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Dong KX, Zhou Y, Cheng YY, Luo HT, Duan JZ, Yang X, Xu YQ, Lu S, He XQ. Clinical application of digital technology in the use of anterolateral thigh lobulated perforator flaps to repair complex soft tissue defects of the limbs. BURNS & TRAUMA 2024; 12:tkae011. [PMID: 38737342 PMCID: PMC11087825 DOI: 10.1093/burnst/tkae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/04/2023] [Accepted: 02/25/2024] [Indexed: 05/14/2024]
Abstract
Background It is challenging to repair wide or irregular defects with traditional skin flaps, and anterolateral thigh (ALT) lobulated perforator flaps are an ideal choice for such defects. However, there are many variations in perforators, so good preoperative planning is very important. This study attempted to explore the feasibility and clinical effect of digital technology in the use of ALT lobulated perforator flaps for repairing complex soft tissue defects in limbs. Methods Computed tomography angiography (CTA) was performed on 28 patients with complex soft tissue defects of the limbs, and the CTA data were imported into Mimics 20.0 software in DICOM format. According to the perforation condition of the lateral circumflex femoral artery and the size of the limb defect, one thigh that had two or more perforators from the same source vessel was selected for 3D reconstruction of the ALT lobulated perforator flap model. Mimics 20.0 software was used to visualize the vascular anatomy, virtual design and harvest of the flap before surgery. The intraoperative design and excision of the ALT lobulated perforator flap were guided by the preoperative digital design, and the actual anatomical observations and measurements were recorded. Results Digital reconstruction was successfully performed in all patients before surgery; this reconstruction dynamically displayed the anatomical structure of the flap vasculature and accurately guided the design and harvest of the flap during surgery. The parameters of the harvested flaps were consistent with the preoperative parameters. Postoperative complications occurred in 7 patients, but all flaps survived uneventfully. All of the donor sites were closed directly. All patients were followed up for 13-27 months (mean, 19.75 months). The color and texture of each flap were satisfactory and each donor site exhibited a linear scar. Conclusions Digital technology can effectively and precisely assist in the design and harvest of ALT lobulated perforator flaps, provide an effective approach for individualized evaluation and flap design and reduce the risk and difficulty of surgery.
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Affiliation(s)
- Kai-xuan Dong
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Key Laboratory of Digital Orthopedics of Yunnan Province, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, China
| | - Ya Zhou
- School of Rehabilitation, Kunming Medical University, 1168 Chunrong west Road, Yuhua Street, Chenggong District, Kunming, Yunnan 650504, China
| | - Yao-yu Cheng
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Key Laboratory of Digital Orthopedics of Yunnan Province, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, China
| | - Hao-tian Luo
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Key Laboratory of Digital Orthopedics of Yunnan Province, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, China
| | - Jia-zhang Duan
- Affiliated Hospital of Yunnan University, 176 Qinnian Road, Wuhua District, Kunming, Yunnan 650032, China
| | - Xi Yang
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, 212 Road, Daguan District, Kunming, Yunnan 650032, China
| | - Yong-qing Xu
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, 212 Road, Daguan District, Kunming, Yunnan 650032, China
| | - Sheng Lu
- Department of Orthopedics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Key Laboratory of Digital Orthopedics of Yunnan Province, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, China
| | - Xiao-qing He
- Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, People's Liberation Army of China, 212 Road, Daguan District, Kunming, Yunnan 650032, China
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Jeyaraman M, Ram PR, Jeyaraman N, Ramasubramanian S, Shyam A. The Era of Digital Orthopedics: A Bone or Bane? J Orthop Case Rep 2024; 14:1-4. [PMID: 38292103 PMCID: PMC10823821 DOI: 10.13107/jocr.2024.v14.i01.4125] [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: 10/05/2023] [Revised: 11/02/2023] [Indexed: 02/01/2024] Open
Abstract
Orthopedics, the medical specialty dedicated to diagnosing, treating, and preventing disorders of the musculoskeletal system, has long been a cornerstone of healthcare. With an aging population and an increasing emphasis on maintaining an active lifestyle, the demand for orthopedic care is on the rise. However, the field of orthopedics is rapidly evolving, and one of the most significant developments in recent years is the emergence of digital orthopedics [1, 2]. This transformation is reshaping the way orthopedic care is delivered, from diagnosis and treatment to patient outcomes and beyond. In this editorial, we explore the concept of digital orthopedics, its implications, and the potential benefits it offers to both patients and health-care professionals.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - Pothuri Rishi Ram
- Department of Orthopaedics, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, Karnataka, India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - Swaminathan Ramasubramanian
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu, India
| | - Ashok Shyam
- Department of Orthopaedics, Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India
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Lovera D, Sandberg O, Mohaddes M, Gyllensten H. Cost-effectiveness of implant movement analysis in aseptic loosening after hip replacement: a health-economic model. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:88. [PMID: 37986000 PMCID: PMC10662297 DOI: 10.1186/s12962-023-00498-w] [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: 04/17/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE To investigate the cost-effectiveness of using Implant Movement Analysis (IMA) to follow up suspected aseptic loosening when the diagnosis after an initial X-ray is not conclusive, compared with a diagnostic pathway with X-ray follow-up. METHODS A health-economic model in the form of a decision tree was developed using quality-adjusted life years (QALY) from the literature, cost-per-patient data from a university hospital and the probabilities of different events from expert physicians' opinions. The base case incremental cost-effectiveness ratio (ICER) was compared with established willingness-to-pay thresholds and sensitivity analyses were performed to account for assumptions and uncertainty. RESULTS The base case ICER indicated that the IMA pathway was cost effective (SEK 99,681, compared with the SEK 500,000 threshold). In the sensitivity analysis, the IMA pathway remained cost effective during most changes in parameters. ICERs above the threshold value occurred in cases where a larger or smaller proportion of people receive immediate surgery. CONCLUSION A diagnostic pathway using IMA after an inconclusive X-ray for suspected aseptic loosening was cost effective compared with a pathway with X-ray follow-up.
