Computer-aided position planning of miniplates to treat facial bone defects

In this contribution, a software system for computer-aided position planning of miniplates to treat facial bone defects is proposed. The intra-operatively used bone plates have to be passively adapted on the underlying bone contours for adequate bone fragment stabilization. However, this procedure can lead to frequent intra-operatively performed material readjustments especially in complex surgical cases. Our approach is able to fit a selection of common implant models on the surgeon's desired position in a 3D computer model. This happens with respect to the surrounding anatomical structures, always including the possibility of adjusting both the direction and the position of the used osteosynthesis material. By using the proposed software, surgeons are able to pre-plan the out coming implant in its form and morphology with the aid of a computer-visualized model within a few minutes. Further, the resulting model can be stored in STL file format, the commonly used format for 3D printing. Using this technology, surgeons are able to print the virtual generated implant, or create an individually designed bending tool. This method leads to adapted osteosynthesis materials according to the surrounding anatomy and requires further a minimum amount of money and time.Comment: 19 pages, 13 Figures, 2 Table

Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

This article is made available through the Brunel Open Access Publishing Fund. Copyright @ 2014 Informa UK Ltd.Purpose: The aim of this study is to describe the clinical features of powered wheelchair users with severely disabling multiple sclerosis (MS) and explore the problematic clinical features influencing prescription. Method: Retrospective review of electronic and case note records of recipients of electric-powered indoor/outdoor powered wheelchairs (EPIOCs) attending a specialist wheelchair service between June 2007 and September 2008. Records were reviewed by a consultant in rehabilitation medicine, data systematically extracted and entered into a computer database. Further data were entered from clinical records. Data were extracted under three themes; demographic, diagnostic, clinical and wheelchair factors. Results: Records of 28 men mean age 57 (range 37–78, SD 12) years and 63 women mean age 57 (range 35–81, SD 11) years with MS were reviewed a mean of 64 (range 0–131) months after receiving their wheelchair. Twenty two comorbidities, 11 features of MS and 8 features of disability were thought to influence wheelchair prescription. Fifteen users were provided with specialised seating and 46 with tilt-in-space seats. Conclusions: Our findings suggest that people with severe MS requiring an EPIOC benefit from a holistic assessment to identify problematic clinical features that influence the prescription of the EPIOC and further medical and therapeutic interventions

Getting the best outcomes from epilepsy surgery.

Neurosurgery is an underutilized treatment that can potentially cure drug-refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug-refractory focal epilepsies. Ann Neurol 2018;83:676-690

Conservative management versus open reduction and internal fixation for mid-shaft clavicle fractures in adults - The Clavicle Trial: Study protocol for a multicentre randomized controlled trial

Background: Clavicle fractures account for around 4% of all fractures and up to 44% of fractures of the shoulder girdle. Fractures of the middle third (or mid-shaft) account for approximately 80% of all clavicle fractures. Management of this group of fractures is often challenging and the outcome can be unsatisfactory. In particular it is not clear whether surgery produces better outcomes than non-surgical management. Currently there is much variation in the use of surgery and a lack of good quality evidence to inform our decision.Methods/Design: We aim to undertake a multicentre randomised controlled trial evaluating the effectiveness and safety of conservative management versus open reduction and internal fixation for displaced mid-shaft clavicle fractures in adults. Surgical treatment will be performed using the Acumed clavicle fixation system. Conservative management will consist of immobilisation in a sling at the side in internal rotation for 6 weeks or until clinical or radiological union. We aim to recruit 300 patients. These patients will be followed-up for at least 9 months. The primary endpoint will be the rate of non-union at 3 months following treatment. Secondary endpoints will be limb function measured using the Constant-Murley Score and the Disabilities of the Arm, Shoulder and Hand (DASH) Score at 3 and 9 months post-operatively.Discussion: This article presents the protocol for a multicentre randomised controlled trial. It gives extensive details of, and the basis for, the chosen methods, and describes the key measures taken to avoid bias and to ensure validity.Trial Registration: United Kingdom Clinical Research Network ID: 8665. The date of registration of the trial is 07/09/2006. The date the first patient was recruited is 18/12/2007. © 2011 Longo et al; licensee BioMed Central Ltd

Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519

Optimization of craniosynostosis surgery: virtual planning, intraoperative 3D photography and surgical navigation

