¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria / How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method

La planificación preoperatoria resulta fundamental en la cirugía de escoliosis idiopática del adolescente (EIA) para determinar los niveles a fusionar y realizar el procedimiento con mayor precisión y diligencia. Sin embargo, su realización protocolizada no está tan extendida entre los especialistas en formación. El objetivo de este artículo es describir en detalle el método de planificación preoperatoria en la EIA empleado en una unidad especializada de raquis infantil y del adolescente de un centro de referencia, así como, la logística y la táctica, apoyado en un software gratuito de medición digital semiautomática y planificación. Se muestran 3 casos representativos de diferentes deformidades vertebrales, intervenidos mediante una artrodesis vertebral posterior tras una planificación preoperatoria según el método descrito. Este método resulta muy adecuado para el cirujano en formación al aunar las ventajas de los métodos tradicionales y los más modernos, y ser sencillo, de bajo coste, accesible, reproducible y con carácter formativo.(AU)

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.(AU)

[Translated article] How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method / ¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria

La planificación preoperatoria resulta fundamental en la cirugía de escoliosis idiopática del adolescente (EIA) para determinar los niveles a fusionar y realizar el procedimiento con mayor precisión y diligencia. Sin embargo, su realización protocolizada no está tan extendida entre los especialistas en formación. El objetivo de este artículo es describir en detalle el método de planificación preoperatoria en la EIA empleado en una unidad especializada de raquis infantil y del adolescente de un centro de referencia, así como, la logística y la táctica, apoyado en un software gratuito de medición digital semiautomática y planificación. Se muestran 3 casos representativos de diferentes deformidades vertebrales, intervenidos mediante una artrodesis vertebral posterior tras una planificación preoperatoria según el método descrito. Este método resulta muy adecuado para el cirujano en formación al aunar las ventajas de los métodos tradicionales y los más modernos, y ser sencillo, de bajo coste, accesible, reproducible y con carácter formativo.(AU)

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.(AU)

[Translated article] How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method.

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialised paediatric and adolescent spine unit of a referral centre, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low-cost, accessible, reproducible and with an educational character.

How do I plan adolescent idiopathic scoliosis surgery? Systematization of a preoperative planning method. / ¿Cómo planifico una cirugía de escoliosis idiopática del adolescente? Sistematización de un método de planificación preoperatoria.

Preoperative planning is essential in adolescent idiopathic scoliosis (AIS) surgery to determine the fusion levels and to perform the procedure with greater precision and diligence. However, the protocolized performance of such planning is not as widespread among specialists in training. The aim of this article is to describe in detail the preoperative planning method for AIS used in a specialized pediatric and adolescent spine unit of a referral center, as well as the logistics and the tactics, supported a free semi-automatic digital measurement and planning software. Three representative cases of different vertebral deformities, treated by posterior spinal fusion after preoperative planning according to the method, are shown. This method is highly suitable for the trainee surgeon as it combines the advantages of traditional and modern methods, and is simple, low cost, accessible, reproducible and with an educational character.

Planificar fracturas es sencillo: desarrollo de un método básico de planificación digital basado en la técnica tradicional con lápiz y papel / Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique

Introducción: La planificación preoperatoria constituye una herramienta fundamental en el manejo de fracturas; sin embargo, su aplicación práctica dista de lo deseado, quizá debido a la ausencia de un método básico y sencillo, adaptado a los tiempos actuales. Describimos un método de planificación digital, entre lo tradicional y lo tecnológico, que conserva su esencia educativa, permite comprender la fractura e individualizar la osteosíntesis. Material y métodos: Tras el análisis inicial de la fractura y características del paciente, se realizan diferentes mediciones en las imágenes de Rx y TC con un programa de imagen médica digital. Estas imágenes se copian en un programa de presentación (Microsoft® PowerPoint o Keynote ©Apple Inc.), en el que se reproducen con el puntero del ordenador los principales fragmentos y líneas de fractura. A continuación, estos se mueven a una posición reducida y se representan gráficamente los implantes para la fijación interna junto con un guion de la estrategia quirúrgica. Resultados: Mostramos 4 casos de diferentes tipos de fracturas intervenidas mediante reducción y osteosíntesis tras una planificación preoperatoria según el método descrito. Se detallan los puntos básicos para la planificación quirúrgica, logística, táctica y los resultados radiológicos postoperatorios de cada caso. Conclusiones: A pesar del auge de programas informáticos avanzados de planificación, los métodos tradicionales con lápiz y papel siguen siendo fundamentales, más aún para el traumatólogo en formación. El método de planificación digital descrito resulta muy adecuado para este objetivo, al aunar las ventajas de ambos métodos: sencillez, accesibilidad, rapidez, bajo coste, reproducibilidad, carácter formativo y eficacia y por posibilitar la simulación, correcciones y la reutilización de casos.(AU)

