Final report on the evaluation of RRM/CRRM algorithms

Deliverable public del projecte EVERESTThis deliverable provides a definition and a complete evaluation of the RRM/CRRM algorithms selected in D11 and D15, and evolved and refined on an iterative process. The evaluation will be carried out by means of simulations using the simulators provided at D07, and D14.Preprin

Precision and safety of Multilevel Cervical Transpedicular Screw Fixation with 3D Patient-Specific Guides; A Cadaveric Study

The aim is to design a patient-specific instrument (PSI) for multilevel cervical pedicle screw placement from C2 to C7, as well as verifying reliability and reproducibility. Computed tomography (CT) scans were obtained from 7 cadaveric cervical spines. Using Mimics software, semiautomatic segmentation was performed for each cervical spine, designing a 3D cervical spine bone model in order to plan transpedicular screw fixation. A PSI was designed according to the previously cited with two cannulated chimneys to guide the drill. The guides were 3D printed and surgeries performed at the laboratory. Postoperative scans were obtained to study screw placement. Sixty-eight transpedicular screws were available for study. 61.8% of all screws were within the pedicle or partially breached <4 mm. No differences were observed between cervical levels. None of these screws had neurovascular injury. Of the 27 screws with a grade 3 (screw outside the pedicle; 39.7%), only 2 had perforation of the transverse foramen and none of them would have caused a neural injury. In conclusion, multilevel PSI for cervical pedicle screw is a promising technology that despite showing improvements regarding free-hand technique requires further studies to improve the positioning of the PSI and their accuracy

Free Neurovascular Latissimus Dorsi Muscle Transplantation for Reconstruction of Hip Abductors

Supplemental Digital Content is available in the text. Resection of tumors affecting the hip abductors can cause significant decrease in muscle strength and may lead to abnormal gait and poor function. We present a case report showing full functional recovery after resection of a synovial sarcoma affecting the right gluteus medius and minimus muscles with reconstruction free neurovascular latissimus dorsi muscle transplantation. The latissimus dorsi muscle was harvested following standard technique and fixed to the ilium and the greater trochanter. Receptor vessels were end-to-end anastomosed to the subscapular vessels followed by an end-to-end epineural suture between the superior gluteal nerve and the thoracodorsal nerve. A year after surgery, there is no evidence of recurrent disease; electromyographic analysis shows complete reinnervation of the latissimus dorsi muscle flap, and the patient has achieved full functional recovery. Free functional latisimus dorsi transfer could be considered as a viable reconstruction technique after hip abductors resection in tumor surgery

ORIF Assisted by Open Subtalar Small Joint Arthroscopy for Intra-articular Displaced Calcaneus Fractures

Nanoscope; Calcaneal fracture; Small joint arthroscopyNanoscopio; Fractura de calcáneo; Artroscopia de pequeñas articulacionesNanoscopi; Fractura de calcani; Artroscòpia de petites articulacion

Ankle Injuries Associated with Basketball Practice: Current Situation and Literature Review