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Affiliation(s)
- Davide Lovera
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sectra, Linköping, Sweden
| | | | - Maziar Mohaddes
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, P. O. Box 457, 405 30, Gothenburg, Sweden.
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Gao H, Liu Z, Bai X, Wang G, Xu G, Ma J, Wang Y, Wang J, Chen W, Wang B. Comparison of freehand technique and a novel laser-guiding navigation system in femoral neck-cannulated screw fixation: a randomized controlled trial. BMC Surg 2023; 23:319. [PMID: 37872521 PMCID: PMC10594929 DOI: 10.1186/s12893-023-02226-w] [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: 06/25/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
Cannulated screw fixation is essential in treating femoral neck fractures, and the widely used freehand technique has several limitations. Therefore, we designed a new laser-positioning and navigation system and compared its efficacy with that of the traditional freehand technique in the cannulated screw fixation of femoral neck fractures. This randomized controlled single-blind trial recruited patients with femoral neck fracture, who were treated using either the newly designed laser-navigation device or the freehand technique. In in-vitro experiments, using the femoral neck model, the laser group was better than the freehand group in terms of operation time (P = 0.0153) and radiation exposure time (P < 0.001). In in-vivo experiments, involving 30 patients (15 in each group), the laser group was better than the freehand group in terms of operation time (P < 0.001), radiation exposure time (P < 0.001), blood loss (P < 0.001) and first success rate (P = 0.03). There was no difference in visual analog scale score, Harris score, and fracture-healing time between the two groups. In conclusion, the novel laser-guiding navigation system resulted in shorter operation time, less radiation exposure, and higher first success rate compared with the freehand technique. Further qualified investigations with a larger number of patients and longer follow-up are required in the future.
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Affiliation(s)
- Hua Gao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Liu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaodong Bai
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Gang Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoqiang Xu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ji Ma
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yijun Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiatian Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wentao Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Baojun Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Guo X, Wang D, Li J, Zhang H. Global research status and trends in orthopaedic surgical robotics: a bibliometric and visualisation analysis study. J Robot Surg 2023:10.1007/s11701-023-01579-x. [PMID: 37017859 DOI: 10.1007/s11701-023-01579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/18/2023] [Indexed: 04/06/2023]
Abstract
This study aimed to investigate and summarise the current state of research and trends in orthopaedic surgical robots. Data on publicly available publications related to orthopaedic surgical robots were extracted by abstract searches of the Web of Science Core Collection database. A bibliometric analysis and detailed reading of the publications were then carried out and the information was visualised using co-authorship analysis, coupling analysis, co-citation analysis and co-occurrence analysis in VOSviewer. With 436 publications included in the study from 1993 to 2022, the overall contribution of publications to the world showed an increasing trend year by year, with a particularly pronounced after 2017, and a geographical trend of predominantly East Asia, North America, and Western Europe. Of these, China was the largest contributor (n = 128). Overall, the UK affiliates and their scholars were leaders in the field, with a high number of publications, total citations, average citations per article and H-index. The most published institutions and authors were Imperial College London (n = 21) and Professor Fares Sahi Haddad of University College London (n = 12), respectively. Journals with a high overall impact on robotic orthopaedic surgery were the Journal of Arthroplasty, Bone Joint Journal, International Journal of Medical Robotics and Computer Assisted Surgery. Keyword co-occurrence network analysis revealed four main clusters: robot-assisted knee, hip arthroplasty, spine surgery, and robotic technology research and development. The top three most common sites for robot-assisted surgery use were the knee, hip and spine. The most used robot types were the knee and spine, with Mako and Arobot being the most used robots for the knee and TiRobot for the spine. This study comprehensively reveals the current status and trends of global research on orthopaedic surgical robots, covering countries, institutions, authors, journals, research hotspots, robot types and surgical sites, providing directional guidance and research ideas for further research on the technological development and clinical evaluation of orthopaedic surgical robots.
