A customized percutaneous three-dimensional-printed guide for scaphoid fixation versus a freehand technique: a comparative study

2021 ◽  
pp. 175319342110491
Author(s):  
Francesc A Marcano-Fernández ◽  
Alexandre Berenguer ◽  
Ferran Fillat-Gomà ◽  
Sergi Corderch-Navarro ◽  
Jaume Cámara-Cabrera ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Conventional Technique ◽  
Fluoroscopy Time ◽  
Surgical Time ◽  
Level Of Evidence ◽  
Intraoperative Radiation ◽  
Scaphoid Fractures ◽  
Freehand Technique ◽  
Screw Position ◽  
Time Reduction

The aim of this study was to compare the accuracy and reliability of percutaneous fixation of minimally displaced scaphoid fractures using a customized three-dimensional (3-D)-printed guide with a conventional freehand method. A prospective cohort of ten patients underwent scaphoid fixation with the aid of a customized 3-D-printed guide. The final screw position, total surgery time (minutes) and fluoroscopy time (seconds) was compared with a retrospective cohort of ten patients who underwent fixation with a conventional technique. There were no differences in final screw position between both methods. The patients in which the 3-D guide was used had a surgery time reduction of 43% and a fluoroscopy time reduction of 52% compared with the control freehand group. The use of a customized 3-D-printed guide permits a fixation that is as accurate as the standard freehand technique, with reduction in surgical time and intraoperative radiation exposure. Level of evidence: III

Scaphoid fracture displacement is not correlated with the fracture angle

2021 ◽  
pp. 175319342110044
Author(s):  
Ophir Aruse ◽  
Igor Immerman ◽  
Omar Badir ◽  
Madi El Haj ◽  
Ido Volk ◽  
...  
Keyword(s):  
Principal Component Analysis ◽  
Computer Model ◽  
Scaphoid Fracture ◽  
Three Dimensional ◽  
Principal Component ◽  
Ct Scans ◽  
Level Of Evidence ◽  
Fracture Angle ◽  
Fracture Displacement ◽  
Scaphoid Fractures

Classifications of scaphoid fractures associate the angle of the fracture with its stability. To examine this assumption, we measured acute scaphoid fracture angles and inclinations in relation to different scaphoid axes, using fracture displacement as an indicator of instability. We examined the effect of using different axes on the measurements of angles. CT scans of 133 scaphoid fractures were classified according to the location of the fractures. Using a three-dimensional computer model, we computed four scaphoid axes. For each fracture, we then measured the fracture angle and the direction of the fracture inclination in relation to each one of the axes. We found a correlation between displacement and the angles of proximal fractures using one of these axes (the surface principal component analysis axis). No such correlations were found for waist fractures, which were the majority of fractures. There were significant differences between the measurements made with different axes. The findings indicate that the angle of the fracture and the direction of the fracture inclination are minor factors in the displacement of most scaphoid fractures. Level of evidence: III

Three-Dimensional Printed Targeting Device for Scaphoid Fracture Fixation

Hand ◽  
2020 ◽  
pp. 155894472090650 ◽  
Author(s):  
Matthew C. DeWolf ◽  
Alexander Hartov ◽  
Thomas A. Fortney ◽  
Lance G. Warhold
Keyword(s):  
Radiation Exposure ◽  
Guide Wire ◽  
Scaphoid Fracture ◽  
Kirschner Wire ◽  
Three Dimensional ◽  
Average Procedure ◽  
Procedure Time ◽  
Intraoperative Radiation ◽  
Freehand Technique ◽  
Average Procedure Time