Introduction: Basketball is one of the most practiced sports in the world. Traditionally, it has been considered that it is a sport of low physical contact, and that sports injuries occur less frequently than in other sports such as football or rugby. However, we have seen the appearance of several recent studies that count basketball as one of the sports with higher injury rates, and among them, especially ankle injuries. Material and methods: In our study, we performed a literature review on ankle injuries associated with basketball practice. We selected the relevant articles of Pubmed using the keywords “basketball”, “ankle” (ankle) and “injury”, published between 2006 and 2015. We limited the selection to those studies that dealt with injuries associated with basketball, whether descriptive or analytical, without taking into account the populations that the authors studied or whether in addition to basketball, other sports were included. The exclusion criteria were as follows: experimental studies, case reports and then whose text is impossible to obtain. Results and discussion: Initially 114 studies were obtained, of which 13 were selected applying the previously mentioned criteria. They observed the incidence of ankle injuries during basketball practice in different population groups, different levels of practice (professional and amateur) and during different periods of time. Among professional athletes, we could observe that ankle sprains account for more than 20% of the injuries suffered by athletes that they are accountable for almost 10% of the matches that a professional player loses because of an injury, and that only about half of them take place during a game, which increases the importance of injuries that occur during practice. When it comes to amateur level basketball, we can observe in several studies that, while the male population is more prone to need medical assistance for ankle injuries during the practice of this sport (from 18.3% of injuries associated with basketball, up to 52%, according to the series), the female population has a greater predisposition for knee injuries (63% of injuries associated with basketball for only 21% of ankle injuries in some jobs). Conclusions: After analysing the recent literature, we could draw among others the following conclusions: basketball is a sport which is closely linked to the appearance of ankle injuries; the most prevalent ankle injury is sprain; the incidence of injuries increases the higher the level of practice, being maximum in professionals; these injuries have an evident impact on the athlete’s usual sports and extrasports practice; and gender may have an influence on the joint affected by basketball related injuries. Basketball is a rising sport at the moment, with a great social and economic impact in the world of today. Its practice is becoming more frequent, and with it the incidence of injuries associated with it, especially those occurring in the ankle joint. It is therefore expected that in the coming years, we are likely to observe the appearance of more works in the literature that confirm this fact, as well as advances in the treatment and recovery of the athletes who suffer them

Ski Lesions Around the Knee: A Literature Review

Ski is a popular sports practiced worldwide although it is considered a high-risk sports with high incidence of injuries. A common place for injuries is the knee, with a wide range from knee sprains to complex ligamentous injuries to fractures. In this chapter, we made a search in PubMed using the words “knee” and “ski.” Later, we selected those articles according to the inclusion criteria. When reviewing the literature, we found that the most common place for a ski-related injury is the knee, with knee sprains and ACL lesions being the most common diagnosis in the latter years with a decreasing incidence of tibia fractures. We could also analyze the risk factors different authors have found, for professional athletes and for recreational skiers. In conclusion, the ACL lesion in the skier presents a high incidence, which suggests an effort should be made to prevent it

Impact of Diabetic Foot Multidisciplinary Unit on Incidence of Lower-Extremity Amputations by Diabetic Foot

Diabetis; Diabetic foot ulcer; Lower-extremity amputationsDiabetes; Úlcera del pie diabético; Amputaciones de extremidades inferioresDiabetis; Úlcera del peu diabètic; Amputacions d'extremitats inferiorsBackground: One of the most devastating complications of diabetes is diabetes-related foot disease (DFD), which is a priority for public health systems. The 2016–2020 Catalonia Health Plan aimed to reduce the incidence of total and major lower-extremity amputations (LEAs) due to DFD by 10% in the population aged 45–74 years. The aim of the present study was to compare the incidence of LEA-DFD 5 years before and after the creation of the Diabetic Foot Multidisciplinary Unit at our Hospital. Methods: We prospectively collected all cases of LEA-DFD performed at Vall d’Hebron University Hospital from 1 January 2016 to 31 December 2020. Cases of LEA-DFD performed from 1 January 2011 to 31 December 2015 were retrospectively reviewed. The incidence of LEA-DFD between these periods was compared. Results: A total of 457 LEAs due to DFD were performed in 316 patients. We observed a reduction of 27.9% [CI: 23.7–32.1%] in the incidence of total LEA in the 2016–2020 period in comparison with the period 2011–2016 (0.8 ± 0.1 vs. 1.1 ± 0.3 per 10.000 inhabitants/year, p < 0.001), as well as a reduction of 49.3% [CI: 44.6–53.9%] in the incidence of major LEA-DFD (0.15 ± 0.1 vs. 0.30 ± 0.1 per 10.000 inhabitants/year, p < 0.001). Conclusions: The implementation of a Diabetic Foot Multidisciplinary Unit resulted in a significant reduction in the rate of amputations due to DFD in the population with diabetes in North Barcelona

