Fabrication of low-cost artificial Tibia Bone using Polyurethane rigid foam and epoxy resin for orthopedic surgical skills training

Introduction@#Skills training using artificial bones became more critical in response to the Orthopedic surgical training restriction caused by the COVID-19 pandemic. To cut the expenses of buying commercial artificial bones, the Ilizarov Limb Reconstruction Service has decided to fabricate its artificial bones for surgical skills training. @*Objective@#To determine if resin-coated polyurethane (PU) rigid foam is a suitable, low-cost alternative to commercial artificial bone. @*Methods@#Tibiae were fabricated using PU rigid foam coated with epoxy resins. Three randomly selected fabricated tibia, and one standard artificial tibia was subjected to drilling with drill bits and K-wires. The time to penetration of one cortex of the three segments of the tibiae was recorded in seconds. An actual circular external fixator was applied. The actual cost of production was calculated. @*Results@#Each fabricated tibia costs ₱456.93. The fabricated tibiae mean time to penetration was 2.15s and 3.37s using drill bits and K-wires. The commercial artificial bone mean time to penetration was 3.41s and 3.57s with drill bits and K-wires. The fabricated tibia was able to withstand the application of a circular external fixator and corticotomy. @*Conclusion@#The fabricated tibia is a suitable and more affordable simulation model for surgical skills training.

A prototype continuous passive motion device compatible with the hinged elbow ilizarov fixator

BACKGROUND@#Joint stiffness is a frequent concern in trauma or surgery of the elbow joint. Early resumption of elbow joint motion is said to limit the complication of stiffness. The Hinged Elbow Ilizarov Fixator has been reported to be useful in the management of elbow dislocations. However, early range of motion is not consistent in these cases since elbow movement were done only through patient-initiated exercises. The use of a continuous passive motion (CPM) device can potentially resolve this issue. However, presently available continuous passive motion devices for the elbow are not compatible with the Hinged Elbow Ilizarov Fixator.@*OBJECTIVE@#The objective of the study is to determine the feasibility of using a specially designed continuous passive motion device on a Hinged Elbow Ilizarov Fixator as applied in a cadaver simulation model.@*METHODS@#A Hinged Elbow Ilizarov Fixator was fixed in the elbow of a Thiel-preserved cadaver. The specially designed continuous passive motion device was applied.@*RESULTS@#Test run showed sufficient continuous flexion-extension motion not accompanied by dislocation, subluxation, or disruption of the elbow joint. A point of stress in the current prototype was noted at the motor-screw interface. Limitations in programming and control were also noted.@*CONCLUSION@#A continuous passive machine adopted to the Hinged Ilizarov Fixator is a viable device. Further improvement in the design of the motor-screw interface needs to be made. Further improvement in programming and control are needed. Likewise, study on the safety and service life of the CPM device needs to be done.

Limb Deformity Correction Using the Ortho SUV Frame

@#BACKGROUND AND OBJECTIVE: Limb deformity in terms of length discrepancy, angular and rotational deformities are amenable to correction using the Ilizarov method. The corrections can be achieved using the Ortho SUV Frame (OSF), a computer assisted six axes external fixator. Previous studies have reported easier and more accurate deformity correction. In this study, we report on our initial experience and treatment outcomes in using this system. MATERIALS AND METHODS: This study is a case series of patients where the Ilizarov circular frame was applied and which the deformity correction was carried out using the OSF. Success and accuracy in correction, length of time to correct, number of revisions needed and complications were gathered from a review of medical records. RESULTS: Thirty limbs in twenty nine cases were included in this report. Seventy seven percent (23/30) of the deformities were due to previous trauma. The rest were due to Blounts, infection and tumor. Correction in eighty seven percent (26/30) were achieved using the turning schedule provided by the Ortho SUV application software. Three cases required surgical removal of soft tissue interposition before further correction using the software was achieved. One case with posterior translation underwent closed manipulation. In the end all planned deformity corrections were achieved. Complications included pin tract swelling and erythema in 13% and all resolved either with oral antibiotics alone or combined with surgical release of pin sites under local anesthesia. CONCLUSION: The Ortho SUV is an effective tool to carry out deformity corrections using the Ilizarov method.

Reliability of the Penny and Beit CURE Radiologic Classifications of Pediatric Patients with Chronic Hematogenous Osteomyelitis in the Philippine General Hospital

@#OBJECTIVE: This study aimed to evaluate the inter- and intraobserver reliability of the Penny and Beit CURE radiologic classifications of pediatric patients with Chronic Hematogenous Osteomyelitis (CHOM) in the Philippine General Hospital (PGH). METHODS: Thirty-four pre-operative radiographs of PGH pediatric patients with CHOM were classified by seven orthopedic surgeons using both Penny and Beit CURE Classification systems. Two sets of radiographs were sent to the surgeons twice, four weeks apart, to classify. The Fleiss and Cohen κ statistics were used to determine inter- and intraobserver reliabilities, respectively. RESULTS: The Penny Classification had a slight to fair interobserver reliability (Fleiss κ = 0.17 and 0.24) and a fair intraobserver reliability (Cohen κ =0.35) with a 49.58% average intraobserver agreement. The interobserver reliability when including all Beit CURE classification subtypes was fair (κ = 0.28 and 0.31). This improved to moderate (κ = 0.41 and 0.54) when using only the four main types of the Beit CURE classification with a 77.31% intraobserver agreement. CONCLUSION: The Beit CURE classification for pediatric CHOM had higher inter- and intraobserver agreement rates than the Penny classification. Further improvement in reliability can be made by combining B2 and B3 subtypes under the Beit CURE classification.