Background: Percutaneous guide wire insertion for scaphoid screw fixation can be challenging and often requires multiple attempts with significant radiation exposure to the surgical team. A 3-dimensional (3D) printed targeting device has the potential to reduce procedure time and intraoperative radiation exposure. Methods: Our targeting device protocol included a preprocedure computed tomography (CT) scan of a casted cadaver wrist, followed by 3D printing of a customized targeting guide. In a comparison trial, seven orthopedic surgery residents performed percutaneous scaphoid guide wire insertion on different cadaver specimens by both freehand technique and using our targeting device. Radiation exposure and procedure times were compared. All specimens underwent postprocedure CT to assess Kirschner wire (K-wire) accuracy, determined by central third placement. Pre- and postprocedure CT scans from the targeting device group were co-registered to compare planned and actual K-wire trajectories. Results: Using the freehand technique, mean fluoroscopy time was 120 seconds (standard deviation: ±53 seconds) generating 2.45 milligray of radiation. Average procedure time was 21 minutes with a mean of 6.4 (range: 3-9) insertion attempts. A single insertion attempt was made using the targeting device with an average procedure time of 30 seconds and no fluoroscopy exposure. Four K-wires were placed within the central scaphoid in both groups. Using the targeting device, average linear deviation from the planned trajectory was 2.1 mm, while the maximum linear deviation was 3.75 mm. Conclusion: When compared to freehand scaphoid guide wire insertion, our targeting device provides similar accuracy while significantly reducing intraoperative radiation exposure and procedure time.

Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients

2019 ◽  
Vol 44 (7) ◽  
pp. 685-691 ◽  
Author(s):  
Bo Liu ◽  
Feiran Wu ◽  
Shanlin Chen ◽  
Xieyuan Jiang ◽  
Wei Tian
Keyword(s):  
Scaphoid Fracture ◽  
Three Dimensional ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Robotic Assisted ◽  
Scaphoid Fractures ◽  
Flexion Extension ◽  
The Mean ◽  
Set Up

This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwent fixation with this method using a commercially available three-dimensional fluoroscopy unit and robotic navigation system. The mean total operative duration was 40 minutes, which comprised of a set-up time of 18 minutes and planning and surgical time of 22 minutes. All patients required only a single guidewire insertion attempt, and there were no screw protuberances or other complications. All fractures united at a mean of 8 weeks. At a mean follow-up of 6.5 months (range 6–8), the mean Mayo wrist score was 96, patient-rated wrist evaluation was 2, flexion-extension arc was 96% and grip strength was 91% of the contralateral side. We conclude from our patients that robotic-assisted percutaneous scaphoid fixation is feasible, safe and accurate, and is a satisfactory method for treating these injuries. Level of evidence: IV

The influence of fracture location and comminution on acute scaphoid fracture displacement: three-dimensional CT analysis

2021 ◽  
pp. 175319342110409
Author(s):  
Anne Eva J. Bulstra ◽  
Rami M. A. Al-Dirini ◽  
Arthur Turow ◽  
Miriam G. E. Oldhoff ◽  
Kimberley Bryant ◽  
...  
Keyword(s):  
Scaphoid Fracture ◽  
Three Dimensional ◽  
Dorsal Side ◽  
Proximal Fragment ◽  
Exit Point ◽  
Level Of Evidence ◽  
Fracture Location ◽  
Fracture Displacement ◽  
Scaphoid Fractures ◽  
Ct Analysis

We aimed to assess the influence of fracture location and comminution on acute scaphoid fracture displacement using three-dimensional CT. CT scans of 51 adults with an acute scaphoid fracture were included. Three-dimensional CT was used to assess fracture location, comminution and displacement. Fracture location was expressed as the height of the cortical breach on the volar and dorsal side of the scaphoid relative to total scaphoid length (%), corresponding to the fracture’s entry and exit point, respectively. We found a near-linear relation between dorsal fracture location and displacement. As dorsal fracture location became more distal, translation (ulnar, proximal, volar) and angulation (flexion, pronation) of the distal fragment relative to the proximal fragment increased. Comminuted fractures had more displacement. Dorsal fracture location predictably dictates the direction of translation and angulation in displaced scaphoid fractures. Surgeon attention to dorsal fracture location can help identify displacement patterns and provide guidance in adequately reducing a displaced scaphoid fracture. Level of evidence: III

scholarly journals Scaphoid Fracture Patterns—Part One: Three-Dimensional Computed Tomography Analysis

2019 ◽  
Vol 08 (06) ◽  
pp. 441-445
Author(s):  
Tessa Drijkoningen ◽  
Amin Mohamadi ◽  
Shai Luria ◽  
Geert A. Buijze
Keyword(s):  
Computed Tomography ◽  
Scaphoid Fracture ◽  
Three Dimensional ◽  
Principal Component ◽  
Fracture Pattern ◽  
Level Of Evidence ◽  
Avulsion Fractures ◽  
Density Mapping ◽  
Scaphoid Fractures ◽  
Fracture Area