Precisión de las guías personalizadas en cirugía ortopédica y traumatología

L'ús de les guies personalitzades en 3D ha estat descrit prèviament per al seu ús en artroplàstia total de genoll, fractures complexes, cirurgia de columna o tumors. Tant la cirurgia tumoral de pelvis com la cirurgia cervical és complexa a causa de la complexitat geomètrica de la localització i la proximitat d'estructures vitals. En el cas dels tumors pèlvics, la importància d'aconseguir marges lliures de tumor però preservant la major reserva òssia possible per a una futura reconstrucció afegeixen dificultat a l'hora de la cirurgia. En la cirurgia de columna cervical, donada la proximitat al cordó medul·lar i grans vasos, la correcta col·locació dels cargols cobra especial importància Objectius: Avaluar l'eficàcia i seguretat de guies personalitzades en 3D per tumors pelvians en model cadavèric. També s'avaluarà l'eficàcia i seguretat de les guies personalitzades 3D per a la col·locació de cargols pediculars cervicals des C2 a C7 en model cadavèric. Mètodes: s'han dissenyat dos estudis amb models cadavèriques. En el primer es dissenyaran guies 3D per guiar la serra a l'hora de realitzar osteotomies pèlviques, simulant els tumors pelvians més comuns. El segon estudi es realitzarà amb 5 models, dissenyant unes guies personalitzades per guiar la broca i col·locar cargols pediculars des C2 a C7. Es realitzarà un TC tant abans de la cirurgia (per dissenyar les guies) com després per avaluar l'eficàcia de les osteotomies i la correcta col·locació dels cargols pedicularsEl uso de las guías personalizadas en 3D ha sido descrito previamente para su uso en artroplastia total de rodilla, fracturas complejas, cirugía de columna o tumores. Tanto la cirugía tumoral de pelvis como la cirugía cervical es compleja debido a la complejidad geométrica de la localización y la cercanía de estructuras vitales. En el caso de los tumores pélvicos, la importancia de conseguir márgenes libres de tumor pero preservando la mayor reserva ósea posible para una futura reconstrucción añaden dificultad a la hora de la cirugía. En la cirugía de columna cervical, dada la proximidad al cordón medular y grandes vasos, la correcta colocación de los tornillos cobra especial importancia Objetivos: Evaluar la eficacia y seguridad de guías personalizadas en 3D para tumores pélvicos en modelo cadavérico. También se evaluará la eficacia y seguridad de las guías personalizadas 3D para la colocación de tornillos pediculares cervicales desde C2 a C7 en modelo cadavérico. Métodos: se han diseñado dos estudios con modelos cadavéricos. En el primero se diseñarán guías 3D para guiar la sierra a la hora de realizar osteotomías pélvicas, simulando los tumores pélvicos más comunes. El segundo estudio se realizará con 5 modelos, diseñando unas guías personalizadas para guiar la broca y colocar tornillos pediculares desde C2 a C7. Se realizará un TC tanto antes de la cirugía (para diseñar las guías) como después para evaluar la eficacia de las osteotomías y la correcta colocación de los tornillos pedicularesThe use of personalized 3D guides has been previously described for total knee arthroplasty, complex fractures, spine surgery or tumors. Both tumoral pelvic surgery and cervical surgery are complex due to the geometric complexity of the location and proximity of vital structures. In the case of pelvic tumors, the importance of achieving tumor-free margins but preserving the greatest possible bone reserve for future reconstruction adds difficulty to the surgery. In cervical spine surgery, given the proximity to the medullary cord and large vessels, the correct placement of the screws is especially important Objectives: To evaluate the efficacy and safety of personalized 3D guides for pelvic tumors in a cadaveric model. The efficacy and safety of the personalized 3D guides for the placement of cervical pedicle screws from C2 to C7 in cadaver model will also be evaluated. Methods: two studies with cadaveric models have been designed. In the first one, 3D guides will be designed to guide the saw when performing pelvic osteotomies, simulating the most common pelvic tumors. The second study will be carried out with 5 models, designing customized guides to guide the drill and place pedicle screws from C2 to C7. A CT scan will be performed both before surgery (to design the guides) and after to evaluate the effectiveness of osteotomies and the correct placement of pedicle screwsUniversitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològique