Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report

Introduction Reports on the use of computer-assisted trauma surgery of comminuted scapula fracture are still quite rare. In this article, we present a case of comminuted scapula fracture, the surgical reconstruction of which was pre-operatively planned using a complex software solution. Materials and methods For surgical planning of the fracture, we used the TraumaTech software facilitating virtual reconstruction (both manual and automatic), surgery planning, design of the implant, planning of screw placement and lengths, and production of a 3D print model of the fracture and the implant. The software also supported ordering such custom-made plate from a plate producer who was capable of fast and precise production of the plate. Results The surgery using the custom-ordered plate was successful. The actual used screw lengths did not differ from the planned ones by more than 2 mm. One year after the surgery, the patient was capable of more demanding activities and doing sports activities. Conclusion This approach provides a great way to prevent complications of the surgery and to shorten its duration. To the best of our knowledge, this is the first description of the treatment of a scapula comminuted fracture utilizing computer-assisted preoperative planning.

A tale of traumatic diaphragmatic hernia

A traumatic diaphragmatic hernia is uncommon which accounts for 0.8 to 1.6%. In Blunt or penetrating abdominal injury, the patient presents as early or delayed respiratory distress or intestinal obstruction. We present the 55-year old female with a road traffic accident (pedestrian versus two-wheeler) with left-sided chest pain and breathlessness, left shoulder and leg pain referred to our institute. On examination, left hemithorax decreased breath sound and bowel sound was present, chest compression test positive, normal bowel sound in the abdomen, restricted left shoulder movement and abnormal mobility of shaft of left tibia and fibula. A plain X-ray of the chest and abdomen showed bowel shadow in the left hemithorax up to the apex. Computed tomography (CT) of thorax and abdomen shows herniation of stomach, transverse colon, omentum in the left hemithorax with collapsed left lung. A plain X-ray of the left shoulder shows neck of scapula fracture, left leg both bone fracture. Suggesting traumatic diaphragmatic hernia took emergency surgery, laparotomy was made intact stomach, transverse colon, omentum reduced with no injuries, radially placed diaphragmatic rent of size 10 cm × 5.5 cm through which left lung inferior lobe visualized, medial edge of rent close to the pericardial pad of fat. Other solid organs normal, left thoracic drain was fashioned. Rent was closed with interrupted polypropylene with intraabdominal drain. Left leg both bone fracture was done with tibial nailing and left neck of scapula fracture managed conservatively. Abdominal approach is sufficient rather than a thoracoabdominal approach given associated intraabdominal injuries, nowadays minimal access approaches preferred.