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Affiliation(s)
- Xinmeng Guo
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jiantao Li
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hao Zhang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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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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Association of the lateral wall integrity with clinical outcomes in older patients with intertrochanteric hip fractures treated with the proximal femoral nail anti-rotation-Asia. INTERNATIONAL ORTHOPAEDICS 2021; 45:3233-3242. [PMID: 34546389 DOI: 10.1007/s00264-021-05211-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to assess the role of the lateral wall in post-operative clinical outcomes in patients with intertrochanteric fractures treated with the proximal femoral nail anti-rotation-Asia (PFNA-II). METHODS A cohort of 466 patients (OTA type 31A1 or A2) was divided into two groups: one was intact lateral wall group, and the other was fractured lateral wall group. Radiographic outcomes were measured by using the loss of neck-shaft angle (NSA), femoral neck shortening (FNS), and offset shortening (OS). Functional outcomes were assessed by using the Harris score and SF-36 Physical Component Summary (SF-36 PCS). Post-operative complications were recorded. RESULTS The fractured lateral wall group had a greater loss of NSA (mean [SD], fractured group (8.7°) [2.7°] vs intact group (4.8°) [2.8°]; mean difference, 3.3° [95% CI 2.9 to 3.8]; P < 0.001) compared with the intact lateral wall group. Similar results were found for FNS and OS. The fractured lateral wall group had a worse Harris scores at the three month follow-up (mean [SD] score, fractured group (66.6) [5.2] points vs intact group (71.3) [5.8] points; mean difference, - 3.3 points [95% CI - 3.9 to - 2.7]; P < 0.001) compared with the intact lateral wall group. Similar results were observed for Harris scores at the three and 12-month follow-ups and SF-36 PCS at the three, six and 12-month follow-ups. The fractured lateral wall group had a higher risk of post-operative complications compared with the intact lateral wall group. CONCLUSION Among older patients with intertrochanteric fractures, the fractured lateral wall was associated with worse clinical outcomes compared with the intact lateral wall. Clinicians should pay attention to the lateral wall integrity in patients with intertrochanteric fractures treated with the PFNA-II.
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Javaid M, Haleem A. Impact of industry 4.0 to create advancements in orthopaedics. J Clin Orthop Trauma 2020; 11:S491-S499. [PMID: 32774017 PMCID: PMC7394797 DOI: 10.1016/j.jcot.2020.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022] Open
Abstract
Scientists and health professional are focusing on improving the medical sciences for the betterment of patients. The fourth industrial revolution, which is commonly known as Industry 4.0, is a significant advancement in the field of engineering. Industry 4.0 is opening a new opportunity for digital manufacturing with greater flexibility and operational performance. This development is also going to have a positive impact in the field of orthopaedics. The purpose of this paper is to present various advancements in orthopaedics by the implementation of Industry 4.0. To undertake this study, we have studied the available literature extensively on Industry 4.0, technologies of Industry 4.0 and their role in orthopaedics. Paper briefly explains about Industry 4.0, identifies and discusses the major technologies of Industry 4.0, which will support development in orthopaedics. Finally, from the available literature, the paper identifies twelve significant advancements of Industry 4.0 in orthopaedics. Industry 4.0 uses various types of digital manufacturing and information technologies to create orthopaedics implants, patient-specific tools, devices and innovative way of treatment. This revolution is to be useful to perform better spinal surgery, knee and hip replacement, and invasive surgeries.
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Affiliation(s)
- Mohd Javaid
- Corresponding author., https://scholar.google.co.in/citations?user=rfyiwvsAAAAJ&hl=en
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Moldovan F, Gligor A, Bataga T. Integration of Three-dimensional Technologies in Orthopedics: A Tool for Preoperative Planning of Tibial Plateau Fractures. Acta Inform Med 2020; 28:278-282. [PMID: 33627930 PMCID: PMC7879455 DOI: 10.5455/aim.2020.28.278-282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: There is a growing scientific interest in the use of three-dimensional (3D) technologies in orthopedic surgery. Digitalization makes research in orthopedics more accurate and quantitative. Scientific literature describes an overview of current 3D technologies applications in orthopedics, without any emphasis on integrating available technologies as a clinical workflow. Objective: To develop a clinical workflow integrating 3D technologies for patient-specific applications in orthopedics validated in practice by employment of a free 3D software solution with the aim of minimizing the intervention. Method: By exploring the applications of 3D technologies in orthopedic surgery, we have created a clinical workflow integrating 3D technologies for patient-specific applications in orthopedics. It is validated in practice for preoperative planning of a 49-year-old male patient who had a tibial plateau fracture of Schatzker type VI in his right leg. The software solution we have used is Democratiz3D, from Embodi3d platform, which allows patient-specific modeling and surgical planning. Results: By using the proposed methodology we obtained the model of the tibial plateau fracture Schatzker type VI, as a “solid” representation in stl type files, which represents a numerically defined geometry of the bones fragments. It helps surgeons in planning the surgical approach. The time from the beginning to the end of the analysis was 193 min, which is 15% lower than times reported in similar studies. Conclusion: The planning potential of the 3D solution is a valuable instrument for surgeons in exploring the nature of tibial plateau fractures and the formulation of a suitable surgical plan for surface alignment, design and screw fixation guides, strength calculations of bone fragments, and printing surgical objects.
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Affiliation(s)
- Flaviu Moldovan
- IOSUD Doctoral School, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - Adrian Gligor
- Biomedical Research Center, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - Tiberiu Bataga
- Department of Orthopedics-Traumatology, "George Emil Palade" University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
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Jia X, Chen Y, Qiang M, Zhang K, Li H, Jiang Y, Zhang Y. Detection of Intra-Articular Screw Penetration of Proximal Humerus Fractures: Is Postoperative Computed Tomography the Necessary Imaging Modality? Acad Radiol 2019; 26:257-263. [PMID: 29269182 DOI: 10.1016/j.acra.2017.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVE Screw penetration is the common complication of proximal humerus fractures treated with locking plates. This study compared postoperative plain radiography to computed tomography (CT) for their abilities in determining screw penetration, and was to evaluate whether advanced imaging modalities (two-dimensional [2D] CT; three-dimensional [3D] CT) could increase surgeons' level of confidence regarding their diagnoses. MATERIALS AND METHODS Two observers reviewed radiological images of 134 patients who sustained proximal humerus fractures treated with locking plates. The observers were asked to answer two questions: (1) Is there screw penetrating into glenohumeral joint for this patient (Yes/No)? and (2) On a scale from 0 to 10, how confident are you about this diagnosis: (0-10) (0 = not at all confident; 10 = very confident)? Three evaluations were performed: (1) plain radiography alone, (2) radiography and 2D CT 4 weeks later, and (3) radiography in combination with 2D and 3D CT after that. This process was then repeated for intraobserver analysis. RESULTS CT obtained almost perfect interobserver and intraobserver agreement (0.818-0.961), which was higher than radiography (0.377-0.655). For incidence of screw penetration, the significant difference was found between radiographs and CT images (P< .0125), but not between 2D and 3D CT images (P > .05). For confidence of diagnosis, the differences between imaging modalities were significant (all P< .001). CONCLUSIONS We suggest that postoperative CT scans (especially 3D CT images) should be used to evaluate the intra-articular screw penetration of proximal humerus fractures, especially when surgeons have not enough confidence in determining screw penetration using radiography alone.
