Radiation-free imaging for distal hole targeting in Intramedullary nailing

Orthopedic surgeons are routinely faced with long-bone fractures. Their preferred surgical procedure for dealing with such cases is Intra-Medullary Nailing (IMN). The aforementioned surgery usually involves alignment of the fractured fragments of the long-bone followed by the insertion of a nail down its medullary canal. To prevent displacement of bone fragments, locking screws are inserted through the proximal and distal bone fragments into holes located at the proximal and distal regions of the nail. The most challenging part of IMN surgery is the location of the two distal holes of the nail after insertion, termed distal hole targeting. To find the exact location of the distal holes, several methods have been developed. The most popular method is the free-hand technique which involves the acquisition of radiographic images of the bone and nail to find the holes. The objective of this thesis is to review the current state of the art regarding distal hole targeting and investigate the possibility of developing an alternative imaging technique for finding the distal holes that will be free of ionizing radiation. More specifically, this work concentrates on characterizing the suitability of Earth’s Field Nuclear Magnetic Resonance (EFNMR) for this particular application. The characterization of this imaging method is performed through a series of experiments. The investigated solution poses several major challenges like contrast between different regions, time consumption, and detecting NMR signals in less than 19 ml water volume. The first two problems are resolved by using a contrast agent, Copper (II) Sulfate (CuSO4), which decreases the relaxation time by 6-7 times. In effect, this has decreased the experimental time. For instance, the experimental time was reduced from 8.32 min to 1.36 min. For the third challenge where the target is to detect the signal for 1.8 ml, all the proposed solutions have not worked as expected

Surgical rib fracture fixation : systematic review of effectiveness, assessment of current UK practice, and development of a core outcome set

AimTo synthesise contemporary evidence for rib fracture fixation, and thereby to fill the gaps in the knowledge required to inform a trial and provide recommendations for future study.MethodA systematic review of systematic reviews and a meta-analysis of primary research were the methods used to examine the effectiveness of rib fracture fixation. Delphi consensus methods were used to survey three international stakeholder groups so as to define a core outcome set and a consensus on indications for and timing of rib fracture fixation. A United Kingdom (UK) survey assessed the provision of rib fracture care and analysis of a UK trauma database assessed the factors that predict rib fixation and the outcomes experienced by rib fracture patients.ResultsThe systematic reviews and meta-analysis suggest that rib fracture fixation shortens the duration of mechanical ventilation, reduces critical care and hospital stay as well as overall mortality. UK clinical data suggests that rib fracture fixation improves these outcomes, and that early intervention confers an advantage over late fixation. With regard to which patients receive an intervention; fracture pattern, pulmonary contusion, admission to a major trauma centre, injury severity and age are all important predictors of undergoing surgery. A core outcome set was derived to include 23 outcomes. Consensus was achieved on 20 indications and 7 timings of surgery. Care of rib fracture patients in England and Wales is delivered in a variety of centres with different care protocols, referral pathways, lead specialties and rehabilitation services.ConclusionFurther evidence is required to assess the effectiveness of rib fracture fixation. A feasibility trial is required to understand more clearly if clinicians have equipoise, patients are willing to be randomised and whether comparative care can be delivered. A trial will need to be stratified for surgical indication and further study is required to define outcome instruments

Progenitor cells in auricular cartilage demonstrate promising cartilage regenerative potential in 3D hydrogel culture

The reconstruction of auricular deformities is a very challenging surgical procedure that could benefit from a tissue engineering approach. Nevertheless, a major obstacle is presented by the acquisition of sufficient amounts of autologous cells to create a cartilage construct the size of the human ear. Extensively expanded chondrocytes are unable to retain their phenotype, while bone marrow-derived mesenchymal stromal cells (MSC) show endochondral terminal differentiation by formation of a calcified matrix. The identification of tissue-specific progenitor cells in auricular cartilage, which can be expanded to high numbers without loss of cartilage phenotype, has great prospects for cartilage regeneration of larger constructs. This study investigates the largely unexplored potential of auricular progenitor cells for cartilage tissue engineering in 3D hydrogels