Computer-assisted and patient-specific 3-D planning and evaluation of a single-cut rotational osteotomy for complex long-bone deformities

Malunion after long bone fracture results in an incorrect position of the distal bone segment. This misalignment may lead to reduced function of the limb, early osteoarthritis and chronic pain. An established treatment option is a corrective osteotomy. For complex malunions, a single-cut rotational osteotomy is sometimes preferred in cases of angular deformity in three dimensions. However, planning and performing this type of osteotomy is relatively complex. This report describes a computer-assisted method for 3-D planning and realizing a single-cut rotational osteotomy with a patient-specific cutting guide for orienting the osteotomy and an angled jig for adjusting the rotation angle. The accuracy and reproducibility of the method is evaluated experimentally using plastic bones. In addition, complex rotational deformities are simulated by a computer to investigate the relation between deformity and correction parameters. The computed relation between deformity and correction parameters enables the surgeon to judge the feasibility of a single-cut rotational osteotomy. This appears possible for deformities combining axial misalignment with sufficient axial rotation. The proposed 3-D method of preoperative planning and transfer with a patient-specific cutting guide and angled jig renders the osteotomy procedure easily applicable, accurate, reproducible, and is a good alternative for complex and expensive navigation systems

Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation. Review of literature

For operative treatment of unstable trochanteric fractures two options exist: extramedullary or intramedullary stabilisation. A review of 18 international papers that compared two different treatment methods for trochanteric fractures, in prospective randomised clinical trials, is presented. In view of the overall results, routine use of intramedullary fixation devices is not to be recommended for stable trochanteric fractures. For these fractures one of the sliding hip screw systems provides a safe and simple alternative. For unstable fractures intramedullary implants are (biomechanically) superior. The review shows that clinical advantages of both treatment methods are suggested and advocated, but still remain to be demonstrated on evidence bas

Long-term functional health status of severely injured patients

Background: Studies of the consequences of major trauma have traditionally focused on mortality rates. The aims of this study were, firstly, to investigate the long-term functional health status in a large, unselected group of severely injured patients and to compare this with normative data, and secondly, to explore relations between functional health status and personal and injury characteristics. Methods: A prospective cohort study was performed at the University Medical Centre Utrecht (a level-1 trauma centre) in The Netherlands. Consecutive survivors of major trauma (ISS >= 16; > 16 years of age) were included from January 1999 until December 2000. After an average of 15 months (range 12-18 months), 335 of the 359 eligible persons (response rate 93%) participated. Demographic and injury characteristics were retrieved from a hospital-based registration system. Functional health status was measured using the 136-item Sickness impact profile (SIP). Co-morbidity was assessed at the follow-up examination using a standard list of 26 conditions. Results: Subjects were 249 men and 86 women, mean age 37.7 years, mean ISS was 24.9 (S.D. = 10.6). Almost, three quarters were traffic victims. Mean hospital stay was 25 days (S. D. = 23.4). Discharge destination was home in 70% of all subjects. At follow-up, the mean overall SIP score was 9.3 (S.D. = 10.1), which means mild to moderate disability. The mean score on the physical function dimension was 7.2 (S.D. = 9.8) and that on psychosocial function was 8.7 (S.D. = 12.0). Most problems were experienced in the categories of Work, Ambulation, Home Management, Recreation and Pastimes, and Alertness Behaviour. Scores of younger subjects deviated more strongly from the norm scores than those of elderly patients. Type of injury, especially lesions of traumatic brain and spinal cord and extremity injuries, was a predictor of both psychosocial and physical functioning after more than 1 year. The most important predictors, however, were age and co-morbidity. (C) 2006 Elsevier Ltd. All rights reserved

Computer assisted orthopaedic and trauma surgery. State of the art and future perspectives

In recent years computer technologies have become more and more integrated in surgical procedures. The potential advantages of computer assisted surgery (CAS) are: increase of accuracy of surgical interventions, less invasive operations, better planning and simulation and reduction of radiation exposure for both patient and surgeon. After introduction of CAS in neurosurgery, the clinical applications of this technique expanded also into trauma and orthopaedic surgery. The first application of this new technique in orthopaedic and trauma surgery was for placement of lumbar pedicle screws. After its introduction into spine surgery, CAS was applied in other fields of orthopaedic surgery like hip, knee and skeletal trauma surgery. In this article the technical background and the various clinical applications and future perspectives of computer assisted orthopaedic and trauma surgery are outline

External fixation with standard AO-plates: technique, indications, and results in 31 cases

The standard AO-plate was used as an external fixator in 31 patients with an infected nonunion or open fracture mainly of the upper extremity. With the use of this technique, good stability can be achieved with an inexpensive and relatively simple construction. The low profile of the frame is an advantage for the patien

Validation of fluoroscopy-based navigation in the hip region: what you see is what you get?

Fluoroscopy-based navigation systems can be used for internal fixation of intracapsular femoral neck fractures, with the object of optimizing positioning of the implant and reducing radiation exposure. With this technique, the virtual position and direction of a reamer can be simultaneously superimposed on anteroposterior (AP) and axial (AX) fluoroscopic images. However, surgeons have to rely on the accuracy of these systems, because the only intraoperative feedback on the true position of the reamer is the projection of a virtual reamer superimposed on two fluoroscopic images. The objective of this study was to evaluate the accuracy of the displayed position of the virtual reamer in relation to the true position of the instrument when using a fluoroscopy-based navigation system (medivision, Oberdorf, Switzerland). Secondary to this, the accuracy of the drill-channel measuring tool of the system was analyzed. The study was performed on 20 sawbones. To evaluate the position of the virtual reamer, an 8-mm Perspex bar was inserted in predefined drill channels in each sawbone. AP and AX fluoroscopic images of the sawbones with the Perspex bar were loaded into the workstation. The Perspex bar was then removed and exchanged for a navigated dynamic hip screw (DHS) reamer. The position of the Perspex bar in the images represented the true position of the reamer. Subsequently, the difference between the position of the virtual reamer and the Perspex bar was measured with a dedicated computer program. Drill-channel lengths measured with the system were compared with measurements obtained with a digital ruler. The mean difference in position of the Perspex bar and reamer at a predefined point was 0.90 mm (range: 0.00-3.21 mm) in 360 images. The mean difference in length measurements between the medivision system and the digital ruler was 1.00 mm (p = 0.01, SD =1.33). Reaming and measuring the screw channel of a DHS with a medivision fluoroscopy-based navigation system can be performed with an acceptable error margi