Showing papers in "Journal of clinical orthopaedics and trauma in 2018"

3D printing and its applications in orthopaedic trauma: A technological marvel.

Abstract: Background With rapid emergence of 3D printing technology, surgeons have recently started to apply this for nearly all areas of orthopaedic trauma surgery. Computed tomography or magnetic resonance images of trauma patients can be utilized for making graspable objects from 3D reconstructed images. Patient specific anatomical models can thereby be created. They enhance surgeon's knowledge of their patients' precise patho-anatomy, regarding both traumatized bones and soft tissue as well as normal areas, and therefore help in accurate preoperative planning. 3D printed patient specific instrumentation can help to achieve precise implant placement, and better surgical results. Most importantly, customized implants, casts, orthoses and prosthetics can be manufactured to match an individual's anatomy. Three dimensional (3D) printing, also called as ‘additive manufacturing’ and ‘rapid prototyping’ is considered as the “second industrial revolution”, and this appears to be especially true for orthopaedic trauma surgery. Methods A literature search was performed for extracting all papers related to 3D Printing applications in orthopaedics and allied sciences on the Pubmed, and SCOPUS; using suitable key terms and Boolean operators (“3D Printing” OR “3 dimensional printing” OR “3D printed” OR “additive manufacturing” OR “rapid prototyping”) AND (‘‘Orthopaedics” OR “Orthopaedics’’) AND (“Trauma” OR “Injury”)in June 2018. Search was also performed in Web of Science, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. No limits were set on the time period or evidence level, as 3D printing in orthopaedics is relatively recent and mainly low level evidence is available. Titles and abstracts were screened and all duplicate and unrelated papers were excluded. Papers related to orthopaedic trauma were manually selected for this review. Results The search on Pubmed retrieved 144 Papers and similar search on SCOPUS retrieved 94 papers. Additional searches did not reveal more relevant papers. After excluding duplicates and unrelated papers, and on screening of titles and abstracts, 59 papers were considered for review. Papers related to spine fractures only were not included, as they have been covered in another paper in this journal issue. Conclusion All over the world, orthopaedic Surgeon's and allied professionals and scientists are enthusiastically using 3D printing technology for designing patient specific models, instrumentation, implants, orthosis and prosthesis, besides 3D bioprinting of bone and cartilage scaffolding, and the same has been applied for nearly all areas of orthopaedic trauma surgery, from head to foot.

Additive manufacturing applications in orthopaedics: A review.

Abstract: The applications of Additive Manufacturing (AM) have increased extensively in the area of orthopaedics. The AM applications are for making anatomic models, surgical instruments & tool design, splints, implants and prosthesis. A brief review of various research articles shows that patient-specific orthopaedic procedures provide multiple applications areas and provide directions for future developments. The purpose of this paper is to identify the best possible usage of additive manufacturing applications in orthopaedics field. It also presents the steps used to prepare a 3D printed model by using this technology and details applications in the field of orthopaedics. AM gives a flexible solution in orthopaedics area, where customised implants can be formed as per the required shape and size and can help substitution with customised products. A 3D model created by this technology gain an accurate perception of patient's anatomy which is used to perform mock surgeries and is helpful for highly complex surgical pathologies. It makes surgeon's job accessible and increases the success rate of the operation. AM provides a perfect fit implant for the specific patient by unlimited geometric freedom. Various scanning technologies capture the status of bone defects, and printing of the model is done with the help of this technology. It gives an exact generation of a physical model which is also helpful for medical education, surgical planning and training. This technology can help to solve present-day challenges as data of every patient is different from another.

Role of CT and MRI in the design and development of orthopaedic model using additive manufacturing.