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Affiliation(s)
- Xiaoyang Jia
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - Yanxi Chen
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China.
| | - Minfei Qiang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - Kun Zhang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - Haobo Li
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - Yuchen Jiang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - Yijie Zhang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
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11
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Zhang Y, Chen Y, Qiang M, Zhang K, Li H, Jiang Y, Jia X. Comparison between three-dimensional CT and conventional radiography in proximal tibia morphology. Medicine (Baltimore) 2018; 97:e11632. [PMID: 30045306 PMCID: PMC6078714 DOI: 10.1097/md.0000000000011632] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To provide morphological parameters of the normal tibial plateau by using three-dimensional (3D) CT and conventional radiography.We performed morphological measurements of tibial plateau on 157 consecutive adults using radiographic and 3D computed tomography (CT). Gender differences as well as differences in measurement techniques were statistically compared. Intraclass correlation coefficient (ICC) was used to evaluate intra- and interobserver reproducibility.The mediolateral dimensions, anteroposterior dimensions of tibial plateau showed significant differences according to gender, but no statistical differences were observed in coronal tibial slope as well as in posterior slope. There were significant differences in all parameters between 2 measurement techniques. 3D-CT measurements had a higher ICC in all parameters than that in the radiographs.This study confirmed that 3D morphological measurements of tibial plateau have more reproducibility than radiographs. Our data will be helpful for tibial component design and placement.
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Abstract
Increasing innovation in rapid prototyping (RP) and additive manufacturing (AM), also known as 3D printing, is bringing about major changes in translational surgical research. This review describes the current position in the use of additive manufacturing in orthopaedic surgery. Cite this article: Bone Joint J 2018;100-B:455-60.
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Affiliation(s)
- A Mumith
- University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - M Thomas
- University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - Z Shah
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 7EH, UK
| | - M Coathup
- University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - G Blunn
- University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK and School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK
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Qiang M, Jia X, Chen Y, Zhang K, Li H, Jiang Y, Zhang Y. Assessment of Screw Length of Proximal Humerus Internal Locking System (PHILOS) Plate for Proximal Humeral Fractures Using Three-Dimensional Computed Tomography Scan. Med Sci Monit 2018; 24:1158-1165. [PMID: 29478073 PMCID: PMC5836538 DOI: 10.12659/msm.906355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Screw perforation and varus collapse are common complications of treatment with a PHILOS (proximal humerus internal locking system) plate for proximal humerus fractures, which are associated with improper screw length selection and lack of medial column support. The purposes of this study were: (1) to measure the proper length of periarticular screws of the PHILOS plate in the humeral head, and (2) to determine what factors influence the screw length and implantation of the inferomedial support screw. Material/Methods Computed tomography (CT) images of the normal proximal humerus in 134 cases were retrospectively reviewed. The length of periarticular screws was measured using three-dimensional (3D) techniques. Intraobserver and interobserver reliability of measurement were evaluated using intraclass correlation coefficients (ICCs). Sex and body height influences on screw length and implantation of the inferomedial screw were analyzed. Results All measurements had excellent agreement (ICC>0.75). The screw length and implantation rate of the inferomedial screw were greater in males than in females. Positive correlations were observed between body height and screw length and implantation of the inferomedial screw (all P<0.001). Conclusions The screws were longer and the implantation rate was higher for inferomedial screws in males than in females, and were positively correlated with body height. Our data can be used as a reference for surgeons to reduce the number of times screws are changed intraoperatively and to reduce operation duration and minimize use of intraoperative fluoroscopy for proximal humerus fractures treated with the PHILOS plate.
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Affiliation(s)
- Minfei Qiang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Xiaoyang Jia
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yanxi Chen
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Kun Zhang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Haobo Li
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yuchen Jiang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yijie Zhang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Morphometry of the Tibial Plateau at the Surface and Resected Levels. J Arthroplasty 2017; 32:2563-2567. [PMID: 28359645 DOI: 10.1016/j.arth.2017.02.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We aim to make an anthropometric analysis of tibial plateau at the surface level and the resected level and analyze the correlation in lengths between 2 levels. We hypothesized that lengths at the surface level were longer than those at the resected level, which brought soft tissue tolerance for tibial component to overhang. METHODS Anthropometric data were measured using three-dimensional structures reconstructed from tibial plateaus of 100 knees in 100 Chinese subjects (50 men and 50 women). Mediolateral, medial anteroposterior, and lateral anteroposterior lengths at the surface level and the resected level were measured, and the Pearson's correlation coefficients of these data were calculated. RESULTS Mediolateral and medial anteroposterior lengths at the surface level were longer than those at the resected level by a mean 2.38 ± 1.29 and 1.99 ± 1.76 mm, respectively. Lateral anteroposterior length at the surface level was shorter than that at the resected level by a mean 1.54 ± 2.49 mm. All these differences between 2 levels had no gender difference. CONCLUSION Our findings suggest that tibial overhang could be better tolerated in the medial compared to the lateral compartment but this hypothesis has to be further investigated in a clinical study.
