A New Automatic Process Based on Generative Design for CAD Modeling and Manufacturing of Customized Orthosis

As is widely recognized, advancements in new design and rapid prototyping techniques such as CAD modeling and 3D printing are pioneering individualized medicine, facilitating the implementation of new methodologies for creating customized orthoses. The aim of this paper is to develop a new automatic technique for producing personalized orthoses in a straightforward manner, eliminating the necessity for doctors to collaborate directly with technicians. A novel design method for creating customized wrist orthoses has been implemented, notably featuring a generative algorithm for the parametric modeling of the orthosis. To assess the efficacy of the developed algorithm, a case study was conducted involving the design and rapid prototyping of a wrist orthosis using Fused Deposition Modeling (FDM) technology. Subsequently, the developed algorithm was tested by clinicians and patients. The results obtained indicate that the implemented algorithm is user-friendly and could potentially enable non-expert users to design customized orthoses. These results introduce innovative elements of originality within the CAD modeling, offering promising solutions to the challenges associated with the design and production of customized orthoses. Future developments could consist of a better investigation regarding the parameters that influence the accuracy of the scanning and of the printing processes

Does hip osteoarthritis have a protective effect against proximal femoral fractures? A retrospective study

The inverse relationship between proximal femoral fracture incidence and hip osteoarthritis remains controversial. However, femoral neck fractures rarely occur in patients with hip osteoarthritis, suggesting a protective effect of osteoarthritis. We sought to determine if the severity of osteoarthritis influenced fracture type. We examined the radiographs of 190 consecutive patients treated at our institution after hip trauma. They were divided into three groups according to the outcome of the trauma: femoral neck fracture; trochanteric fracture; and no fracture. We then analysed the severity of osteoarthritis within these groups. No relationship between the grade of hip osteoarthritis and the presence of a proximal femoral fracture was found. However, the grade of osteoarthritis was related both to the outcome of the trauma (p<0.0001) and to the location of the fracture (p<0.0001). Patients with osteoarthritis of the hip had a three-fold increased likelihood of trochanteric fracture compared to femoral neck fracture. Osteoarthritis does not protect against proximal femoral fractures, but strongly affects the location of the fracture in the proximal femur, increasing the possibility of a trochanteric location. © 2014 Wichtig Publishing

Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature.

OBJECTIVES: to determine the role of carotid artery disease in the pathophysiology of stroke after coronary artery bypass (CABG). DESIGN: systematic review of the literature. RESULTS: the risk of stroke after CABG was 2% and remained unchanged between 1970-2000. Two-thirds occurred after day 1 and 23% died. 91% of screened CABG patients had no significant carotid disease and had a &lt;2% risk of peri-operative stroke. Stroke risk increased to 3% in predominantly asymptomatic patients with a unilateral 50-99% stenosis, 5% in those with bilateral 50-99% stenoses and 7-11% in patients with carotid occlusion. Significant predictive factors for post-CABG stroke included; (i) carotid bruit (OR 3.6, 95% CI 2.8-4.6), (ii) prior stroke/TIA (OR 3.6, 95% CI 2.7-4.9) and (iii) severe carotid stenosis/occlusion (OR 4.3, 95% CI 3.2-5.7). However, the systematic review indicated that 50% of stroke sufferers did not have significant carotid disease and 60% of territorial infarctions on CT scan/autopsy could not be attributed to carotid disease alone. CONCLUSIONS: carotid disease is an important aetiological factor in the pathophysiology of post-CABG stroke. However, even assuming that prophylactic carotid endarterectomy carried no additional risk, it could only ever prevent about 40-50% of procedural strokes