Abstract Objective Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area. Methods We studied 51 patients with an adequate computed tomography scan of an acute scaphoid fracture using 3D modeling. Fracture surfaces were identified and fragment volumetric size of the fracture fragments was measured. A principal component analysis was used to find groups. Density mapping was used to image probable common fracture areas in the scaphoid. Results Forty-nine of 51 fractures had a similar pattern. It was not possible to identify subgroups based on fracture pattern. The mean volumetric size of the fracture fragments of the proximal (1.45 cm3 ± 0.49 cm3 standard deviation [SD]) and distal fracture fragments (1.53 cm3 ± 0.48 cm3 SD) was similar. There was a single common fracture area in the middle third of the bone. In the distal third, there were no horizontal fractures through—but only directly proximal to—the tubercle suggesting that these would be best classified as distal waist fractures. Conclusion Acute scaphoid fractures mainly occur in the middle third of the bone and tend to divide the scaphoid in half by volumetric size of the fracture fragments. There were two distinct grouping patterns: fractures through the proximal and middle third were horizontal oblique, whereas fractures of the distal third were vertical oblique. It seems that scaphoid fractures might be classified into proximal pole fractures, a range of waist fractures, and tubercle avulsion fractures. Level of evidence This is a Level IV study.

Guided surgery with 3D printed device: a case report

2020 ◽  
Author(s):  
Michelle Carvalho de Sales ◽  
Rafael Maluza Flores ◽  
Julianny da Silva Guimaraes ◽  
Gustavo Vargas da Silva Salomao ◽  
Tamara Kerber Tedesco ◽  
...  
Keyword(s):  
Operating Time ◽  
Three Dimensional ◽  
Conventional Technique ◽  
Cervical Region ◽  
Mean Deviation ◽  
Apical Region ◽  
Virtual Planning ◽  
Surgical Guide ◽  
Surgical Guides ◽  
High Level

Dental surgeons need in-depth knowledge of the bone tissue status and gingival morphology of atrophic maxillae. The aim of this study is to describe preoperative virtual planning of placement of five implants and to compare the plan with the actual surgical results. Three-dimensional planning of rehabilitation using software programs enables surgical guides to be specially designed for the implant site and manufactured using 3D printing. A patient with five teeth missing was selected for this study. The patient’s maxillary region was scanned with CBCT and a cast model was produced. After virtual planning using ImplantViewer, five implants were placed using a printed surgical guide. Two weeks after the surgical procedure, the patient underwent another CBCT scan of the maxilla. Statistically significant differences were detected between the virtually planned positions and the actual positions of the implants, with a mean deviation of 0.36 mm in the cervical region and 0.7 mm in the apical region. The surgical technique used enables more accurate procedures when compared to the conventional technique. Implants can be better positioned, with a high level of predictability, reducing both operating time and patient discomfort.

scholarly journals Two-Dimensional Visualization of the Three-Dimensional Planned Sacroiliac Screw Corridor with the Slice Fusion Method

2021 ◽  
Vol 10 (2) ◽  
pp. 184
Author(s):  
Maximilian Kerschbaum ◽  
Siegmund Lang ◽  
Florian Baumann ◽  
Volker Alt ◽  
Michael Worlicek
Keyword(s):  
Pelvic Ring ◽  
Three Dimensional ◽  
Fusion Method ◽  
Two Dimensional ◽  
Posterior Pelvic Ring ◽  
Simple Method ◽  
Sacroiliac Screw ◽  
Screw Insertion ◽  
Multiplanar Reconstructions ◽  
Screw Position

Insertion of sacro-iliac (SI) screws for stabilization of the posterior pelvic ring without intraoperative navigation or three-dimensional imaging can be challenging. The aim of this study was to develop a simple method to visualize the ideal SI screw corridor, on lateral two-dimensional images, corresponding to the lateral fluoroscopic view, used intraoperatively while screw insertion, to prevent neurovascular injury. We used multiplanar reconstructions of pre- and postoperative computed tomography scans (CT) to determine the position of the SI corridor. Then, we processed the dataset into a lateral two-dimensional slice fusion image (SFI) matching head and tip of the screw. Comparison of the preoperative SFI planning and the screw position in the postoperative SFI showed reproducible results. In conclusion, the slice fusion method is a simple technique for translation of three-dimensional planned SI screw positioning into a two-dimensional strict lateral fluoroscopic-like view.

