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Samaila EM, Negri S, Zardini A, Bizzotto N, Maluta T, Rossignoli C, Magnan B. Value of three-dimensional printing of fractures in orthopaedic trauma surgery. J Int Med Res 2020; 48:300060519887299. [PMID: 31813322 PMCID: PMC7262838 DOI: 10.1177/0300060519887299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/17/2019] [Indexed: 11/21/2022] Open
Abstract
Objective Information technology-based innovation is playing an increasingly key role in healthcare systems. The use of three-dimensional (3D)-printed bone fracture replicas in orthopaedic clinical practice could provide a new tool for fracture simulations and treatment, and change the interaction between patient and surgeon. We investigated the additional value of 3D-printing in the preparation and execution of surgical procedures and communication with patients, as well as its teaching and economic implications. Methods Fifty-two patients with complex articular displaced fractures of the calcaneus, tibial plateau, or distal radius were enrolled. 3D-printed real-size models of the fractured bone were obtained from computed tomography scans and exported to files suitable for 3D-printing. The models were handled by trauma surgeons, residents, and patients to investigate the potential advantages and procedural improvements. The patients’ and surgeons’ findings were recorded using specific questionnaires. Results 3D-printed replicas of articular fractures facilitated surgical planning and preoperative simulations, as well as training and teaching activities. They also strengthening the informed consent process and reduced surgical times and costs by about 15%. Conclusion 3D-printed models of bone fractures represent a significant step towards more-personalized medicine, with improved education and surgeon–patient relationships.
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Affiliation(s)
- Elena Manuela Samaila
- Orthopaedic and Trauma Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology of the University of Verona, Verona, Italy
| | - Stefano Negri
- Orthopaedic and Trauma Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology of the University of Verona, Verona, Italy
| | - Alessandro Zardini
- Department of Business Administration, University of Verona, Verona, Italy
| | - Nicola Bizzotto
- Department of Orthopaedic and Trauma Surgery, Dolomiti Sport Clinic, Ortisei, Italy
| | - Tommaso Maluta
- Orthopaedic and Trauma Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology of the University of Verona, Verona, Italy
| | - Cecilia Rossignoli
- Department of Business Administration, University of Verona, Verona, Italy
| | - Bruno Magnan
- Orthopaedic and Trauma Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology of the University of Verona, Verona, Italy
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Regis D, Sandri A, Bizzotto N, Magnan B. Open patellar tendon avulsion from tibial tuberosity after ACL reconstruction successfully treated with suture anchors. Acta Biomed 2019; 90:196-201. [PMID: 31821309 PMCID: PMC7233723 DOI: 10.23750/abm.v90i12-s.8938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
Patellar tendon rupture after anterior cruciate ligament (ACL) reconstruction is a rare complication which usually occurs in the early postoperative period during rehabilitation. The management of open avulsions from tibial tuberosity has not been clearly defined yet. We describe a previously unreported case of traumatic and open patellar tendon avulsion from tibial tuberosity one year following ACL reconstruction in an elite football player which was successfully treated with suture anchors. (www.actabiomedica.it)
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Bortolotto C, Eshja E, Peroni C, Orlandi MA, Bizzotto N, Poggi P. 3D Printing of CT Dataset: Validation of an Open Source and Consumer-Available Workflow. J Digit Imaging 2017; 29:14-21. [PMID: 26175139 DOI: 10.1007/s10278-015-9810-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The broad availability of cheap three-dimensional (3D) printing equipment has raised the need for a thorough analysis on its effects on clinical accuracy. Our aim is to determine whether the accuracy of 3D printing process is affected by the use of a low-budget workflow based on open source software and consumer's commercially available 3D printers. A group of test objects was scanned with a 64-slice computed tomography (CT) in order to build their 3D copies. CT datasets were elaborated using a software chain based on three free and open source software. Objects were printed out with a commercially available 3D printer. Both the 3D copies and the test objects were measured using a digital professional caliper. Overall, the objects' mean absolute difference between test objects and 3D copies is 0.23 mm and the mean relative difference amounts to 0.55 %. Our results demonstrate that the accuracy of 3D printing process remains high despite the use of a low-budget workflow.
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Affiliation(s)
- Chandra Bortolotto
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy.