Abstract: Objective To study the role of Computed tomography (CT) and Magnetic resonance imaging (MRI) for design and development of orthopaedic model using additive manufacturing (AM) technologies. Methods A significant number of research papers in this area are studied to provide the direction of development along with the future scope. Results Briefly discussed various steps used to create a 3D model by Additive Manufacturing using CT and MRI scan. These scanning technologies are used to produce medical as well as orthopaedic implants by using AM technologies. The images so produced are exported in different software like OsiriX Imaging Software, 3D slicer, Mimics, Magics, 3D doctor and InVesalius to produce a 3D digital model. Various criteria's achieved by CT and MRI scan for design and development of orthopaedic implant using additive manufacturing are also discussed briefly. AM model created by this process show exact shape, size, dimensions, textures, colour and features. Conclusion AM technologies help to convert the digital model into a 3D physical object, thereby improving the understanding of patient anatomy for treatment as well as for educational purpose. These scanning technologies have various applications to enhance the AM in the field of orthopaedic. In orthopaedic every patient model is a customised unit, sourced from the individual patient. 3D CAD data captured by these scanning technologies are directly exported in standard triangulate language (STL) format for printing by AM technologies. Crossestion of the physical model fabricated by this process shows a patient's anatomy if the model prepared by using the bone-like material.

Publication trends and knowledge mapping in 3D printing in orthopaedics.

Abstract: Purpose Three dimensional (3D) printing, also called ‘rapid prototyping’ and ‘additive manufacturing’ is considered as a “second industrial revolution.” With this rapidly emerging technology, CT or MR images are used for the creation of graspable objects from 3D reconstituted images. Patient-specific anatomical models can be, therefore, manufactured efficiently. These can enhance surgeon's understanding of their patients' patho-anatomy and also help in precise preoperative planning. The 3D printed patient-specific guides can also help in achieving accurate bony cuts, precise implant placement, and nice surgical results. Customized implants, casts, orthoses and prosthetics can be created to match an individual patient's anatomy. The 3D printing of individualized artificial cartilage scaffolds and 3D bioprinting are some other areas of growing interest. We aim to study the publication trends in 3D printing as applied to the field of orthopaedics. Materials and methods A literature search was performed to extract all papers related to 3D printing applications in orthopaedics and allied sciences on the Pubmed, Web of Science and SCOPUS databases. Suitable keywords and boolean operators (“3D Printing” OR “3-dimensional printing” OR “3D printed” OR “additive manufacturing” OR “rapid prototyping”) AND (‘‘Orthopaedics” OR “Orthopaedics’’) were used, in May 2018. Search was attempted in Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Database of Abstracts of Review of Effectiveness (DARE) databases, using keywords 3d printing orthopaedics. A similar search was repeated in pubmed and SCOPUS to get more specific papers. No limits were set on the period or evidence level, as 3D printing in orthopaedics is relatively new and evidence available is usually limited to low-level studies. Trends in a publication on these topics were analyzed, focussing on publications, type of research (basic science or clinical), type of publication, authors, institution, and country. Some citations received by these papers were also analyzed in SCOPUS and Web of Science. MS Excel (2008 - Mac version) and VOS Viewer1.6.8 (2018- Mac version) software were used to analyze the search results and for citation mapping respectively. We also identified top 10 most cited articles in the field. Results An increasing trend in publications in 3D printing-related work in orthopedic surgery and related fields was observed in the recent past. A search on Pubmed using the above strategy revealed 389 documents. A similar search revealed 653 documents on SCOPUS, many (314) of which were from an engineering background and only 271 were related to medicine. No papers were found in the Cochrane database. Search on TRIP database revealed 195 papers. A similar search revealed 237 papers on orthopedic applications on Pubmed and 269 documents on SCOPUS, whereas a search on Web of Science revealed only 23 papers. Publication trends were then analyzed on data derived from SCOPUS database. Overall, most papers were published from China, followed by United States, United Kingdom, and India. Conclusion There has been an upsurge of interest in 3D printing in orthopedic surgery, as is evident by an increasing trend in research and publications in this area in the recent years. Presently, 3D printing is in a primitive stage in the field of orthopedic surgery as our knowledge is still insufficient, and costs and learning curve are somewhat high. However, looking at latest publication trends, we are enthusiastic that it holds the key to future in orthopaedics and trauma cases.

Current status of 3D printing in spine surgery.

Abstract: Three-dimensional printing (3DP) is one of the latest tools in the armamentarium of the modern spine surgeon. The yearning to be more precise and reliable whilst operating on the spine has led to an interest in this technology which has claimed to achieve these goals. 3D printing has been used pre-operatively for surgical planning and for resident or patient education. It has also found its way to the operation theatre where it is used to fabricate customized surgical tools or patient-specific implants. Several authors have highlighted significant benefits when 3D printing is used for specific indications in spine surgery. Novel applications of this technology in spine surgery have also been described and though still in a nascent stage, these are important for this technology to sustain itself in the future. However, major limitations have also come to light with this technology in use. This article seeks to review the current status and applications of 3D printing in spinal surgery and its major drawbacks while briefly describing the essentials of the technology. It is imperative that the modern spine surgeon knows about this important innovation and when and how it can be applied to improve surgical outcomes.

3D printing- creating a blueprint for the future of orthopedics: Current concept review and the road ahead!

Abstract: The use of 3D printing in Orthopedics is set to transform the way surgeries are planned and executed. The development of X rays and later the CT scan and MRI enabled surgeons to understand the anatomy and condition better and helped plan surgeries on images obtained. 3DGraphy a term used for 3D printed orthopedic patient models and Jigs has gone a step further by providing surgeons with a physical copy of the patient's affected part that can not only be seen but also felt and moved around spatially. Similarly 3D printed Jigs are patient specific devices that are used to ensure optimal screw trajectory and implant placement with minimal exposure. While the use of 3D printed models and Jigs have now become routine, a similar revolution is happening in the field of designing and printing patient specific implants. Metal printing along with enhanced capability to print other biocompatible materials like PEEK and PLA is likely to improve the current implant manufacturing process. On the horizon is another interesting development related to this field – 3D Bio printing. Printing human tissues and organs is considered the final frontier and impressive strides have been made in printing bone graft substitutes and cartilage like material. This paper is an overview of all the current developments and the road ahead in this invigorating field.

Meniscal repair and regeneration: Current strategies and future perspectives.

Abstract: The management of meniscal injuries remains difficult and challenging. Although several clinical options exist for the treatment of such injuries, complete regeneration of the damaged meniscus has proved difficult due to the limited healing capacity of the tissue. With the advancements in tissue engineering and cell-based technologies, new therapeutic options for patients with currently incurable meniscal lesions now potentially exist. This review will discuss basic anatomy, current repair techniques and treatment options for loss of meniscal integrity. Specifically, we focus on the possibility and feasibility of the latest tissue engineering approaches, including 3D printing technologies. Therefore, this discussion will facilitate a better understanding of the latest trends in meniscal repair and regeneration, and contribute to the future application of such clinical therapies for patients with meniscal injuries.

Management of growth arrest: Current practice and future directions.

Abstract: Introduction Premature growth arrest can pose a challenge to the orthopedic surgeon. Various options for treating physeal arrest exist. Methods Systematic searches were conducted on PubMed/Medline, ScienceDirect, OVID, and Cochrane Library. Secondary searching was performed, where certain articles from reference lists of the selected studies were reviewed that were not found in the primary search. Results This review article discusses the different methods of management for premature growth arrest. Conclusions The use of mesenchymal stem cells provides a promising alternative treatment modality.

Computed tomography based 3D printed patient specific blocks for total knee replacement

Abstract: Objectives 3D printing is an emerging technology and its use in orthopaedics is being explored. We discuss the role of computed tomography based 3D printed patient specific jigs in total knee replacement. We also discuss the various advantages of 3D printed patient specific jigs and the future scope of their use in total knee replacement. Methods A search of English literature was done and articles discussing the role of CT scan based 3D printed patient specific jigs in total knee replacement were included in the study. Results The role of 3D printed jigs in total knee replacement have been found in the prediction of femoral valgus angle, component sizing and in retained hardware. They have shown promise with studies suggesting they might improve the overall mechanical alignment of the knee. There are studies which have also studied the combined role of patient specific instruments with navigation. Conclusion 3D printed jigs hold promise in total knee replacement. Their use in total knee replacement in the presence of retained hardware is useful for the surgeon. They have also showed promise in improving prediction of component sizing and improving mechanical alignment of the knee. Further studies with longer follow up and larger sample size will help in establishing their role in total knee replacement.

