Planejamento pré-operatório de correção de deformidades supramaleolares através de impressão 3D / Preoperative planning of supramaleolar deformities correction through 3D printing

Planejamento pré-operatório de correção de deformidades supramaleolares através de impressão 3DRELATO DE CASOModelos impressos em 3D têm sido explorados profundamente no campo médico, destacando-se como importante ferramenta de auxílio para planejamento cirúrgico. Os autores apresentam relato de caso de um paciente, com artrose pós-traumática do tornozelo direito, submetido a osteotomia supramaleolar, em cunha de fechamento medial. Esta cirurgia foi realizada após planejamento operatório por impressão 3D, o que pode demonstrar reprodutibilidade deste método. (AU)

3D printed models have been explored deeply in the medical field, standing out as an important aid tool for surgical planning. The authors present a case report of a patient with post-traumatic arthrosis of the right ankle, who underwent supramaleolar osteotomy, using a medial closure wedge. This surgery was performed after operative planning by 3D printing, which can demonstrate the reproducibility of this method. (AU)

Reconstruction of Acetabular Defects With Impaction Grafting in Primary Cemented Total Hip Arthroplasty Produces Favorable Results: Clinical and Radiographic Outcomes Over 6.4 Years on Average.

BACKGROUND: Cemented primary total hip arthroplasty (THA) associated with acetabular reconstruction (AR) involving impacted bone grafting has been employed successfully in the revision of cavitary defects but the results are reportedly less predictable for segmental defects. The objective of the study is to evaluate the clinical and radiographic results of patients who had presented cavitary, segmental, and combined acetabular defects and received THA/AR involving impacted morselized cancellous bone autografts followed by rigorous postoperative management. METHODS: Clinical outcomes were assessed retrospectively of 154 patients who had been submitted to 169 THA/AR procedures performed by a single surgeon over a 15-year period. The Harris Hip Score system was applied to 103 patients, and the degree of acetabular migration was determined from radiograph images of 91 AR procedures, of which 40 were segmental/combined and 51 were cavitary reconstructions. RESULTS: The frequency of aseptic acetabular loosening was 3% while that of thromboembolic events was 4.1%. According to Harris Hip Score, 87.4% of outcomes were classified as excellent/good after an average follow-up period of 6.4 years irrespective of the type of acetabular defect. Horizontal and/or vertical acetabular migrations and changes in angular tilt were observed in all ARs, although the minor movements detected did not undermine the structural stability of the reconstructions or the functional capacity of patients. CONCLUSION: The described THA/AR technique can be used effectively in the reconstruction of segmental/combined and cavitary acetabular defects. The success of the technique as applied to segmental/combined defects was attributed in part to the rigorous rehabilitation protocol with temporary postoperative weight-bearing restriction.

Radiographic evaluation of the glenohumeral joint space in patients undergoing arthroscopic shoulder surgery in the beach-chair position.

BACKGROUND: Shoulder arthroscopy can be performed with the patient in the lateral decubitus or beach-chair position, but in both cases, glenohumeral (GH) joint spaces must be increased to improve visualization and allow access of the optical instrument. The aim of this study was to determine the effects of limb setup and longitudinal traction on the opening of the GH space with patients placed in the beach-chair (dorsal decubitus) position. METHODS: GH spaces at 3 test points corresponding to the anatomic locations of Bankart lesions were determined indirectly from radiographic images obtained from 67 patients presenting shoulder pathology with an indication for arthroscopic surgery. Measurements were made with the operative limb in neutral rotation and positioned in relation to the coronal plane in adduction, 45° of abduction, or adduction with an axillary spacer, in each case with and without longitudinal traction. RESULTS: GH spaces were optimized at 2 of 3 test points when the operative limb was positioned in adduction or neutral rotation and manual longitudinal traction was applied with or without a polystyrene spacer placed under the axilla, but use of the spacer was essential to maximize the GH space at all 3 locations. In contrast, 45° of abduction proved to be the least appropriate position because it afforded the smallest GH space values with or without traction. CONCLUSION: Appropriate positioning of the patient on the operating table is a critical aspect of shoulder arthroscopy. Radiographic images revealed that adducted upper-limb traction with the use of an axillary spacer in patients in the beach-chair position generates a significant increase in the GH space in the lower half of the glenoid cavity, thereby facilitating visualization and access of the optical equipment to the GH compartments.

The use of a joystick technique facilitates closed reduction and percutaneous fixation of multidirectionally unstable supracondylar humeral fractures in children.

BACKGROUND: Multidirectionally unstable supracondylar fracture of the distal humerus presents with severe instability in both flexion and extension. Closed reduction and percutaneous fixation is challenging and may not be obtained by the traditional reduction maneuver. METHODS: We retrospectively evaluated 8 children (4 boys and 4 girls) with a mean age at presentation of 7.6 years (range, 5.3 to 10.9 y) who underwent closed reduction and percutaneous fixation using a joystick technique for the treatment of multidirectionally unstable supracondylar fractures. Clinical and functional results were assessed by the system described by Flynn. Radiographs at last follow-up were compared with those taken immediate after pinning as well as with normal contralateral elbow radiographs at final follow-up. RESULTS: After an average follow-up of 14.5 months (range, 12 to 24 mo), there was no difference between the injured upper extremity and the contralateral side according to cosmetic, functional, and radiographic evaluation. There was no complication such as pin-site infection, loss of fixation, malunion, cubitus varus, iatrogenic nerve injury, or need for further surgery. CONCLUSIONS: The joystick technique is a safe and effective method that can avoid aggressive and frustrating attempts of closed reduction and further open reduction of multidirectionally unstable supracondylar fractures of the humerus in children. LEVEL OF EVIDENCE: Level IV-case series.