Soft tissue abnormalities in Wassel Type VI radial polydactyly: a detailed anatomical study

2021 ◽  
Vol 46 (4) ◽  
pp. 352-359
Author(s):  
Susumu Saito ◽  
Itaru Tsuge ◽  
Hiroki Yamanaka ◽  
Naoki Morimoto
Keyword(s):  
Soft Tissue ◽  
Three Dimensional ◽  
Anatomical Study ◽  
Metacarpophalangeal Joint ◽  
Abductor Pollicis Brevis ◽  
Level Of Evidence ◽  
Thenar Muscle ◽  
Pulley System ◽  
Radial Deviation ◽  
Tissue Abnormalities

Wassel VI radial polydactyly is associated with metacarpal adduction and radial deviation of the metacarpophalangeal joint of the ulnar duplicate. The soft tissue abnormalities responsible for these deformities were characterized using preoperative multi-planar three-dimensional ultrasound and intraoperative observation in four patients. In all patients, the abductor pollicis brevis and superficial head of the flexor pollicis brevis inserted into the radial first metacarpal, whereas the adductor pollicis and deep head of the flexor pollicis brevis inserted into the ulnar thumb. Aberrant location of the flexor pollicis longus and absence of the A1 pulley system was associated with severe radial deviation. An additional superficial thenar muscle along the ulnar metacarpal was associated with minimal metacarpal adduction. Uneven forces on the ulnar duplicate could be associated with these characteristic deformities and joint instability. Knowledge of these abnormalities allows better planning of surgery and further insight into this rare radial polydactyly configuration. Level of evidence: II

scholarly journals Application of a Proposed Multi-Positional Circumferential Arm Liposuction Method and Quantification of its Clinical Efficacy Evaluation

2021 ◽  
Author(s):  
Yunpeng Gu ◽  
Ning Kang ◽  
Qianwen Lv ◽  
Yue Qi ◽  
Zhenjun Liu ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Quantitative Research ◽  
Three Dimensional ◽  
Reduction Rate ◽  
Full Description ◽  
Type I ◽  
Efficacy Evaluation ◽  
Level Of Evidence ◽  
Simple Measurement ◽  
Based Medicine

Abstract Background Upper arm liposuction mainly focuses on the posterolateral region, which may lead to a lack of harmony between the aspirated and unaspirated areas. In addition, the treatment effect of arm liposuction is often evaluated only by preoperative and postoperative photograph comparison and simple measurement; quantitative research on this topic is still lacking. Methods The multi-positional circumferential arm liposuction (MCAL) technique was proposed and applied to a total of 34 females in our hospital from 2017 to 2019. Three-dimensional data of 12 patients before the operation and after 2–3 months were collected and processed by 3D imaging, and the volume reduction rate was evaluated quantitatively. Results The MCAL method was successfully applied in the clinic, and its surgical effect was quantitatively studied. The mean follow-up time of 12 patients was (75.2 ±13.1) days, and the postoperative volume was significantly reduced. The postoperative volume of patients with type I, type II and type III decreased by (10.79 ±2.55)%, (17.25 ±3.02)% and (22.76 ±3.51)%, respectively. Conclusion Our new MCAL technique was successful, maximizing the esthetic results in upper limb contour refinements in the superficial fascial layer. The clinical efficacy of this proposed MCAL method was evaluated by CT and 3D digital technology, which provided further accuracy in demonstrating its effect on the shape of the arm. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com.

scholarly journals Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

2020 ◽  
Vol 09 (02) ◽  
pp. 141-149
Author(s):  
Pooja Prabhakar ◽  
Lauren Wessel ◽  
Joseph Nguyen ◽  
Jeffrey Stepan ◽  
Michelle Carlson ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Scaphoid Fracture ◽  
Receiver Operating Curve ◽  
Scaphoid Nonunion ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Time From Injury

Abstract Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case–control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.

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