Current status of top 10 nutraceuticals used for Knee Osteoarthritis in India.

Abstract: Knee Osteoarthritis (OA) is a progressive degenerative joint disease affecting the quality of life of the elderly population. There is considerable evidence that nutraceuticals from natural herbs may play a significant role in inflammation and joint destruction in OA. We review the current status of some of the commonly used nutraceuticals in Indian market - Boswellia, Aflapin, Chondroitin sulphate, Glucosamine sulphate, Collagen peptide, Curcumin, Fish Oil, Ginger, Green tea, and Rosehip extract. We have summarized their mechanism of action, biological effects, toxicities and efficacy in the management of Knee OA. These supplements have been found to be effective in knee OA in various studies. No serious side effects have been reported for any of these supplements. Overall, our study identifies and support the use of these nutraceuticals to provide symptomatic relief to patients with knee OA and justify their use as an adjunct therapy for the management. More good quality trials are needed to provide definitive answers to questions related to their efficacy and safety for OA prevention and treatment.

Autologous stem cell implantation with core decompression for avascular necrosis of the femoral head

Abstract: Objective Avascular necrosis (AVN) of the femoral head is a painful, progressive disease that can lead to limited mobility and early hip replacement. Autologous stem cell implantation into the necrotic lesion of the femoral head has been described, on the basis that patients with AVN have a reduced number of stem cells in the marrow. In this study, we aim to describe our technique for decompression of the hip with autologous implantation of stem cells for AVN of the femoral head, as well as retrospectively analyze our results. Methods The records and imaging of patients with avascular necrosis of the femoral head treated by a single surgeon were retrospectively reviewed. All patients were treated with the combination of core decompression with autologous stem cell implantation from the iliac crest. Preoperatively, demographic information, stage of AVN per Association Research Circulation Osseous (ARCO) classification on magnetic resonance imaging and radiograph, and visual analogue pain scores (VAS) of the hip were recorded. Postoperatively, VAS were recorded and imaging was reviewed for progression of AVN or evidence of femoral head collapse. Statistical analysis was conducted comparing pre and postoperative VAS scores. Results Overall, we treated 43 hips in 28 patients with autologous stem cell implantation, with an average follow up of 16 months. Patients ranged from ARCO Ia to ARCO IIc classification of AVN. The average pre-operative visual analogue scale (VAS) of pain was 7.8. Post operatively, the average VAS score decreased to 2.5 (p Conclusion Our findings indicate that hip compression with autologous stem cell implantation for AVN of the femoral head provides significant symptomatic relief and may be beneficial in arresting progression of disease.

Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up.

Abstract: Introduction The aim of this paper is to present our experience with femoral press-fit fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. Methods The patient population was randomly placed in two groups: group A (58 patients), who underwent femoral screw fixation; group B (62 patients), who underwent femoral press-fit fixation. Results At last follow-up 9.2% of patients were lost; 28% of patients in group A and 64% of patients in group B had excellent International Knee Documentation Committee score (grade A); 66% of patients in group A and 32% of patients in group B had good International Knee Documentation Committee scores (grade B). The difference was statistically significant (p Conclusions Femoral press-fit fixation of bone- patellar tendon- bone autograft provides stable fixation at low cost, it ensures unlimited bone-to-bone healing and high primary stability, avoiding the disadvantages of hardware and the need for removal in case of revision.

The evolution of three-dimensional technology in musculoskeletal oncology.

