Finite-element-based 3D computer modeling for personalized treatment planning in clubfoot deformity: Case report with technique description.

RATIONALE: In clubfoot deformity, planning of corrective treatment requires a complex understanding of the foot anatomy, as well as of the geometry and distribution of altered mechanical forces acting at the level of the deformed foot. At the same time, treatment success depends largely on the selection of the most appropriate shape and angles of the customized orthesis developed for foot correction. Therefore, a complex assessment of the intensity and distribution of the mechanical forces at this site is mandatory prior to initiation of any corrective therapy. PATIENT CONCERNS: We present here the case of a 3-year-old male child with clubfoot deformity, weighting 20 kg, with no other congenital malformations, in whom finite element modeling (FEM) technology associated with a newly developed technique of three-dimensional (3D) computational simulation was applied for personalized treatment planning. INTERVENTIONS: The FEM-based computational 3D simulation technique allowed selection of the corrective treatment associated with the most physiologic pattern of force distribution at the level of the foot. OUTCOMES: The proposed technique led to selection of the most appropriate therapy that successfully corrected the foot deformity. After 3D computer simulations, the elongations recorded were 2.71 cm for Achilles tendon, 1.69 cm for anterior tibialis tendon, 1.35 cm for the long flexor of the toes, and 1.69 cm for the long flexor of the hallux. The Von Mises equivalent stress distribution was σ = 4.26 MPa, not exceeding the elastic capacity of the bones, therefore the residual deformations were minimal. The customized treatment selected in this way was highly appropriate for the child, and led to complete recovery of the deformity in three months. LESSONS: This case is the first one in which FEM-based computational 3D modeling was applied for selection of treatment strategy in a child with clubfoot. The case reported here illustrates the role of advanced medical computer technology, based on complex image processing, FEM and 3D simulations, in providing an effective clinical decision support tool for personalized treatment selection in children with clubfoot deformity.

Oxidative stress in severe pulmonary trauma in critical ill patients. Antioxidant therapy in patients with multiple trauma--a review.

Multiple trauma patients require extremely good management and thus, the trauma team needs to be prepared and to be up to date with the new standards of intensive therapy. Oxidative stress and free radicals represent an extremely aggressive factor to cells, having a direct consequence upon the severity of lung inflammation. Pulmonary tissue is damaged by oxidative stress, leading to biosynthesis of mediators that exacerbate inflammation modulators. The subsequent inflammation spreads throughout the body, leading most of the time to multiple organ dysfunction and death. In this paper, we briefly present an update of biochemical effects of oxidative stress and free radical damage to the pulmonary tissue in patients in critical condition in the intensive care unit. Also, we would like to present a series of active substances that substantially reduce the aggressiveness of free radicals, increasing the chances of survival.