Introduction: Preoperative planning constitutes a fundamental tool in the management of fractures; however, its practical application is far from the desired, perhaps due to the absence of a basic and simple method, adapted to the current times. We describe a digital planning method, halfway between the traditional and the technological, which preserves its educational essence, allows the understanding of the fracture and the individualization of the osteosynthesis. Material and methods: After the initial analysis of the fracture and the patient's characteristics, different measurements are made on X-ray and CT images with a digital medical imaging software. These images are then copied into a presentation program (Microsoft® PowerPoint or Keynote ©Apple Inc.), in which the main fragments and fracture lines are traced with the computer pointer. These are subsequently moved into a reduced position and the implants for internal fixation are graphically represented together with a guide of the surgical strategy. Results: We show 4 cases of different types of fractures operated through reduction and osteosynthesis after preoperative planning according to the described method. The basic points for the surgical planning, logistics, tactics and postoperative radiological results of each case are detailed. Conclusions: Despite rise of advanced planning software, traditional paper and pencil methods are still fundamental, even more so for the trauma surgeon in training. The digital planning method described is very appropriate for this purpose, as it combines the advantages of both methods: simplicity, accessibility, quickness, low-cost, reproducibility, educational character, efficiency and possibility of simulation, corrections and reuse of cases.(AU)

[Translated article] Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique / Planificar fracturas es sencillo: desarrollo de un método básico de planificación digital basado en la técnica tradicional con lápiz y papel

Introducción: La planificación preoperatoria constituye una herramienta fundamental en el manejo de fracturas; sin embargo, su aplicación práctica dista de lo deseado, quizá debido a la ausencia de un método básico y sencillo, adaptado a los tiempos actuales. Describimos un método de planificación digital, entre lo tradicional y lo tecnológico, que conserva su esencia educativa, permite comprender la fractura e individualizar la osteosíntesis. Material y métodos: Tras el análisis inicial de la fractura y características del paciente, se realizan diferentes mediciones en las imágenes de Rx y TC con un programa de imagen médica digital. Estas imágenes se copian en un programa de presentación (Microsoft® PowerPoint o Keynote ©Apple Inc.), en el que se reproducen con el puntero del ordenador los principales fragmentos y líneas de fractura. A continuación, estos se mueven a una posición reducida y se representan gráficamente los implantes para la fijación interna junto con un guion de la estrategia quirúrgica. Resultados: Mostramos 4 casos de diferentes tipos de fracturas intervenidas mediante reducción y osteosíntesis tras una planificación preoperatoria según el método descrito. Se detallan los puntos básicos para la planificación quirúrgica, logística, táctica y los resultados radiológicos postoperatorios de cada caso. Conclusiones: A pesar del auge de programas informáticos avanzados de planificación, los métodos tradicionales con lápiz y papel siguen siendo fundamentales, más aún para el traumatólogo en formación. El método de planificación digital descrito resulta muy adecuado para este objetivo, al aunar las ventajas de ambos métodos: sencillez, accesibilidad, rapidez, bajo coste, reproducibilidad, carácter formativo y eficacia y por posibilitar la simulación, correcciones y la reutilización de casos.(AU)