Abstract: Musculoskeletal tumours pose considerable challenges for the orthopaedic surgeon during pre-operative planning, resection and reconstruction. Improvements in imaging technology have improved the diagnostic process of these tumours. Despite this, studies have highlighted the difficulties in achieving consistent resection free margins especially in tumours of the pelvis and spine when using conventional methods. Three-dimensional technology - three-dimensional printing and navigation technology - while relatively new, may have the potential to prove useful in the musculoskeletal tumour surgeon's arsenal. Three-dimensional printing (3DP) allows the production of objects by adding material layer by layer rather than subtraction from raw materials as performed conventionally. High resolution imaging, computer tomography (CT) and magnetic resonance imaging (MRI), are used to print highly complex and accurate items. Powder-based printing, vat polymerization-based printing and droplet-based printing are the common 3DP technologies applied. 3DP has been utilized pre-operatively in surgical planning and intra-operatively for patient specific instruments and custom made prosthesis. Pre-operative 3DP models transfer information to the surgeon in a concise yet exhaustive manner. Patient specific instruments are customized 3DP instruments utilized with the intention to easily replicate surgical plans. Complex musculoskeletal tumours pose reconstructive challenges and standard implants are often unable to reconstruct defects satisfactorily. The ability to use custom materials and tailor the pore size, elastic modulus and porosity of the 3DP prosthesis to be comparable to the patient's bone allows for a potential patient-specific prosthesis with unique incorporation and longevity properties. Similarly, navigation technology utilizes CT or MRI images to provides surgeons with real time intraoperative three-dimensional calibration of instruments. It has been shown to potentially allow surgeons to perform more accurate resections. These technological advancements have the potential to greatly impact the management of musculoskeletal tumours. 3D planning models, patient-specific instruments and customized 3DP implants and navigation should not be thought of as separate, but rather, patient-specific adaptation of relevant modes of application should be selected on a case-by-case basis when taking all unique factors of each case into consideration.

Danger zone of radial nerve in Indian population – A cadaveric study

Abstract: Background Identification of the radial nerve is necessary during surgery of the humerus fracture to avoid injury to it. Iatrogenic nerve injury during humerus fracture surgery is a well-known complication. Prevention of this type of injuries would be of great value. Aim of this study is to reduce the chance of iatrogenic nerve injury by defining of a danger zone in the distal upper arm regarding the radial nerve in indian population. Methods Thirty six upper limbs of eighteen adult human formalin preserved cadavers (14 males & 4 females) were used in this study. The posterior aspect of the arm was dissected to expose the radial nerve from the triangular space to the point where the radial nerve pierced the lateral intermuscular septum. Systematic identification of radial nerve and multiple measurements were done for each specimen. Results The mean humeral length was 30.96 + 1.23 cm. Mean Distance of medial epicondyle to entry of radial nerve into spiral groove was 18.5 + 0.79 cm. Mean Distance of lateral epicondyle to exit of radial nerve into spiral groove was 11.34 + 0.41 cm. The mean length of radial nerve groove/spiral groove was 4.3 + 0.75 cm. Conclusions Our study has identified the point of intersection of radial nerve to humerus in Indian population. Understanding the safe zones and the zone of danger of the humerus provides more safety during the surgical interference of the humerus. To do this, the radial nerve must be identified and protected. Wide incision and blunt dissection is still recommended to minimize the risk of radial nerve damage.

3D printing in designing of anatomical posterior column plate.

Abstract: Background Acetabulum has a complex anatomy due to which anatomical acetabular plates are still under developmental phase. Although intra-operative contouring of reconstruction plate is done as a standard practice, it is associated with increased operative time and morbidity of patient. We have designed an acetabular plate for posterior fixation from experience of previous studies performed in our institute on acetabular fracture fixation which should be appropriate for most of the patient of Indian origin. Apart from avoiding intra-operative contouring of acetabular plates it also helps in preventing intra articular screw penetration. Methods We selected five consecutive patients with acetabular fracture needed to be operated from posterior approach and designed patient specific plate template from virtual surgical planning and 3D printing. These plate templates were then matched with our acetabular plate design and were used intra-operatively. Many parameters were assessed to evaluate accuracy of our plate design in those five patients. Result All the plate templates appear to match our designed plate and no intra-operative contouring was required with our plate design. Conclusion This was a pilot study and we need a large sample size to study accuracy of our acetabular plate design which might avoid intra-operative contouring, decreasing morbidity of patient and prevent wastage of resources in pre-operative planning and computer designing.