| | - Esmeralda Eshja
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy
| | - Caterina Peroni
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy
| | - Matteo A Orlandi
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy
| | - Nicola Bizzotto
- Azienda Ospedaliera Universitaria Polo Chirurgico Confortini, Verona, Italy
| | - Paolo Poggi
- Radiology Department, Ospedale Maggiore di Lodi, Piazzale Donatori di Sangue, Lodi, Italy
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Bizzotto N, Tami I, Santucci A, Adani R, Poggi P, Romani D, Carpeggiani G, Ferraro F, Festa S, Magnan B. 3D Printed replica of articular fractures for surgical planning and patient consent: a two years multi-centric experience. 3D Print Med 2016; 2:2. [PMID: 30050974 PMCID: PMC6036663 DOI: 10.1186/s41205-016-0006-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/04/2016] [Indexed: 12/12/2022] Open
Abstract
Background CT scanning with 3D reconstructed images are currently used to study articular fractures in orthopedic and trauma surgery. A 3D-Printer creates solid objects, starting from a 3D Computer representation. Case Description We report from two year of multicenter experience in 3D printing of articular fractures. Discussion and Evaluation During the study period, 102 patients (distal radius fractures, radial head, tibial plateau, astragalus, calcaneus, ankle, humeral head and glenoid) underwent 3D printing. The medical models were used by surgeons to appreciate the dislocation of fragments and the yielding of the articular surface. In addition, models were showed to patient as part of the acquisition of the informed consent before surgery. Conclusions 3D printing of articular fractures are innovative procedures that achieve a preoperative tangible, highly useful evaluation of the fractures to plan intervention and educate patients.
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Affiliation(s)
- Nicola Bizzotto
- Orthopedic and Hand Surgery Department, Dolomiti Sportclinic, Via Purger 181, Ortisei-Bolzano, Italy
| | - Ivan Tami
- Centro manoegomito, Clinica Ars Medica, Via Grumo 16, Gravesano - Lugano, Switzerland
| | - Attilio Santucci
- Orthopedic Department, Villa Stuart, FIFA Medical Center, Via Trionfale 5952, Roma, Italy
| | - Roberto Adani
- Hand Surgery Department, University Hospital of Modena, Viale del Pozzo 71, Modena, Italy
| | - Paolo Poggi
- Radiology Deparment, Hospital of Lodi, Via Savoia 4, Lodi, Italy
| | - Denis Romani
- Orthopedic Deparment, University Hospital of Verona, Piazzale Stefani 1, Verona, Italy
| | - Guilherme Carpeggiani
- Orthopedic Deparment, University Hospital of Verona, Piazzale Stefani 1, Verona, Italy
| | - Filippo Ferraro
- Tecs Italia Laboratory srl. Via A. Magio, 12, Bassano del Grappa, (Vi) Italy
| | - Sandro Festa
- 3DZ Industry: Via del Credito, 26/2, 3, Castelfranco Veneto, TV Italy
| | - Bruno Magnan
- Orthopedic Deparment, University Hospital of Verona, Piazzale Stefani 1, Verona, Italy
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Bizzotto N, Tami I, Tami A, Spiegel A, Romani D, Corain M, Adani R, Magnan B. 3D Printed models of distal radius fractures. Injury 2016; 47:976-8. [PMID: 26876530 DOI: 10.1016/j.injury.2016.01.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/13/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Nicola Bizzotto
- Dolomiti Sportclinic, Via Purger 181, 39046 Ortisei/St. Ulrich, Bolzano/Bozen, Italy.
| | - Ivan Tami
- Centro manoegomito, Clinica Ars Medica, Gravesano, Lugano Switzerland.
| | | | | | - Denis Romani
- Department of Orhopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Massimo Corain
- Hand Surgery Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Roberto Adani
- Hand Surgery Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Bruno Magnan
- Department of Orhopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
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Bizzotto N, Sandri A, Trivellin G, Magnan B, Micheloni G, Zamò A, Bernardi P, Sbarbati A, Regis D. Chromium-induced diffuse dermatitis with lymph node involvement resulting from Langerhans cell histiocytosis after metal-on-metal hip resurfacing. Br J Dermatol 2015; 172:1633-1636. [DOI: 10.1111/bjd.13517] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 12/01/2022]
Affiliation(s)
- N. Bizzotto
- Department of Orthopaedic and Trauma Surgery; Integrated University Hospital; 37126 Verona Italy
| | - A. Sandri
- Department of Orthopaedic and Trauma Surgery; Integrated University Hospital; 37126 Verona Italy
| | - G. Trivellin
- Department of Orthopaedic and Trauma Surgery; Integrated University Hospital; 37126 Verona Italy
| | - B. Magnan
- Department of Orthopaedic and Trauma Surgery; Integrated University Hospital; 37126 Verona Italy
| | - G.M. Micheloni
- Department of Orthopaedic and Trauma Surgery; Integrated University Hospital; 37126 Verona Italy
| | - A. Zamò
- Department of Pathology and Diagnostics; Section of Pathological Anatomy; University of Verona; Verona Italy
| | - P. Bernardi
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences; Section of Anatomy and Histology; University of Verona; Verona Italy
| | - A. Sbarbati
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences; Section of Anatomy and Histology; University of Verona; Verona Italy
| | - D. Regis
- Department of Orthopaedic and Trauma Surgery; Integrated University Hospital; 37126 Verona Italy
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Affiliation(s)
- Nicola Bizzotto
- Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
| | - Andrea Sandri
- Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
| | - Dario Regis
- Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
| | - Denis Romani
- Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
| | - Ivan Tami
- Clinica Ars Medica, Gravesano, Lugano, Switzerland
| | - Bruno Magnan
- Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