Introduction: Preoperative planning constitutes a fundamental tool in the management of fractures; however, its practical application is far from the desired, perhaps due to the absence of a basic and simple method, adapted to the current times. We describe a digital planning method, halfway between the traditional and the technological, which preserves its educational essence, allows the understanding of the fracture and the individualization of the osteosynthesis. Material and methods: After the initial analysis of the fracture and the patient's characteristics, different measurements are made on X-ray and CT images with a digital medical imaging software. These images are then copied into a presentation program (Microsoft® PowerPoint or Keynote ©Apple Inc.), in which the main fragments and fracture lines are traced with the computer pointer. These are subsequently moved into a reduced position and the implants for internal fixation are graphically represented together with a guide of the surgical strategy. Results: We show 4 cases of different types of fractures operated through reduction and osteosynthesis after preoperative planning according to the described method. The basic points for the surgical planning, logistics, tactics and postoperative radiological results of each case are detailed. Conclusions: Despite rise of advanced planning software, traditional paper and pencil methods are still fundamental, even more so for the trauma surgeon in training. The digital planning method described is very appropriate for this purpose, as it combines the advantages of both methods: simplicity, accessibility, quickness, low-cost, reproducibility, educational character, efficiency and possibility of simulation, corrections and reuse of cases.(AU)

[Translated article] Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique.

INTRODUCTION: Preoperative planning constitutes a fundamental tool in the management of fractures; however, its practical application is far from the desired, perhaps due to the absence of a basic and simple method, adapted to the current times. We describe a digital planning method, halfway the traditional and the technological, which preserves its educational essence, allows for the understanding of the fracture and the individualisation of the osteosynthesis. MATERIAL AND METHODS: After the initial analysis of the fracture and the patient's characteristics, different measurements are made on X-ray and CT images with a digital medical imaging software. These images are then copied into a presentation programme (Microsoft® PowerPoint or Keynote ©Apple Inc.), in which the main fragments and fracture lines are traced with the computer pointer. These are subsequently moved into a reduced position and the implants for internal fixation are graphically represented together with a guide of the surgical strategy. RESULTS: We show 4 cases of different types of fractures operated through reduction and osteosynthesis after preoperative planning according to the described method. The basic points for the surgical planning, logistics, tactics and postoperative radiological results of each case are detailed. CONCLUSIONS: Despite the rise of advanced planning software, traditional paper and pencil methods are still fundamental, even more so for the trauma surgeon in training. The digital planning method described is very appropriate for this purpose, as it combines the advantages of both methods: simplicity, accessibility, quickness, low cost, reproducibility, educational character, efficiency and possibility of simulation, corrections and reuse of cases.

Uso de planificación preoperatoria e impresión 3D en ortopedia y traumatología: ingresando en una nueva era / Use of preoperative planning and 3D printing in orthopedics and traumatology: entering a new era

Resumen: La impresión en tres dimensiones (3D) incluye un grupo de tecnologías por medio de las cuales es posible generar objetos tridimensionales a partir de información binaria. La ortopedia y traumatología es uno de los campos de la medicina en los que mayor impacto ha tenido la planificación 3D, en especial en trauma y ortopedia oncológica. Las aplicaciones de esta técnica incluyen el diagnóstico, planificación quirúrgica, creación de guías intraoperatorias, implantes personalizados, entrenamiento quirúrgico, impresión de ortesis y prótesis y la bioimpresión. Se han demostrado ventajas en su uso como la mayor precisión técnica, el acortamiento de tiempos quirúrgicos, disminución de pérdida sanguínea y menor exposición a rayos. Si bien el proceso está cada vez más optimizado y accesible por los avances en software y automatización, es una técnica que requiere un entrenamiento adecuado. El objetivo de esta revisión es ofrecer un acercamiento a esta tecnología y sus principios básicos.

Abstract: Three-dimensional (3D) printing includes a group of technologies by means of which it is possible to generate three-dimensional objects from binary information. Orthopedics and traumatology are fields of medicine in which 3D planning has had the greatest impact, especially in trauma and oncological orthopedics. Applications of this technique include diagnosis, surgical planning, intraoperative guide creation, custom implants, surgical training, orthotic and prosthetic impression, and bioprinting. Advantages have been demonstrated in its use, such as greater technical precision, shorter surgical times, decreased blood loss and less exposure to X-rays. Although the process is increasingly optimized and accessible due to advances in software and automation, it is a technique that requires adequate training. The objective of this review is to offer an approach to this technology and its basic principles.

Fracture planning is easy: Development of a basic method of digital planning based on the traditional pencil and paper technique. / Planificar fracturas es sencillo: desarrollo de un método básico de planificación digital basado en la técnica tradicional con lápiz y papel.