A critical appraisal of medial open wedge high tibial osteotomy for knee osteoarthritis.

Abstract: A medial open wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure to correct varus deformity related to Knee Osteoarthritis. It consistently provides relief in knee pain and improves knee function. This technique is recommended for active, middle and old aged individuals with an isolated medial compartment knee OA. The MOWHTO scores several advantages over lateral closed wedge osteotomy and hence is now a preferred choice of HTO.

Three dimensional scapular prints for evaluating glenoid morphology: An exploratory study.

Abstract: Background Computerised Tomography (CT) scans are conventionally employed to assess the glenoid morphology prior to total shoulder arthroplasty (TSA). This study explores the role of three-dimensional (3D) models for assessing glenoid morphology. Methods CT scans of 32 patients scheduled for TSA were reconstructed to scapular models using customised software and a desktop 3D printer. The size and aspect ratios were maintained. Glenoid version, glenoid maximum height and width, and the maximum acromion antero-posterior (AP) length were compared between the models and CT scans. Results The models were an accurate qualitative reflection of scapular anatomy. The average retroversion in 3D models was 8.19°±30.8° compared to 10.26°±42.5° in scan images. The mean difference was 2.07°±24.6° (p=0.408). However, the mean absolute error was 5.02°±12.3°. The mean difference of the glenoid maximum width and the acromion maximum AP length was 0.22±3.33mm (p=0.862) and 0.32±14.12mm (p=0.213) respectively. However, the mean difference was significant for the glenoid maximum height measuring 3.67±12.04mm with p=0.004. The correlation between the examiners was high for all parameters, with intraclass correlation ranging between 0.94 and 0.99. Conclusion 3D printing technology promises to be a useful tool for preoperative planning with accurate reproduction of transverse plane anatomy. 3D prints represent superior definition of reconstructed anatomical measures such as glenoid height as compared to conventional CT Scans.

Best care paradigm to optimize functionality after extra-articular distal humeral fractures in the young patient

Abstract: For younger patients with extra-articular distal humerus fractures closed management is plagued with high rates of malunion, suboptimal functional outcomes, extended immobilization with loss of early motion, a delay in return to work, and a general period of lost productivity. Surgical management offers an appealing alternative. Maintaining respect for the triceps musculature and minimizing iatrogenic injury to the radial nerve are primary concerns with operative treatment. Accordingly, use of a triceps-sparing approach and single column plating may be the optimal treatment paradigm in the young patient presenting with an extra-articular distal humerus fracture.

Cervical pedicle screw guiding jig, an innovative solution.

Abstract: Pedicle screws are one the commonest used modality in spinal instrumentation. However, the method of pedicle screw fixation in cervical spine as compared to thoracic and lumbar spine is still technically demanding because it carries the risk of catastrophic damage to the surrounding neurovascular structures We have utilized virtual planning and 3D (3-dimension) printing to develop a patient specific jig to guide the accurate placement of pedicle screws. A patient with bifacetal dislocation C7 over D1 classified as flexion-distraction injury type 3 who was planned for decompression and fusion by posterior instrumentation at C6, C7, D1 and D2 was selected. A CT scan with 1 mm cuts was used to produce DICOM images of the same. Using these DICOM images virtual planning was done on MIMICS and 3 MATICS software to create patient specific jigs. These jigs were then 3D printed using a 3D printer and used for accurate placement of pedicle screws intra-operatively after adequate sterilization. Our procedure is low cost but high technology based. It is simple, accurate, and very cost effective. The technology transfer is very easy and can be adopted easily.

Safe corridor for iliosacral and trans-sacral screw placement in Indian population: A preliminary CT based anatomical study.