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Jia XY, Chen YX, Qiang MF, Zhang K, Li HB, Jiang YC, Zhang YJ. Postoperative Evaluation of Reduction Loss in Proximal Humeral Fractures: A Comparison of Plain Radiographs and Computed Tomography. Orthop Surg 2017; 9:167-173. [PMID: 28560796 DOI: 10.1111/os.12332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 02/16/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To compare postoperative CT images with plain radiographs for measuring prognostic factors of reduction loss of fractures of the proximal part of the humerus. METHODS A total of 65 patients who sustained fractures of the proximal humerus treated with locking plates from June 2012 to October 2015 were retrospectively analyzed. There were 24 men and 41 women, with a mean age of 60.0 years (range, 22-76 years). According to the Neer classification system of proximal humeral fracture, there were 26 two-part, 27 three-part and 12 four-part fractures of the proximal part of the humerus, and all fractures were treated with open reduction and internal fixation (ORIF) using locked plating. All postoperative CT images and plain radiographs of the patients were obtained. Prognostic factors of the reduction loss were the change of neck shaft angle (NSA) and the change of humeral head height (HHH). The change of NSA and HHH were evaluated by the difference between postoperative initial and final follow-up measurement. Reduction loss was defined as the change ≥10° for NSA or ≥5 mm for HHH. The NSA and HHH were measured using plain radiographs and 3-D CT images, both initially and at final follow-up. The paired t-test was used for comparison of NSA, change of NSA, HHH, and change of HHH between two image modalities. The differences between two image modalities in the assessment of reduction loss were examined using the χ2 -test (McNemar test). Intraclass correlation coefficients (ICC) were used to assess the intra-observer and inter-observer reliability. RESULTS 3-D CT images (ICC range, 0.834-0.967) were more reliable in all parameters when compared with plain radiographs (ICC range, 0.598-0.915). Significant differences were found between the two image modalities in all parameters (plain radiographs: initial NSA = 133.6° ± 3.8°, final NSA = 130.0° ± 1.9°, initial HHH = 17.9 ± 0.9 mm, final HHH = 15.8 ± 1.5 mm; 3-D CT: initial NSA = 131.4° ± 3.4°, final NSA = 128.8° ± 1.7°, initial HHH = 16.8 ± 1.2 mm, final HHH = 14.5 ± 1.1 mm; all P < 0.05). In the assessment of reduction loss, the percentage was 16.9% (11/65) for the plain radiographs and 7.7% (5/65) for the 3-D CT scans (P < 0.05). For the 5 patients with reduction loss, which were observed by two imaging modalities, the mean Constant-Murley score was 61.0 ± 1.6. The patients with reduction loss, observed only in plain radiographs but not CT images, had good shoulder function (Constant-Murley score: 82.7 ± 1.0). CONCLUSIONS Our data reveal that 3-D CT images are more reliable than plain radiographs in the assessment of the prognostic factors of reduction loss of fractures of the proximal part of the humerus with treatment of locking plates; this reliable CT technique can serve as an effective guideline for the subsequent clinical management of patients.
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Affiliation(s)
- Xiao-Yang Jia
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan-Xi Chen
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min-Fei Qiang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao-Bo Li
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu-Chen Jiang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi-Jie Zhang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
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Garcia-Tutor E, Romeo M, Chae MP, Hunter-Smith DJ, Rozen WM. 3D Volumetric Modeling and Microvascular Reconstruction of Irradiated Lumbosacral Defects after Oncologic Resection. Front Surg 2016; 3:66. [PMID: 28018904 PMCID: PMC5153530 DOI: 10.3389/fsurg.2016.00066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 11/30/2016] [Indexed: 12/26/2022] Open
Abstract
Background Locoregional flaps are sufficient in most sacral reconstructions. However, large sacral defects due to malignancy necessitate a different reconstructive approach, with local flaps compromised by radiation and regional flaps inadequate for broad surface areas or substantial volume obliteration. In this report, we present our experience using free muscle transfer for volumetric reconstruction, in such cases, and demonstrate three-dimensional (3D) haptic models of the sacral defect to aid preoperative planning. Methods Five consecutive patients with irradiated sacral defects secondary to oncologic resections were included, surface area ranging from 143–600 cm2. Latissimus dorsi (LD)-based free flap sacral reconstruction was performed in each case, between 2005 and 2011. Where the superior gluteal artery was compromised, the subcostal artery (SA) was used as a recipient vessel. Microvascular technique, complications, and outcomes are reported. The use of volumetric analysis and 3D printing is also demonstrated, with imaging data converted to 3D images suitable for 3D printing with Osirix software (Pixmeo, Geneva, Switzerland). An office-based, desktop 3D printer was used to print 3D models of sacral defects, used to demonstrate surface area and contour and produce a volumetric print of the dead space needed for flap obliteration. Results The clinical series of LD free flap reconstructions is presented, with successful transfer in all cases, and adequate soft-tissue cover and volume obliteration achieved. The original use of the SA as a recipient vessel was successfully achieved. All wounds healed uneventfully. 3D printing is also demonstrated as a useful tool for 3D evaluation of volume and dead space. Conclusion Free flaps offer unique benefits in sacral reconstruction where local tissue is compromised by irradiation and tumor recurrence, and dead space requires accurate volumetric reconstruction. We describe for the first time the use of the SA as a recipient in free flap sacral reconstruction. 3D printing of haptic bio-models is a rapidly evolving field with a substantial role in preoperative planning.
