Digital Glomus Tumor - A Commonly Undiagnosed Cause of Finger Pain: Case Report.

Glomus tumors are rare vascular hamartomas most commonly found in the subungual region of the fingers. They present with a classic triad of paroxysmal pain, point tenderness, and cold sensitivity. The diagnosis is often missed for several years due to under recognition of this condition. A 42-year-old female presented with a several year history of pain in the middle finger when it was struck or exposed to cold. She had point tenderness on the fingernail, and increased curvature of the nail. Magnetic Resonance Imaging (MRI) revealed a 7mm subungual glomus tumor. The tumor was surgically excised via a transungual approach, resulting in complete relief of her pain. Glomus tumors are diagnosed clinically based on the presence of classic symptoms and positive provocative tests. These tests include point tenderness on palpation and pain when ice is placed on the digit. MRI imaging can be used when the diagnosis is unclear or to localize the tumor prior to surgery. Increased awareness of this condition among physicians could reduce the time to diagnosis and treatment.

Mechanical Analysis of a Novel 3D-printed External Fixator Design Versus Industry-standard External Fixators.

INTRODUCTION: External fixation is a critical component of orthopaedic fracture management and is used for various conditions, including trauma and pediatric orthopaedics. However, the availability and high cost of external fixation devices are a concern, especially in rural and developing countries. 3D printing technology has shown promise in reducing manufacturing costs and improving accessibility to external fixation devices. The purpose of this study was to evaluate the mechanical properties of a fully 3D-printed desktop external fixation device and compare the results with the mechanical properties of commonly used, clinically available external fixators. METHODS: A fully 3D printable external fixator was designed and printed in polylactic acid at two infill densities, 20% and 100%. The mechanical properties of the 3D-printed external fixators and several commercially available fixators were tested according to applicable sections of the American Society for Testing and Materials F1541 standard protocol in axial, medial-lateral, and anterior-posterior orientations. The primary outcomes measured included failure load, safe load, rigidity, and yield load. The mean differences between experimental and control groups were calculated using one-way analysis of variance and Tukey tests. RESULTS: The 20% infill 3D-printed construct showed poor performance compared with commercially available external fixators in all testing conditions and across most variables. The 100% infill 3D-printed construct was comparable with or superior to all commercially available devices in most testing conditions. The cost for printing a single 3D-printed 100% infill external fixator was $14.49 (United States Dollar). DISCUSSION: This study demonstrates that a low-cost desktop 3D printer can create an entirely 3D-printed external fixator that resists clinically relevant forces similar to medical-grade industry-standard external fixators. Therefore, there is potential for customizable and low-cost external fixators to be manufactured with desktop 3D printing for use in remote areas and other resource-constrained environments for fracture care.

Clinical Practice Update: Achilles Tendon Rupture.

Achilles tendon rupture is a common injury. It most often occurs in middle aged men who participate in recreational sports. The injury classically presents with a loud popping noise and immediate pain and weakness of the lower extremity during actions such as jumping or running. The diagnosis is made clinically, but an MRI is often obtained for confirmation of rupture and to aid in surgical planning. Treatment is either operative, with open or minimally invasive approaches, or non-operative, with functional bracing or plaster casting. Surgical treatment was preferred for much of the 20th century, but non-operative treatment has gained significant favor in the past 15 years as new evidence has demonstrated similar long-term outcomes to surgery. Neither treatment option is currently considered superior to the other in all cases. Surgery is associated with a risk for surgical complications and is, therefore, often a poor option for the elderly and those with significant comorbidities. Non-operative management is associated with an increased risk for re-injury which is often undesirable for young and highly active patients. Ultimately, the goals and priorities of each individual patient should guide the decision of which treatment option to pursue.

3D Printed Orthopaedic External Fixation Devices: A Systematic Review.

BACKGROUND: External fixators are complex, expensive orthopaedic devices used to stabilize high-energy and complex fractures of the extremities. Although the technology has advanced dramatically over the last several decades, the mechanical goals for fracture stabilization of these devices have remained unchanged. Three-dimensional (3D) printing technology has the potential to advance the practice and access to external fixation devices in orthopaedics. This publication aims to systematically review and synthesize the current literature on 3D printed external fixation devices for managing orthopaedic trauma fractures. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols were followed for this manuscript with minor exceptions. PubMed, Embase, Cochrane Review, Google Scholar, and Scopus online databases were systematically searched. Two independent reviewers screened the search results based on predetermined inclusion and exclusion criteria related to 3D printing and external fixation of fractures. RESULTS: Nine studies met the inclusion criteria. These included one mechanical testing study, two computational simulation studies, three feasibility studies, and three clinical case studies. Fixator designs and materials varied significantly between authors. Mechanical testing revealed similar strength to traditional metal external fixators. Across all clinical studies, five patients underwent definitive treatment with 3D printed external fixators. They all had satisfactory reduction and healing with no reported complications. CONCLUSIONS: The current literature on this topic is heterogeneous, with highly variable external fixator designs and testing techniques. A small and limited number of studies in the scientific literature have analyzed the use of 3D printing in this area of orthopaedic surgery. 3D printed external fixation design advancements have yielded promising results in several small clinical case studies. However, additional studies on a larger scale with standardized testing and reporting techniques are needed.

Rapid expansion of post traumatic syringomyelia following parathyroidectomy: A case report and review of the literature.

Background: Post-traumatic syringomyelia (PTS) is an uncommon complication of spinal cord injury (SCI) characterized by development of a fluid filled cavity in the spinal cord parenchyma. Presentation involves pain, weakness, and abnormal reflexes. There are few known triggers for disease progression. We present a case of symptomatic PTS that appears to have been triggered by parathyroidectomy. Case Description: A 42-year-old female with a distant history of SCI developed clinical and imaging findings consistent with acute expansion of PTS immediately following parathyroidectomy. Her symptoms included acute numbness, tingling, and pain in both arms. Magnetic resonance imaging (MRI) revealed a syrinx in the cervical and thoracic spinal cord. However, this was initially misdiagnosed as transverse myelitis and was treated as such without resolution of symptoms. Over the following 6 months, the patient experienced progressive weakness. Repeat MRI demonstrated expansion of the syrinx with new involvement of the brain stem. The patient was diagnosed with PTS and referred for outpatient neurosurgery evaluation at a tertiary facility. Treatment was delayed due to problems with housing and scheduling at the outside facility, allowing for continued worsening of her symptoms. The syrinx was surgically drained and a syringo-subarachnoid shunt was placed. Follow-up MRI confirmed correct placement of the shunt as well as resolved syrinx and decreased thecal sac compression. The procedure effectively halted symptom progression but did not resolve all symptoms completely. The patient has regained her ability to perform much of her activities of daily living but remains in a nursing home facility. Conclusion: There are currently no cases of PTS expansion following non-central nervous system surgery reported in the literature. The reason for PTS expansion following parathyroidectomy in this case is unknown but may highlight the need for extra caution when intubating or positioning a patient with a history of SCI.