Abstract: Objectives Nonsurgical management of unstable pelvic ring injuries is associated with poor outcomes. Posterior pelvic ring injuries include sacroiliac joint disruption and sacral fractures or a combination of the two. Morbidity is high in non-operatively managed patients. Screw fixation is being increasingly used to manage unstable posterior pelvic injuries. Limitations include a steep learning curve and potential for neurovascular injury. This is the first study in Indian population to describe the safe corridor for screw placement and check the feasibility of screw in both upper and lower sacral segments. Methods This study involved retrospective analysis of 105 pelvic CT scans of patients admitted to the emergency department of a Level 1 trauma centre. Vertical height at the level of constriction (vestibule) of S1 and S2 was measured in coronal sections and anteroposterior width of constrictions was measured in axial sections. We created a trajectory for 7.3 mm cylinder keeping additional 2 mm free bony corridor around it and confirmed that bony limits were not breached in axial, coronal and sagittal sections. Whenever there was breach in bony limit we checked applicability of 6.5 mm screw. Results The vertical height and anteroposterior width of vestibule/constriction of S1 was significantly higher in males, whereas S2 vestibule height and width were similar in males and females. Both male and female pelves were amenable to S1 Trans-sacral and S1 Iliosacral screw fixation with a 7.3 mm screw when a safe corridor of 2 mm was kept on all sides. However, when S2 segment was analysed, only 42.9% of male pelves and 25.7% of female pelves were amenable to insertion of trans-sacral 7.3 mm screw. Conclusion An individualized approach is necessary and each patient’s CT must be carefully studied before embarking on sacroiliac screw fixation in Indian population.

A systematic review and meta-analysis of complications in conversion arthroplasty methods for failed intertrochanteric fracture fixation.

Abstract: Background Conversion arthroplasty for failed primary fixation of intertrochanteric fractures can be achieved using various methods, including cemented total hip arthroplasty, uncemented total hip arthroplasty, hybrid total hip arthroplasty, and hemiarthroplasty. Complication rates vary between each conversion method. The purpose of this paper is to examine the effect of conversion method on total conversion complication rates. Methods We performed a meta-analysis of five studies with sufficient data for analysis. We created a null hypothesis stating that the expected distribution of complications across conversion methods would reflect the distribution of conversion method used for failed primary fixation. Using a z test, we compared proportions of the expected distribution of complications to the observed distribution of complications. Results A total of 138 cases of conversion arthroplasty with 49 complications were available for analysis. The mean age was 73 (range, 32–96) years. 19 males and 48 females were included, with one study not including patient gender. The mean time from primary fixation failure to conversion was 11 months, and the mean duration of conversion surgery was 132 min. Expected and observed complication rate distributions were as follows: cemented total hip arthroplasty, 6.5% versus 4.1% ( p = 0.79); uncemented total hip arthroplasty, 77.5% versus 81.6% ( p = 0.69); hybrid total hip arthroplasty, 2.9% versus 2.0% ( p = 1); and hemiarthroplasty, 13% versus 12.2% ( p = 1). Conclusions Our findings suggest that the method of conversion arthroplasty following failed primary intertrochanteric femur fracture fixation does not influence complication rate.

What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture?

Abstract: Introduction The fracture displacement in intramedullary nail in femoral subtrochanteric fracture may cause fracture non-union. We retrospectively analysed our recent experience to clear the influence about fracture displacement in intramedullary nail in femoral subtrochanteric fracture. Materials and methods This study includes 36 patients in the intramedullary nail group followed up for more than 12 months; these patients suffered from femoral subtrochanteric fracture from 2009.1–2014.12 in our hospital. The operation time, amount of bleeding, length of hospital stay, fracture healing time, Harris function score of hip joint, fracture displacement, TAD and postoperative complications were summarized. Results The average follow up time was 20.2 months, average operation time was 126 min, average amount of bleeding was 258 ml, average hospitalization was 13.1 days, average fracture healing time was 6.8 months, average fracture displacement was 1.23 cm, average TAD was 19.7 mm and average hip Harris function score was 82.5 points. Five cases suffered non-union. Only the fracture displacement degree made significant correlation with fracture non-union. All union patients had a fracture displacement less than 2.2 cm and all non-union patients had a fracture displacement more than 2.5 cm. Conclusion Intramedullary nail treatment must focus on fracture reduction and recovery of femoral medial support with assisted incision technique or closed cerclage wire technique when necessary. In our opinions, only the fracture displacement degree made significant correlation with bone non-union and all cases achieved bone union when it less than 2.2 cm according to our statistics. But it still need further research to find out the displacement of fracture fragments could be tolerant.