INTRODUCTION: Preoperative planning constitutes a fundamental tool in the management of fractures; however, its practical application is far from the desired, perhaps due to the absence of a basic and simple method, adapted to the current times. We describe a digital planning method, halfway between the traditional and the technological, which preserves its educational essence, allows the understanding of the fracture and the individualization of the osteosynthesis. MATERIAL AND METHODS: After the initial analysis of the fracture and the patient's characteristics, different measurements are made on X-ray and CT images with a digital medical imaging software. These images are then copied into a presentation program (Microsoft® PowerPoint or Keynote ©Apple Inc.), in which the main fragments and fracture lines are traced with the computer pointer. These are subsequently moved into a reduced position and the implants for internal fixation are graphically represented together with a guide of the surgical strategy. RESULTS: We show 4 cases of different types of fractures operated through reduction and osteosynthesis after preoperative planning according to the described method. The basic points for the surgical planning, logistics, tactics and postoperative radiological results of each case are detailed. CONCLUSIONS: Despite rise of advanced planning software, traditional paper and pencil methods are still fundamental, even more so for the trauma surgeon in training. The digital planning method described is very appropriate for this purpose, as it combines the advantages of both methods: simplicity, accessibility, quickness, low-cost, reproducibility, educational character, efficiency and possibility of simulation, corrections and reuse of cases.

Razonamiento quirúrgico en inestabilidad crónica posterolateral de rodilla / Surgical rationale in chronic posterolateral knee injury

Los pacientes con mal alineamiento en varo pueden ser difíciles de tratar cuando tienen una lesión crónica de la esquina posterolateral (EPL), resultando en doble o triple varo y subsecuentemente varus thrust durante la marcha. Una osteotomía tibial alta es un procedimiento útil y necesario particularmente en el estadío crónico. Este artículo revisa los fundamentos de la planificación preoperatoria en una lesión crónica de la EPL.

Patients with varus malalignment can be difficult to manage when they have a chronic injury to the posterolateral corner (PLC), resulting in double or triple varus and subsequent varus thrust during gait. A high tibial osteotomy is a useful and necessary procedure particularly in the chronic setting. This article reviews the basics of preoperative planning in a chronic injury of the PLC.

Management of severe valgus knee by total unconstrained arthroplasty: A comparative study with long-term follow-up. / Tratamiento de valgos severos de rodilla mediante artroplastia total no constreñida: estudio comparativo con seguimiento a largo plazo.

OBJECTIVE: To evaluate the use of unconstrained implants in the correction of large valgus deformities using total knee arthroplasty (TKA). MATERIAL AND METHOD: A total of 817 primary TKA operated between 1998 and 2006 were retrospectively assessed. 50 TKA were selected (group A) in 49 patients, with a minimum deformity of 15° of valgus, 41 cases were included. Another 50 ATR were selected (group B), with a maximum deformity of 15° of varus, finally including 44 cases in 42 patients. The same surgeon performed every operation. The minimum follow-up time was 10 years. The Knee Society Score (KS and FS), the Oxford Knee Score (OKS) and the Range of Mobility (ROM), both preoperative and postoperative at 1,.5 and 10 years, as well as radiographic evolution and complications were evaluated. RESULTS: Preoperative values of KS, FS and OKS were lower in group A (P<.0001, P<.01 and P<.05, respectively), but not ROM. Postoperatively, KS, FS, OKS and ROM were not different between the groups, neither year, nor 5, nor 10 years. There were also no radiological or complications between the two groups. DISCUSSION: The use of non-constricted implants in severe valgus was not inferior to the mild varus, implying, in addition, a saving in economic terms, with excellent postoperative results. CONCLUSIONS: Correction of severe valgus deformities can be performed with non-constrained primary implants, without obtaining worse results than those obtained in mild deformities.

