ABSTRACT
One of the reasons for failure of total elbow replacement is loosening of the ulnar component. Cementing techniques are often outdated. A special small nozzle is needed for the ulnar component, when a cement gun is used. This may not always be available, or surgeons may prefer to use a syringe. We postulated that the use of a cement gun and smaller nozzle would result in improved filling of the ulnar canal. A cadaveric study was performed in which the ulnas of paired specimens were cemented with a cement gun or with a syringe. A 3D printed ulnar component was inserted and computed tomography scanning was performed on all specimens. Filling of the ulnar intramedullary canal was analysed using 3D reconstructions of the specimens. A greater degree of filling was seen by the use of the cement gun in 85.7%. Filling was 52.7% in the syringe group (25.1-78.7%), compared to 63.3% for the cement gun group (p < 0.05). The use of a small nozzle cement gun provided a significantly higher filling degree of the ulnar canal. We recommend to always use a cement gun with a specific small nozzle to cement the ulnar component in total elbow arthroplasty.
ABSTRACT
In malunion cases, restoration of anatomy is a key factor in obtaining a good functional outcome, but this can be technically very challenging.Three-dimensional printed bone models can further improve understanding of the malunion pattern.The use of three-dimensional (3D) computer planning, and the assembly of patient-specific instruments and implants, especially in complex deformities of the upper limb, allow accurate correction while reducing operation time, blood loss volume and radiation exposure during surgery.One of the major disadvantages of the 3D technique is the additional cost because it requires specific computer software, a dedicated clinical engineer, and a 3D printer.Further technical developments and clinical investigations are necessary to better define the added value and cost/benefit relationship of 3D in the treatment of complex fractures, non-unions, and malunions. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180074.
ABSTRACT
Malunion is a common complication of distal radius fractures, especially those treated conservatively. In clinical studies, a significant correlation between anatomic reduction and wrist function has been shown. Corrective osteotomy is the preferred treatment for symptomatic cases, notwithstanding the technical challenges. The use of computer simulation improves pre-operative understanding of the three-dimensional deformity. Patient-specific surgical guides, based on precise pre-operative planning, lead to superior perioperative accuracy and reproducibility. The pre-operative planning and surgical technique of distal radius corrective surgery using three-dimensional computer technology are described in detail. The preliminary results demonstrate the excellent clinical and radiographic outcome of this technique.
Subject(s)
Fractures, Malunited/surgery , Osteotomy/methods , Radius Fractures/surgery , Adolescent , Adult , Aged , Computer Simulation , Female , Fracture Fixation/methods , Fractures, Malunited/physiopathology , Hand Strength/physiology , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Patient Care Planning , Preoperative Care/methods , Prospective Studies , Radius Fractures/physiopathology , Range of Motion, Articular/physiology , Treatment Outcome , Young AdultABSTRACT
Laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the preferred surgical procedure to treat morbid obesity. It has proven its effects on excess weight loss and its positive effect on comorbidities. One of the main issues, however, is the post-operative evaluation of the bypassed gastric remnant. In literature, cancer of the excluded stomach after RYGB is rare. We describe the case of a 52-year-old woman with gastric linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass, diagnosed by means of laparoscopy and Single-Balloon enteroscopy, and it is clinical importance. Linitis plastica of the excluded stomach after RYGB is a very rare entity. This case report shows the importance of long-term post-operative follow-up, and the importance of single-balloon enteroscopy for visualization of the bypassed stomach remnant, when other investigations remain without results. This case report is only the second report of a linitis plastica in the bypassed stomach after Roux-en-Y gastric bypass.