Paraspinal Schwannoma of dorsal ramus nerve: A case report.

Abstract: Spinal Schwannomas are benign nerve sheath tumors and the most common intradural extramedullary tumors of the spine, mainly occurring in the cervical and lumbar region. The location distinct from the spinal canal is very rare. We report a rare case of a 45year old male with Schwannoma in the dorsal paraspinal musculature. Complete surgical excision of the lesion was performed with clear margins and neuropathological analysis revealed a Schwannoma. There has been no recurrence after 6 months.

Application of three dimensional printing in surgery for cam type of femoro-acetabular impingement

Abstract: Surgical treatment of femoroacetabular impingement (FAI) focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. Cam type of impingement is managed by performing an osteochondroplasty to remove the excess impinging bone from the head neck junction, thus improving the head neck offset. This procedure can be done by safe surgical dislocation, arthroscopy assisted mini-open method or all arthroscopy technique. Whatever be the approach, adequate excision of the Cam deformity is necessary to avoid suboptimal results. Under-excision leads to persistent symptoms and progression of disease, while over-excision can lead to weak bone vulnerable to fracture or disturb the labral seal. Various techniques utilized for intra-operative evaluation of amount of excision required described in literature are fluoroscopy, spherometer gauges, intra-operative Computed Tomography (CT) scan, navigation etc. Rapid prototyping, also called as three dimensional (3D) printing, is a technology to create dimensionally accurate model from a computer-assisted design. Accurate physical models can be designed from the medical imaging data like CT scans and 3D printed to aid in various medical applications. Its application in orthopaedic field is on a rise, recently. However, there is no report on utilization of this technique in surgeries for FAI. We have reported a case of Cam type FAI in an eighteen year old boy, which we treated surgically by performing osteochondroplasty using safe surgical dislocation. We did CT based virtual surgical planning to design femoral head and neck jigs, which were 3D printed and used intra-operatively to guide for adequate and optimum excision of bone at head neck junction. We found these customized jigs accurate and useful for the surgery. However, a comparison study with various other techniques is warranted for a detailed research on its usefulness and challenges. The main purpose of this article is to elaborate on the technical steps for designing of jigs for 3D printing to guide in osteochondroplasty surgery for FAI.

Radiological evaluation of pelvic inlet and outlet radiographic view in Indian population.

Abstract: Background Pelvic fractures represent one of the most challenging clinical problems in which an urgent multidisciplinary approach is required. The early management in a suspected pelvic fracture starts with the good radiological evaluation. The standard radiographic view includes the anteroposterior, inlet and outlet views. The inlet and outlet views are taken with 45° tilt from anteroposterior plane. However, recent studies have shown that there is significant individual variation within the population and these values should be redefined. Material and Methods This is a retrospective study carried out in a tertiary care teaching institute. Total 110 patients (including 42 female and 68 male patients) of age older than 18 years, who had a routine pelvic Computed Tomography (CT) scan performed for any indications unrelated to pelvic pathologies were included. Statistical analysis Mean and standard deviation were calculated. For each angle measured, the effect of age was determined and a comparison was made between male and female patients, p value Results The mean angle of caudal tilt for the ideal screening inlet view was 33° +/−8 (16.3–31.3) and the mean angle of cephalic tilt for the ideal screening outlet view was 56° +/−9 (51.6–81.8). Conclusion This study re-evaluated the optimal inlet and outlet angles in Indians and demonstrated that the mean angles needed to create an ideal pelvic inlet and outlet views are 33° and 56° respectively.