-Dimensional Planning and Patient-Specific Surgical Guides: Recent Advances and Perspectives. Front Surg 2021; 8:615026. [PMID: 33614702 PMCID: PMC7887308 DOI: 10.3389/fsurg.2021.615026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
Malunions of the upper extremity can result in severe functional problems and increase the risk of osteoarthritis. The surgical reconstruction of complex malunions can be technically challenging. Recent advances in computer-assisted orthopedic surgery provide an innovative solution for complex three-dimensional (3-D) reconstructions. This study aims to evaluate the clinical applicability of 3-D computer-assisted planning and surgery for upper extremity malunions. Hence, we provide a summary of evidence on this topic and highlight recent advances in this field. Further, we provide a practical implementation of this therapeutic approach based on three cases of malunited forearm fractures treated with corrective osteotomy using preoperative three-dimensional simulation and patient-specific surgical guides. All three cases, one female (56 years old) and two males (18 and 26 years old), had painful restrictions in range of motion (ROM) due to forearm malunions and took part in clinical and radiologic assessments. Postoperative evaluation of patient outcomes showed a substantial increase in range of motion, reduction of preoperatively reported pain, and an overall improvement of patients' satisfaction. The therapeutic approach used in these cases resulted in an excellent anatomical and functional reconstruction and was assessed as precise, safe, and reliable. Based on current evidence and our results, the 3-D preoperative planning technique could be the new gold standard in the treatment of complex upper extremity malunions in the future.
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Affiliation(s)
- Babak Saravi
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Rebecca Steger
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jörn Zwingmann
- Department of Orthopedics and Trauma Surgery, St. Elisabeth Hospital Ravensburg, Ravensburg, Germany
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Casari FA, Roner S, Fürnstahl P, Nagy L, Schweizer A. Computer-assisted open reduction internal fixation of intraarticular radius fractures navigated with patient-specific instrumentation, a prospective case series. Arch Orthop Trauma Surg 2021; 141:1425-1432. [PMID: 33715063 PMCID: PMC8295140 DOI: 10.1007/s00402-021-03856-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intra-articular fractures are associated with posttraumatic arthritis if inappropriately treated. Exact reduction of the joint congruency is the main factor to avoid the development of arthrosis. Aim of this study was to evaluate feasibility of computer-assisted surgical planning and 3D-printed patient-specific instrumentation (PSI) for treatment of distal intraarticular radius fractures. METHOD 7 Patients who suffered a distal intraarticular radius fracture were enrolled in this prospective case series. Preoperative CT-scan was recorded, whereupon a 3D model was computed for surgical planning and design of PSI for surgical navigation. Postoperative accuracy and joint congruency were assessed. Patients were followed-up 3, 6 and 12 months postoperatively. RESULTS Mean follow-up was 16 months. Over all range of motion was restored and flexion, extension and pronation showed significant recovery, p < 0.05. Biggest intraarticular joint step-off and gap reduced from average 2.49 (± 1.04) to 0.8 mm (± 0.44), p < 0.05 and 6.12 mm (± 1.04) to 2.21 mm (± 1.16), p < 0.05. Average grip strength restored (3-16 months) from 20.33 kg (± 7.12) to 39.3 kg (± 19.55) p < 0.05, 100% of the healthy contralateral side. 3D-accuracy for guided fragments was 2.07 mm (± 0.64) and 8.59° (± 2.9) and 2.33 mm (± 0.69) and 12.86° (± 7.13), p > 0.05 for fragments reduced with ligamentotaxis. CONCLUSION Computer-assisted and PSI navigated intraarticular radius fracture treatment is feasible, safe and accurate. The benefits of this method, however, do not outstand the additional effort. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- F. A. Casari
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich-CH, Switzerland ,ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
| | - S. Roner
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich-CH, Switzerland ,ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
| | - P. Fürnstahl
- ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
| | - L. Nagy
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich-CH, Switzerland ,ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
| | - A. Schweizer
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich-CH, Switzerland ,ROCS; Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Balgrist-Campus, Lengghalde 5, 8008 Zurich-CH, Switzerland
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Shibano K, Kunugiza Y, Kawashima K, Tomita T. Total Knee Arthroplasty with Concomitant Corrective Tibial Osteotomy Using Patient-Specific Instrumentation and Computed Tomography-Based Navigation in Severe Post-High Tibial Osteotomy Valgus Collapse. Arthroplast Today 2020; 6:742-746. [PMID: 32923561 PMCID: PMC7476213 DOI: 10.1016/j.artd.2020.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 78-year-old woman with lateral knee osteoarthritis and severe valgus knee deformity after high tibial osteotomy. The patient's severe valgus tibial deformity with a valgus angle of 45° was evaluated using a 3-dimensional bone model, and a closing-wedge osteotomy was planned. Combined total knee arthroplasty and closing-wedge tibial osteotomy were performed using patient-specific instrumentation and a computed tomography–based navigation system. A semiconstrained total knee system with a long stem was implanted for fixation of the osteotomy site in the tibia. The patient was able to walk without pain 2 years postoperatively. The Knee Society Score improved from 13 to 73 points, and the functional score improved from 30 to 65 points. This preoperative planning method and the treatment procedure would be beneficial for clinical decision-making and treatment of severe valgus knee deformities.
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Affiliation(s)
- Koji Shibano
- Department of Orthopedics, Minoh City Hospital, Osaka, Japan
| | - Yasuo Kunugiza
- Department of Orthopedics, JCHO Hoshigaoka Medical Center, Osaka, Japan
| | - Kunihiko Kawashima
- Department of Orthopedics, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Tetsuya Tomita
- Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
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Fürnstahl P, Casari FA, Ackermann J, Marcon M, Leunig M, Ganz R. Computer-assisted femoral head reduction osteotomies: an approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients. BMC Musculoskelet Disord 2020; 21:759. [PMID: 33208124 PMCID: PMC7677844 DOI: 10.1186/s12891-020-03789-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/11/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Legg-Calvé-Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe. METHODS In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro-Wilk test and for significance using Wilcoxon signed-rank test. RESULTS The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively. CONCLUSION The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.
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Affiliation(s)
- P. Fürnstahl
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - F. A. Casari
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Orthopedic Department, Balgrist University Hospital, Zurich, Switzerland
| | - J. Ackermann
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Orthopedic Biomechanics, ETH Zurich, Zurich, Switzerland
| | - M. Marcon
- Radiology Department, Balgrist University Hospital, Zurich, Switzerland
| | - M. Leunig
- Schulthess Clinic, Zurich, Switzerland
| | - R. Ganz
- Faculty of Medicine, University of Berne, Berne, Switzerland
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