Mención Internacional en el título de doctorCraniosynostosis is a congenital defect defined as the premature fusion of one or more cranial sutures. This fusion leads to growth restriction and deformation of the cranium, caused by compensatory expansion parallel to the fused sutures. Surgical correction is the preferred treatment in most cases to excise the fused sutures and to normalize cranial shape. Although multiple technological advancements have arisen in the surgical management of craniosynostosis, interventional planning and surgical correction are still highly dependent on the subjective assessment and artistic judgment of craniofacial surgeons. Therefore, there is a high variability in individual surgeon performance and, thus, in the surgical outcomes. The main objective of this thesis was to explore different approaches to improve the surgical management of craniosynostosis by reducing subjectivity in all stages of the process, from the preoperative virtual planning phase to the intraoperative performance. First, we developed a novel framework for automatic planning of craniosynostosis surgery that enables: calculating a patient-specific normative reference shape to target, estimating optimal bone fragments for remodeling, and computing the most appropriate configuration of fragments in order to achieve the desired target cranial shape. Our results showed that automatic plans were accurate and achieved adequate overcorrection with respect to normative morphology. Surgeons’ feedback indicated that the integration of this technology could increase the accuracy and reduce the duration of the preoperative planning phase. Second, we validated the use of hand-held 3D photography for intraoperative evaluation of the surgical outcome. The accuracy of this technology for 3D modeling and morphology quantification was evaluated using computed tomography imaging as gold-standard. Our results demonstrated that 3D photography could be used to perform accurate 3D reconstructions of the anatomy during surgical interventions and to measure morphological metrics to provide feedback to the surgical team. This technology presents a valuable alternative to computed tomography imaging and can be easily integrated into the current surgical workflow to assist during the intervention. Also, we developed an intraoperative navigation system to provide real-time guidance during craniosynostosis surgeries. This system, based on optical tracking, enables to record the positions of remodeled bone fragments and compare them with the target virtual surgical plan. Our navigation system is based on patient-specific surgical guides, which fit into the patient’s anatomy, to perform patient-to-image registration. In addition, our workflow does not rely on patient’s head immobilization or invasive attachment of dynamic reference frames. After testing our system in five craniosynostosis surgeries, our results demonstrated a high navigation accuracy and optimal surgical outcomes in all cases. Furthermore, the use of navigation did not substantially increase the operative time. Finally, we investigated the use of augmented reality technology as an alternative to navigation for surgical guidance in craniosynostosis surgery. We developed an augmented reality application to visualize the virtual surgical plan overlaid on the surgical field, indicating the predefined osteotomy locations and target bone fragment positions. Our results demonstrated that augmented reality provides sub-millimetric accuracy when guiding both osteotomy and remodeling phases during open cranial vault remodeling. Surgeons’ feedback indicated that this technology could be integrated into the current surgical workflow for the treatment of craniosynostosis. To conclude, in this thesis we evaluated multiple technological advancements to improve the surgical management of craniosynostosis. The integration of these developments into the surgical workflow of craniosynostosis will positively impact the surgical outcomes, increase the efficiency of surgical interventions, and reduce the variability between surgeons and institutions.Programa de Doctorado en Ciencia y Tecnología Biomédica por la Universidad Carlos III de MadridPresidente: Norberto Antonio Malpica González.- Secretario: María Arrate Muñoz Barrutia.- Vocal: Tamas Ung

A Survey on Artificial Intelligence Techniques for Biomedical Image Analysis in Skeleton-Based Forensic Human Identification

This paper represents the first survey on the application of AI techniques for the analysis of biomedical images with forensic human identification purposes. Human identification is of great relevance in today’s society and, in particular, in medico-legal contexts. As consequence, all technological advances that are introduced in this field can contribute to the increasing necessity for accurate and robust tools that allow for establishing and verifying human identity. We first describe the importance and applicability of forensic anthropology in many identification scenarios. Later, we present the main trends related to the application of computer vision, machine learning and soft computing techniques to the estimation of the biological profile, the identification through comparative radiography and craniofacial superimposition, traumatism and pathology analysis, as well as facial reconstruction. The potentialities and limitations of the employed approaches are described, and we conclude with a discussion about methodological issues and future research.Spanish Ministry of Science, Innovation and UniversitiesEuropean Union (EU) PGC2018-101216-B-I00Regional Government of Andalusia under grant EXAISFI P18-FR-4262Instituto de Salud Carlos IIIEuropean Union (EU) DTS18/00136European Commission H2020-MSCA-IF-2016 through the Skeleton-ID Marie Curie Individual Fellowship 746592Spanish Ministry of Science, Innovation and Universities-CDTI, Neotec program 2019 EXP-00122609/SNEO-20191236European Union (EU)Xunta de Galicia ED431G 2019/01European Union (EU) RTI2018-095894-B-I0