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Bizzotto N, Costanzo A, Bizzotto L, Regis D, Sandri A, Magnan B. Leap Motion Gesture Control With OsiriX in the Operating Room to Control Imaging. Surg Innov 2014; 21:655-6. [PMID: 24742500 DOI: 10.1177/1553350614528384] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Dario Regis
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Sandri
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Bruno Magnan
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Bizzotto N, Sandri A, Lavini F, Dall'Oca C, Regis D. Video in operating room: GoPro HERO3 camera on surgeon's head to film operations--a test. Surg Innov 2013; 21:338-40. [PMID: 24363275 DOI: 10.1177/1553350613513514] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicola Bizzotto
- Department of Orthopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
| | - Andrea Sandri
- Department of Orthopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
| | - Franco Lavini
- Department of Orthopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
| | - Carlo Dall'Oca
- Department of Orthopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
| | - Dario Regis
- Department of Orthopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy
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Trivellin G, Sandri A, Bizzotto N, Marino MA, Mezzari S, Sambugaro E, Regis D. Ceramic liner fatigue fracture: 3-D CT findings in a late recurrent THA dislocation. Orthopedics 2013; 36:e101-4. [PMID: 23276339 DOI: 10.3928/01477447-20121217-26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Dislocation is one of the most common complications of total hip arthroplasty (THA). To the authors' knowledge, late recurrent dislocation of a THA with a ceramic-on-ceramic coupling secondary to fatigue fracture of the ceramic liner has never been described. A 76-year-old woman with right hip osteoarthritis underwent cementless modular THA with a ceramic-on-ceramic coupling. Approximately 10 years postoperatively, she experienced right hip pain with no trauma, which resolved in 14 days. Family members reported that the patient had shown a progressive cognitive and muscular decline in the previous months. Six months later, the patient was admitted for THA dislocation, which was immediately reduced. Computed tomography revealed that the right acetabular component had a retroversion of 4° and an inclination angle of 45°. An orthopedic brace was applied, but dislocation recurred 2 days after discharge. A 3-dimensional CT reconstruction showed a fracture of the ceramic liner in the posterolateral region. The patient underwent revision surgery, and the ceramic liner breakage was confirmed. After removal of the acetabular components, a cemented polyethylene cup was implanted. The stability of the stem was verified. The existing modular neck was replaced with a chromium-cobalt neck, and a new ceramic head was applied. At 7-month follow-up, the patient had good functional recovery with no hip instability. Fatigue failure of a ceramic liner should be considered as responsible for late dislocation after ceramic-on-ceramic THA. As part of the diagnostic strategy, 3-dimensional CT reconstruction should be used to evaluate ceramic liner breakage.
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Affiliation(s)
- Giacomo Trivellin
- Department of Orthopaedic Surgery, Azienda Ospedaliera Universitaria Integrata, Polo Chirurgico Confortini, Verona, Italy.
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Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS. Predicting failure after surgical fixation of proximal humerus fractures. Injury 2011; 42:1283-8. [PMID: 21310406 DOI: 10.1016/j.injury.2011.01.017] [Citation(s) in RCA: 229] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 01/11/2011] [Accepted: 01/17/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several studies reported high failures rates after internal fixation of proximal humerus fractures. Loss of reduction and screw cut-out are the most common reasons for revision surgery. Several risk factors for failure have been described in the literature. The aim of the present study was to assess risk factors for failure after surgical fixation of unstable proximal humerus fractures in a multivariate setup. METHODS Two different surgical techniques (PHILOS locking plate and Humerusblock) were used. In the PHILOS group, every kind of postoperative relative movement between the implant and the humeral head or shaft was defined as failure. In the Humerusblock group, postoperative movement between the humeral head and the shaft in terms of angulation or translational displacement was defined as failure. The following parameters were assessed: age, gender, cancellous bone mineral density (BMD) of the humeral head, fracture type, medial metaphyseal comminution, medial metaphyseal head extension, initial angulation of the humeral head in the frontal plane, initial anteversion of the humeral head, medial hinge displacement, maximum displacement of the tuberosities with respect to the head, surgical technique, anatomic reconstruction and restoration of the medial cortical support. RESULTS The following parameters were found to have a significant influence on the failure rate: age, local BMD, anatomic reduction, and restoration of the medial cortical support. The failure rate significantly increased with the number of risk factors. CONCLUSION Preoperative assessment of the local BMD and the patients' biological age as well as intraoperative anatomic reduction and restoration of the medial cortical support are the essentials for successful surgical fixation of proximal humerus fractures. Multifragmentary fracture patterns in old patients with low local BMD are prone for fixation failure. If the surgeon is not able to achieve anatomic reduction and restoration of the medial cortical support intraoperatively in this situation, adjustments such as augmentation or primary arthroplasty should be considered.
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Affiliation(s)
- Dietmar Krappinger
- Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstraße 35, A-6020 Innsbruck, Austria.
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