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Affiliation(s)
- Emilio Garcia-Tutor
- Department of Plastic and Reconstructive Surgery, Hospital de Guadalajara, Guadalajara, Spain; MD Anderson Cancer Center, Madrid, Spain
| | - Marco Romeo
- Department of Plastic and Reconstructive Surgery, Hospital de Guadalajara , Guadalajara , Spain
| | - Michael P Chae
- Department of Surgery, School of Clinical Science at Monash Health, Faculty of Medicine, Monash University, Monash Medical Centre, Clayton, VIC, Australia; Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, VIC, Australia
| | - David J Hunter-Smith
- Department of Surgery, School of Clinical Science at Monash Health, Faculty of Medicine, Monash University, Monash Medical Centre, Clayton, VIC, Australia; Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, VIC, Australia
| | - Warren Matthew Rozen
- Department of Surgery, School of Clinical Science at Monash Health, Faculty of Medicine, Monash University, Monash Medical Centre, Clayton, VIC, Australia; Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, VIC, Australia
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Jia X, Chen Y, Qiang M, Zhang K, Li H, Jiang Y, Zhang Y. Compared to X-ray, three-dimensional computed tomography measurement is a reproducible radiographic method for normal proximal humerus. J Orthop Surg Res 2016; 11:82. [PMID: 27422405 PMCID: PMC4947252 DOI: 10.1186/s13018-016-0417-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate comprehension of the normal humeral morphology is crucial for anatomical reconstruction in shoulder arthroplasty. However, traditional morphological measurements for humerus were mainly based on cadaver and radiography. The purpose of this study was to provide a series of precise and repeatable parameters of the normal proximal humerus for arthroplasty, based on the three-dimensional (3-D) measurements. METHODS Radiographic and 3-D computed tomography (CT) measurements of the proximal humerus were performed in a sample of 120 consecutive adults. Sex differences, two image modalities differences, and correlations of the parameters were evaluated. Intra- and inter-observer reproducibility was evaluated using intraclass correlation coefficients (ICCs). RESULTS In the male group, all parameters except the neck-shaft angle of humerus, based on 3-D CT images, were greater than those in the female group (P < 0.05). All variables were significantly different between two image modalities (P < 0.05). In 3-D CT measurement, all parameters expect neck-shaft angle had correlation with each other (P < 0.001), particularly between two diameters of the humeral head (r = 0.907). All parameters in the 3-D CT measurement had excellent reproducibility (ICC range, 0.878 to 0.936) that was higher than those in the radiographs (ICC range, 0.741 to 0.858). CONCLUSIONS The present study suggested that 3-D CT was more reproducible than plain radiography in the assessment of morphology of the normal proximal humerus. Therefore, this reproducible modality could be utilized in the preoperative planning. Our data could serve as an effective guideline for humeral component selection and improve the design of shoulder prosthesis.
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Affiliation(s)
- Xiaoyang Jia
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Yanxi Chen
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China.
| | - Minfei Qiang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Haobo Li
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Yuchen Jiang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
| | - Yijie Zhang
- Department of Orthopaedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120, Shanghai, China
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Chae MP, Rozen WM, Spychal RT, Hunter-Smith DJ. Breast volumetric analysis for aesthetic planning in breast reconstruction: a literature review of techniques. Gland Surg 2016; 5:212-26. [PMID: 27047788 DOI: 10.3978/j.issn.2227-684x.2015.10.03] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Accurate volumetric analysis is an essential component of preoperative planning in both reconstructive and aesthetic breast procedures towards achieving symmetrization and patient-satisfactory outcome. Numerous comparative studies and reviews of individual techniques have been reported. However, a unifying review of all techniques comparing their accuracy, reliability, and practicality has been lacking. METHODS A review of the published English literature dating from 1950 to 2015 using databases, such as PubMed, Medline, Web of Science, and EMBASE, was undertaken. RESULTS Since Bouman's first description of water displacement method, a range of volumetric assessment techniques have been described: thermoplastic casting, direct anthropomorphic measurement, two-dimensional (2D) imaging, and computed tomography (CT)/magnetic resonance imaging (MRI) scans. However, most have been unreliable, difficult to execute and demonstrate limited practicability. Introduction of 3D surface imaging has revolutionized the field due to its ease of use, fast speed, accuracy, and reliability. However, its widespread use has been limited by its high cost and lack of high level of evidence. Recent developments have unveiled the first web-based 3D surface imaging program, 4D imaging, and 3D printing. CONCLUSIONS Despite its importance, an accurate, reliable, and simple breast volumetric analysis tool has been elusive until the introduction of 3D surface imaging technology. However, its high cost has limited its wide usage. Novel adjunct technologies, such as web-based 3D surface imaging program, 4D imaging, and 3D printing, appear promising.
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Affiliation(s)
- Michael P Chae
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| | - Warren Matthew Rozen
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| | - Robert T Spychal
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| | - David J Hunter-Smith
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
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Zhang J, Tian XB, Sun L, Hu RY, Tian JL, Han W, Zhao JM. Establishing a Customized Guide Plate for Osteotomy in Total Knee Arthroplasty Using Lower-extremity X-ray and Knee Computed Tomography Images. Chin Med J (Engl) 2016; 129:386-91. [PMID: 26879010 PMCID: PMC4800837 DOI: 10.4103/0366-6999.176082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The conventional method cannot guarantee the precise osteotomies required for a perfect realignment and a better prognosis after total knee arthroplasty (TKA). This study investigated a customized guide plate for osteotomy placement in TKAs with the aid of the statistical shape model technique using weight-bearing lower-extremity X-rays and computed tomography (CT) images of the knee. METHODS From October 2014 to June 2015, 42 patients who underwent a TKA in Guizhou Provincial People's Hospital were divided into a guide plate group (GPG, 21 cases) and a traditional surgery group (TSG, 21 cases) using a random number table method. In the GPG group, a guide plate was designed and printed using preoperative three-dimensional measurements to plan and digitally simulate the operation. TSG cases were treated with the conventional method. Outcomes were obtained from the postoperative image examination and short-term follow-up. RESULTS Operative time was 49.0 ± 10.5 min for GPG, and 62.0 ± 9.7 min in TSG. The coronal femoral angle, coronal tibial angle, posterior tibial slope, and the angle between the posterior condylar osteotomy surface and the surgical transepicondylar axis were 89.2 ± 1.7°, 89.0 ± 1.1°, 6.6 ± 1.4°, and 0.9 ± 0.3° in GPG, and 86.7 ± 2.9°, 87.6 ± 2.1°, 8.9 ± 2.8°, and 1.7 ± 0.8° in TSG, respectively. The Hospital for Special Surgery scores 3 months after surgery were 83.7 ± 18.4 in GPG and 71.5 ± 15.2 in TSG. Statistically significant differences were found between GPG and TSG in all measurements. CONCLUSIONS A customized guide plate to create an accurate osteotomy in TKAs may be created using lower-extremity X-ray and knee CT images. This allows for shorter operative times and better postoperative alignment than the traditional surgery. Application of the digital guide plate may also result in better short-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Jin-Min Zhao
- Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
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Wahab MAKA, Ebraheim MA, Saleh A. The role of 64-MDCT with 3D images in evaluation of intra-articular calcaneal fractures and management planning. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chen Y, Qiang M, Zhang K, Li H, Dai H. A reliable radiographic measurement for evaluation of normal distal tibiofibular syndesmosis: a multi-detector computed tomography study in adults. J Foot Ankle Res 2015. [PMID: 26213578 PMCID: PMC4514948 DOI: 10.1186/s13047-015-0093-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Syndesmotic injury may be difficult to diagnose, and radiological evaluation is very important. The purpose of this study was to offer a series of reliable and repeatable normal tibiofibular syndesmosis parameters in diagnosing injuries of the syndesmosis. Methods Multi-detector computed tomography (MDCT) and radiographs of the distal tibiofibular syndesmosis in 484 cases were retrospectively reviewed. Relevant parameters included the tibiofibular clear space (TCS), the tibiofibular overlap (TFO), the depth of the incisura fibularis (IFD), and the height of the incisura fibularis (IFH), which were measured by novel three-dimensional (3-D) and two-dimensional (2-D) techniques. The distance between the measuring plane of the distal tibiofibular syndesmosis and the tibial plafond was measured. Intra- and inter-rater reliability was assessed by intraclass correlation coefficient (ICC) and the root mean square standard deviation (RMS-SD), to determine measurement precision. Sex differences of parameters were analyzed using analysis of covariance (ANCOVA) with body height as the covariate. Paired sample t-testing was used to compare parameters in different image modalities, including radiography, and 2-D and 3-D CT. Results The reliability of the 3-D images measurement (ICC range, 0.907 to 0.972) was greater than that for the 2-D axial images (ICC range, 0.895 to 0.927), and the AP view radiographs (ICC range, 0.742 to 0.838). The intra-rater RMS-SD of the 3-D CT, 2-D CT and radiographic measurements were less than 0.94 mm, 0.26 mm, and 2.87 mm, respectively. The measuring plane of the distal tibiofibular syndesmosis showed the sex difference, which was 12.1 mm proximal to the tibial plafond in the male group and 7.8 mm in the female group. In this plane, the parameters for tibiofibular syndesmosis were measured in different image modalities. All variables were significantly different between females and males (p < 0.05). Conclusions 3-D measurement technique could be helpful to identify the precise measurement planes for syndesmosis, which were not at the fixed level above the tibial plafond because of the sex difference. In this plane, reliable measurement results could be provided, in either 2-D or 3-D MDCT images. Electronic supplementary material The online version of this article (doi:10.1186/s13047-015-0093-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yanxi Chen
- Department of Orthopedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120 Shanghai, China
| | - Minfei Qiang
- Department of Orthopedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120 Shanghai, China
| | - Kun Zhang
- Department of Orthopedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120 Shanghai, China
| | - Haobo Li
- Department of Orthopedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120 Shanghai, China
| | - Hao Dai
- Department of Orthopedic Trauma, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120 Shanghai, China