Fracturas diafiarias de los miembros inferiores: planificación preoperatoria digital / Diaphyseal fractures of the lower limbs: digital preoperative planning

La planificación preoperatoria es procedimiento indispensable previo a la realización de cualquier cirugía ortopédica con el fin de obtener un resultado exitoso, sin embargo, el proceso suele ser lento y engorroso, por lo que pocos cirujanos ortopedistas lo realizan de manera rutinaria. Planteamos el desarrollo de un Software de planificación preoperatoria digital para fracturas diafisiarias de miembros inferiores que pueda ser utilizado como una herramienta confiable en la práctica diaria del cirujano ortopedista. Mediante la obtención de un archivo de imagen con la fractura que se desea planificar, a través de una cámara digital o de un sistema PACS integrado, nuestro software permitirá la realización de una planificación preoperatoria de manera precisa y rápida brindándole al usuario herramientas de registros y almacenamiento de datos, calibración y mejoramiento de imagen, medición de distancias y ángulos, segmentación del trazo de fracturas, etc. También se incluyen galería implantes ortopédicos, así como sistema de clasificación AO, todo lo anterior con el fin de generar de un reporte que incluya todos los detalles necesarios que puedan facilitar la labor del ortopedista previo al momento del acto quirúrgico

Preoperative planning is a cornerstone procedure prior any orthopaedic surgery in terms of achieving excellent results, however, the process is slow and difficult; hence,there are few orthopaedic surgeons who perform it on a day-to-day basis. We Propose the Development of a Preoperative Planning Software for the lower limbs long bone diaphiseal fractures that can serve as reliabletool for the orthopaedic surgeon. Using an image archive with the fracture site, obtained from a digital camera or a PACS integrated system, our software can perform a preoperative planning in a fast and precise manner, giving the user tools to perform data managementand storing, image calibration and rendering, distance measuring and angle calculation, fracture site segmentation, etc. Also includes a diverse orthopaedic implants gallery, and the AO comprehensive classificationsystem; all of the above made it with the final goal to generate a report who includes all the necessary details,to facilitate the surgeon duty, prior to the surgery per se.

Planificación manual preoperatoria en el reemplazo total de rodilla primario / Manual preoperative planning: primary total knee replacement

Introducción: El reemplazo total de rodilla primario es un procedimiento que presenta, en la actualidad, un índice de éxito a los 15 años del 95 por ciento. La importancia de la planificación preoperatoria en cualquier tipo de cirugía ortopédica ha sido ampliamente difundida en los últimos años. El objetivo del presente estudio es evaluar, en forma prospectiva, la utilidad, eficacia y reproducibilidad de un método de planificación preoperatoria en cirugía primaria de reemplazo total de rodilla. Materiales y métodos: Entre el 1 de enero de 2009 y el 31 de diciembre de 2009 se realizaron en nuestro centro 152 reemplazos totales de rodilla primarios (RTR). En el presente estudio se incluyeron, de forma prospectiva y consecutiva, 40 pacientes. Antes de la cirugía se realizó la planificación quirúrgica de cada caso. El proceso lo efectuaron siempre los mismos dos evaluadores. Los resultados fueron recolectados y analizados por evaluadores independientes del procedimiento quirúrgico. Resultados: Se evaluaron en forma prospectiva 40 rodillas en 36 pacientes (11 varones y 25 mujeres). En 4 pacientes se operaron ambas rodillas en forma simultánea. La edad promedio fue de 62 años. Se operaron 6 por artrosis, 2 por necrosis y 2 por AR. La predicción correcta del tamaño fue del 65 por ciento (total 26 pacientes). Se consideró aceptable una medida de error ± 1 (92,5 por ciento). Conclusiones:A partir de la presente experiencia es posible concluir que este método de planificación es sistemático, sencillo, accesible y razonablemente reproducible.

Background: Primary total knee replacement success rate is 95% at 15 years. The importance of preoperative planning in any type of orthopedic surgery has been widely reported. The purpose of this study was to evaluate the utility, accuracy and reproducibility of a simple preoperative planning method in primary total knee replacement. Methods: Between January and December 2009 we performed 152 primary total knee replacements (RTR). 40 patients were prospectively included. Each case was carefully planned before procedure. The process was always performed by the same two reviewers. The results were collected and analyzed by independent observers. Results: 40 knees in 36 patients were evaluated. 11 men, 25 women. Average age 62 years. 36 were operated on for osteoarthritis, 2 for avascular necrosis and 2 for RA. The ideal size was planned in 65% (26 patients). Accepting a + /-1 error, the size was predicted in 92.5% of the cases. Conclusions: This planning method is simple and systematic, accessible and easy to reproduce.