Precontoured Plate Fixation for Incomplete Atypical Diaphyseal Fracture of Femur using Three-Dimensional Printing Rapid Prototyping: Two Cases Reports

Clinical Applications of "In-Hospital" 3D Printing in Hip Surgery: A Systematic Narrative Review

Introduction: Interest in 3D printing for orthopedic surgery has been increasing since its progressive adoption in most of the hospitals around the world. The aim of the study is to describe all the current applications of 3D printing in patients undergoing hip surgery of any type at the present time. Materials and Methods: We conducted a systematic narrative review of publications indexed in MedLine through the search engine PubMed, with the following parameters: 3D printing AND (orthopedics OR traumatology) NOT tissue engineering NOT scaffold NOT in vitro and deadline 31 July 2023. After reading the abstracts of the articles, papers were selected according to the following criteria: full text in English or Spanish and content related to hip surgery. Those publications involving experimental studies (in vitro or with anatomical specimens) or 3D printing outside of hospital facilities as well as 3D-printed commercial implants were excluded. Results are presented as a reference guide classified by disease, including the used software and the steps required for the development of the idea. Results: We found a total of 27 indications for in-house 3D printing for hip surgery, which are described in the article. Conclusions: There are many surgical applications of 3D printing in hip surgery, most of them based on CT images. Most of the publications lack evidence, and further randomized studies should be encouraged to assess the advantages of these indications.

Surgical strategy of the treatment of atypical femoral fractures

The atypical femoral fracture (AFF) has been attracting significant attention because of its increasing incidence; additionally, its treatment is challenging from biological and mechanical aspects. Although surgery is often required to manage complete AFFs, clear guidelines for the surgical treatment of AFFs are currently sparse. We reviewed and described the surgical treatment of AFFs and the surveillance of the contralateral femur. For complete AFFs, cephalomedullary intramedullary nailing spanning the entire length of the femur can be used. Various surgical techniques to overcome the femoral bowing common in AFFs include a lateral entry point, external rotation of the nail, and the use of a nail with a small radius of curvature, or a contralateral nail. In the case of a narrow medullary canal, severe femoral bowing, or pre-existing implants, plate fixation may be considered as an alternative. For incomplete AFFs, prophylactic fixation depends on several risk factors, such as a subtrochanteric location, presence of a radiolucent line, functional pain, and condition of the contralateral femur; the same surgical principles as those in complete AFFs can be applied. Finally, once AFF is diagnosed, clinicians should recognize the increased risk of contralateral AFFs, and close surveillance of the contralateral femur is recommended.

Plate osteosynthesis for atypical femoral fractures in patients with severely bowed femurs: comparing short versus long segment fixation - a case series

BACKGROUND

Intramedullary nail fixation is currently the modality of choice in surgical treatment for atypical femoral fractures (AFF). Its uses are limited, however, in severely bowed femurs, narrow medullary canals, or in the presence of thick endosteal callus at the apex of the femoral curve. In these cases, extramedullary plate osteosynthesis is preferred. The consideration when adopting plate osteosynthesis is whether a short or long segment fixation is superior. We hypothesize that a long segment fixation has the potential advantage of protecting the entire length of the femur from future fractures in the adynamic bone. In this series, we present two cases from our institution, with the aims of discussing the benefits and limitations of short versus long segment plate fixation in AFF.

CASE SUMMARY

We report two uncommon cases of bisphosphonate-related AFF in two Asian patients with severe femoral curvature, who were treated with extramedullary plate osteosynthesis at our institution. One patient underwent fixation with a short segment plate osteosynthesis, and the other received a long plate osteosynthesis spanning the proximal to distal femur in an attempt to protect the bone from future fractures. Both patients showed a favourable and uncomplicated course post-surgery, with early return to ambulation and radiographic bone union at follow up.

CONCLUSION

We expect to see an increase in the number of patients with AFF and bowed femurs, especially with the increased usage of bisphosphonates given an ageing Asian population. Surgical treatment with short and long plate osteosynthesis are options with their own advantages and limitations. With the advent of new anatomical plate options, long segment fixation has become more accessible and may be considered in this patient group as it has the potential advantage of protecting the adynamic femur from future fractures. Further studies should be targeted to determine which method of treatment is superior in this particular group of patients.