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Effect of sustentaculum screw placement on outcomes of intra-articular calcaneal fracture osteosynthesis: A prospective cohort study using 3D CT. Int J Surg 2015; 19:72-7. [DOI: 10.1016/j.ijsu.2015.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 05/03/2015] [Accepted: 05/07/2015] [Indexed: 11/18/2022]
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Chen Y, Zhang K, Qiang M, Li H, Dai H. Comparison of plain radiography and CT in postoperative evaluation of ankle fractures. Clin Radiol 2015; 70:e74-82. [PMID: 26055409 DOI: 10.1016/j.crad.2015.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 03/25/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
AIM To compare postoperative plain radiographs with computed tomography (CT) post-processing images in evaluating the quality of anatomical reduction and internal fixation of ankle fractures. MATERIALS AND METHODS A total of 168 patients who sustained closed ankle fracture and were treated with open reduction and internal fixation in East Hospital were reviewed. Postoperative plain radiographs and CT post-processing images were evaluated. The observation was performed under volume-rendering mode and multiplanar reconstruction mode. The assessment was performed by two independent orthopaedic surgeons. The inter- and intra-observer variations were analysed by kappa statistics. The differences between plain radiographs and CT post-processing images were compared using χ(2) test (McNemar's test). RESULTS Inter- and intra-observer agreement was almost perfect (0.813-1.000) using CT post-processing images, which was higher than that using plain radiographs (0.323-0.848). More non-anatomical reduction could be recognised in the supination-external rotation (SER), supination-adduction (SAD), pronation-external rotation (PER), and overall groups (p<0.05) and more poor internal fixation could be recognised in the SER, SAD, and overall groups (p<0.05) using CT post-processing images than using radiographs. CONCLUSION More residual articular step, fracture fragment displacement, and poor internal fixation could be detected by CT post-processing images than plain radiographs.
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Affiliation(s)
- Y Chen
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China.
| | - K Zhang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - M Qiang
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - H Li
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
| | - H Dai
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China
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Computer-assisted preoperative planning for proximal humeral fractures by minimally invasive plate osteosynthesis. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Chen Y, Qiang M, Zhang K, Li H, Dai H. Novel computer-assisted preoperative planning system for humeral shaft fractures: report of 43 cases. Int J Med Robot 2014; 11:109-19. [PMID: 25156030 DOI: 10.1002/rcs.1604] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Yanxi Chen
- Department of Orthopaedic Trauma, East Hospital; Tongji University School of Medicine; Shanghai China
| | - Minfei Qiang
- Department of Orthopaedic Trauma, East Hospital; Tongji University School of Medicine; Shanghai China
| | - Kun Zhang
- Department of Orthopaedic Trauma, East Hospital; Tongji University School of Medicine; Shanghai China
| | - Haobo Li
- Department of Orthopaedic Trauma, East Hospital; Tongji University School of Medicine; Shanghai China
| | - Hao Dai
- Department of Orthopaedic Trauma, East Hospital; Tongji University School of Medicine; Shanghai China
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Qiang M, Chen Y, Zhang K, Li H, Dai H. Measurement of three-dimensional morphological characteristics of the calcaneus using CT image post-processing. J Foot Ankle Res 2014; 7:19. [PMID: 24625107 PMCID: PMC4007629 DOI: 10.1186/1757-1146-7-19] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/07/2014] [Indexed: 11/13/2022] Open
Abstract
Background Although computed tomography (CT) with three-dimensional (3D) rendering of the calcaneus is used for diagnostic evaluation of disorders, morphological measurements for the calcaneus are mostly based on a two-dimensional plane. The purposes of this study were to design a method for 3D morphological measurements of the normal calcaneus based on CT post-processing techniques, to measure morphological parameters in the male and female groups and describe gender differences of the parameters, and to investigate the reliability of such measurements. Methods One hundred and seventy-nine patients (83 men and 96 women) with a mean age of 40.6 (range, 21 to 59) years who underwent CT scans for their feet were reviewed retrospectively. The 3D structure of a normal calcaneus after shaded surface display reconstruction was extracted by interactive and automatic segmentation. Morphological measurements were achieved by means of a 3D measurement method based on CT image post-processing. Lengths and heights of the main parts of the calcaneus, Gissane’s angle, Böhler’s angle and the area of articular facet were worked out in 3D space. Gender-related size differences of parameters were compared using analysis of covariance (ANCOVA), adjusting for body height. Intra-observer and inter-observer reliabilities were assessed using intraclass correlation coefficients (ICCs) and the root mean square standard deviation (RMS-SD) for precision study. Results A large range of measurement values was found. Only the length of the anterior process was without gender difference (p > 0.05). The other parameters in the male group were greater than those in the female group (p < 0.01 for each, ANCOVA). All parameters had excellent reliability and reproducibility (ICC > 0.8). Precision was acceptable for intra-observer RMS-SD (linear, angular and areal measurements no more than 0.6 mm, 1.2° and 0.25 mm2, respectively). Inter-observer RMS-SD ranged from 0.4 to 1.6 mm for linear measurements, 1.2 to 2.5° for angles and 0.24 to 0.40 mm2 for areas. Conclusions Three-dimensional morphological measurement based on a CT post-processing technique was highly reliable and repeatable for calcaneal anatomic morphological measurement. The current data will be helpful for anatomic reduction of calcaneal fractures and calcaneal malunion.
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Affiliation(s)
| | - Yanxi Chen
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Road, 200120 Shanghai, China.
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