Use of Three-dimensional Printing for Tibial Pilon Fracture Diagnosis and Treatment.

Objective To evaluate whether three-dimensional (3D) printing increases agreement in the classification of tibial pilon fractures. Methods Orthopedists and traumatologists reviewed radiographs, computed tomography scans with 3D reconstruction, and prototyping 3D printing, and classified the fractures based on the Rüedi-Allgöwer and Arbeitsgemeinschaft für Osteosynthesefragen (AO, Association for the Study of Internal Fixation) Foundation/Orthopedic Trauma Association (AO/OTA) classification systems. Next, data evaluation used Kappa agreement coefficients. Results The use of the 3D model did not improve agreement for tibial pilon fractures regarding the treatment proposed by the groups. Regarding the classification systems, the agreement only improved concerning the AO/OTA classification when the 3D model was used in the assessment by the foot and ankle specialists. Conclusion Although 3D printing is statistically relevant for surgeons specializing in foot and ankle, its values remain lower than optimal.

Metabolic syndrome and its components in adult hypopituitary patients.

PURPOSE: To evaluate the prevalence of metabolic syndrome (MetS) and its components in adult hypopituitary patients. PATIENTS AND METHODS: Retrospective, cross-sectional analysis of a cohort of hypopituitary adult patients followed in a single reference center for pituitary diseases. MetS was defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Patients with 18 years or older, presenting two or more anterior pituitary deficiencies associated or not with diabetes insipidus (DI), were included, while patients with hypopituitarism due to Acromegaly or Cushing's disease were excluded. RESULTS: We studied 99 hypopituitary patients (52 males, mean age 50.1 ± 16.3 years, mean age at diagnosis 33.7 ± 17.6 years) who have been followed for a mean time of 15.9 ± 10.1 years. Hypothalamic-pituitary tumors and non-tumoral etiologies were observed in 53.4% and 46.6% of the cases, respectively. FSH/LH, GH, TSH, ACTH deficiency and DI was present in 99%, 98.6%, 96%, 81.8%, and 23.2%, respectively. The prevalence of MetS was 39.4% and was significantly higher in patients older than 50 years (p = 0.02), overweight/obese (p < 0.001), with hypopituitarism diagnosed in adult life (p = 0.02), who did not replace GH (p = 0.004) and in smokers (p = 0.007). In the logistic regression model, body mass index (BMI) and GH replacement were significantly associated with the presence of MetS. Reduced HDL cholesterol was the most prevalent component of MetS in hypopituitary patients. CONCLUSIONS: MetS is a common finding in adult hypopituitary patients, which is mainly influenced by increased BMI and untreated GH deficiency. Trial Registration number (Plataforma Brasil): CAAE 51008815.2.0000.0096 (May 31, 2017) .