A Graphic Overlay Method for Selection of Osteotomy Site in Chronic Radial Head Dislocation: An Evaluation of 3D-printed Bone Models

The effect of three-dimensional (3D) printing on quantitative and qualitative outcomes in paediatric orthopaedic osteotomies: a systematic review

Three-dimensional (3D) printing technology is increasingly being utilized in various surgical specialities. In paediatric orthopaedics it has been applied in the pre-operative and intra-operative stages, allowing complex deformities to be replicated and patient-specific instrumentation to be used. This systematic review analyses the literature on the effect of 3D printing on paediatric orthopaedic osteotomy outcomes.A systematic review of several databases was conducted according to PRISMA guidelines. Studies evaluating the use of 3D printing technology in orthopaedic osteotomy procedures in children (aged ≤ 16 years) were included. Spinal and bone tumour surgery were excluded. Data extracted included demographics, disease pathology, target bone, type of technology, imaging modality used, qualitative/quantitative outcomes and follow-up. Articles were further categorized as either 'pre-operative' or 'intra-operative' applications of the technology.Twenty-two articles fitting the inclusion criteria were included. The reported studies included 212 patients. There were five articles of level of evidence 3 and 17 level 4.A large variety of outcomes were reported with the most commonly used being operating time, fluoroscopic exposure and intra-operative blood loss.A significant difference in operative time, fluoroscopic exposure, blood loss and angular correction was found in the 'intra-operative' application group. No significant difference was found in the 'pre-operative' category.Despite a relatively low evidence base pool of studies, our aggregate data demonstrate a benefit of 3D printing technology in various deformity correction applications, especially when used in the 'intra-operative' setting. Further research including paediatric-specific core outcomes is required to determine the potential benefit of this novel addition. Cite this article: EFORT Open Rev 2021;6:130-138. DOI: 10.1302/2058-5241.6.200092.

Isolated Proximal Radioulnar Joint Instability: Anatomy, Clinical Presentation, and Current Treatment Options

Isolated proximal radioulnar joint instability is an uncommon and often challenging problem that may manifest as recurrent instability of the proximal aspect of the radius, usually during forearm pronation and supination. Instability is due to deficiency of the stabilizing structures around the proximal aspect of the radius, and biomechanical studies have highlighted the importance of the annular ligament and the interosseous membrane in both transverse and longitudinal plane stability. Reconstruction of the stabilizing structures around the radial head often is indicated in cases of recurrent instability and includes joint-preserving procedures such as annular ligament reconstruction, proximal ulnar osteotomy, and interosseous membrane reconstruction. Rarely, salvage procedures such as interpositional arthroplasty or 1-bone forearm reconstruction are necessary. A thorough understanding of the anatomic structures that stabilize the proximal aspect of the radius and the complexities of forearm biomechanics is required in order to successfully diagnose and manage this condition.

The pathogenesis of congenital radial head dislocation/subluxation

The pathogenesis of congenital radial head dislocation/subluxation is unknown and has not been previously investigated. In this review, we explore the pathogenesis and define five different primary insults: collagen abnormalities, abnormal endochondral ossification of the developing growth plate, abnormalities of forearm ossification outside the growth plate, disproportionate growth of the radius and ulna, and altered HOX D expression/activity. Finally, the clinical relevance of our review is discussed.