The Use of a 3D Printer in Pre-operative Planning for a Patient Requiring Acetabular Reconstructive Surgery.

INTRODUCTION: Surgical management of acetabular fractures is often highly complex, and a successful outcome depends upon an appreciation of the fracture pattern and the most appropriate approach to reduce and hold it. Currently, computed tomography (CT) images are used in conjunction with plain x-rays to identify the main fracture components and their spatial relationship to one another, and as such surgeons still have to make decisions based upon their ability to visualise the fracture from the images available. 3D printers have now become widely available and inexpensive, and can be used to rapidly produce life-size models based on CT scans of an individual patient. The availability of patient specific, accurate and detailed models of complex acetabular fractures can aid planning of surgical management on a patient specific basis. CASE REPORT: This report describes the use of a 3D printer to create a life-size model reconstruction of the pelvis of a 48 year old male patient who sustained a left sided associated both column acetabular fracture following a motorbike accident in the Sahara Desert. The model allowed visualisation of the multiple fracture fragments and their relative displacements. The tactile feedback allowed assessment of the different fracture fragments. The relative displacement of the quadrilateral plate and posterior column fragments could be assessed and the surgeon felt that these would be amenable to reduction from an ilioinguinal approach. An anatomic reduction was achieved and was held with the application of a pelvic brim plate with 2 screws lagging the posterior column/quadrilateral plate fragment. CONCLUSION: There are previous examples of 3D models being used in orthopaedic surgery through the use of rapid prototyping, however this method is usually expensive and time consuming. Advances in 3D printer technology offer surgeons a number of advantages when treating these complex fractures. With the ever-increasing economy, ease of use and speed of additive processing, the possible applications of this technology within orthopaedic surgery are numerous. Given the possible applications of this technology, and its ever increasing availability, we feel that its use can only improve patient outcomes and so should be explored further for use in orthopaedic surgery

A Feasibility Study into the Use of Three-Dimensional Printer Modelling in Acetabular Fracture Surgery

There are a number of challenges associated with the operative treatment of acetabular fractures. The approach used is often extensive, while operative time and perioperative blood loss can also be significant. With the proliferation of 3D printer technology, we present a fast and economical way to aid the operative planning of complex fractures. We used augmented stereoscopic 3D CT reconstructions to allow for an appreciation of the normal 3D anatomy of the pelvis on the fractured side and to use the models for subsequent intraoperative contouring of pelvic reconstruction plates. This leads to a reduction in the associated soft tissue trauma, reduced intraoperative time and blood loss, minimal handling of the plate, and reduced fluoroscopic screening times. We feel that the use of this technology to customize implants, plates, and the operative procedure to a patient’s unique anatomy can only lead to improved outcomes

A simple effective clean practice protocol significantly improves hand decontamination and infection control measures in the acute surgical setting.

BACKGROUND: The Hand Hygiene Liaison Group and Epic Projects (Pratt et al., J Hosp Infect 47[Suppl A], 2001) have asked specifically for further trials of educational interventions to improve hand decontamination compliance and infection control in the hospital setting. This study investigates the efficacy of a 'clean practice protocol' (CPP), derived from international guidelines, to improve compliance of infection-control practices by surgical teams in a large UK teaching hospital. METHODS: The key infection-control activities were summated to form the CPP presented here. An undisclosed infection-control audit of consultant-led ward-rounds from breast, gastrointestinal, vascular, urological, and intensive care departments was performed. The audit results were presented to the surgical teams, after which an education/awareness program was implemented. A repeat undisclosed audit was performed 3 months later. In both audits, infection-control activities were recorded together with consultation time and any patient infective complications. RESULTS: The surgical teams performed as follows in the initial audit: hand decontamination (28% of consultations), correct use of gloves (2%), instrument cleaning (0%), garment contamination (49%), and notes contamination (34%). Introduction of the CPP education program significantly improved hand decontamination to 87% (p < 0.0001), the correct use of gloves/aprons to 50% (p < 0.0001), and overall infection-control practice from 63% to 89% (p < 0.05). CONCLUSIONS: The introduction of the CPP significantly improved compliance of hand decontamination, correct usage of gloves and aprons, and overall infection-control in a large teaching hospital. The CPP is a highly effective auditing and educational tool that can be readily adapted for use in hospitals globally to monitor and improve infection-control practices

A simple effective clean practice protocol significantly improves hand decontamination and infection control measures in the acute surgical setting.

BACKGROUND: The Hand Hygiene Liaison Group and Epic Projects (Pratt et al., J Hosp Infect 47[Suppl A], 2001) have asked specifically for further trials of educational interventions to improve hand decontamination compliance and infection control in the hospital setting. This study investigates the efficacy of a 'clean practice protocol' (CPP), derived from international guidelines, to improve compliance of infection-control practices by surgical teams in a large UK teaching hospital. METHODS: The key infection-control activities were summated to form the CPP presented here. An undisclosed infection-control audit of consultant-led ward-rounds from breast, gastrointestinal, vascular, urological, and intensive care departments was performed. The audit results were presented to the surgical teams, after which an education/awareness program was implemented. A repeat undisclosed audit was performed 3 months later. In both audits, infection-control activities were recorded together with consultation time and any patient infective complications. RESULTS: The surgical teams performed as follows in the initial audit: hand decontamination (28% of consultations), correct use of gloves (2%), instrument cleaning (0%), garment contamination (49%), and notes contamination (34%). Introduction of the CPP education program significantly improved hand decontamination to 87% (p < 0.0001), the correct use of gloves/aprons to 50% (p < 0.0001), and overall infection-control practice from 63% to 89% (p < 0.05). CONCLUSIONS: The introduction of the CPP significantly improved compliance of hand decontamination, correct usage of gloves and aprons, and overall infection-control in a large teaching hospital. The CPP is a highly effective auditing and educational tool that can be readily adapted for use in hospitals globally to monitor and improve infection-control practices