Partial Versus Total Trapeziectomy With Interposition Arthroplasty for Trapeziometacarpal Osteoarthritis Grade II to III Eaton-Littler : A Clinical Trial

Total trapeziectomy is the most widely used technique to treat isolated thumb trapeziometacarpal joint osteoarthritis. However, this technique has been associated with proximal migration of the thumb metacarpal, which has led some physicians to consider partial trapeziectomy as a valid alternative. The purpose of this study was to assess whether partial trapeziectomy improves final key pinch strength compared with total trapeziectomy. We randomized 34 patients with basal thumb osteoarthritis into 2 groups to undergo partial or total trapeziectomy with interposition arthroplasty. Key pinch strength at 12 months was the primary outcome measure. Other variables measured included trapezial space height, range of motion, grip strength, change in key pinch strength, patient-reported outcome measures, and pain. No difference between groups was detected regarding final pinch strength, trapezial space height, grip strength, range of motion, change in pinch strength, patient-reported outcomes (Quick -Disabilities of the Arm, Shoulder, or Hand), or pain. We cannot conclude that partial trapeziectomy provides an advantage over total trapeziectomy at 1 year after surgery. Although trapeziometacarpal space was substantially preserved in the partial trapeziectomy group at 12 months, this difference was not statistically or clinically significant. Diagnostic III

Three-dimensional-printed patient-specific instrumentation is an accurate tool to reproduce femoral bone tunnels in multiple-ligament knee injuries

Altres ajuts: acords transformatius de la UABMultiple-ligament knee reconstruction techniques often involve the creation of several bone tunnels for various reconstruction grafts. A critical step in this procedure is to avoid short tunnels or convergences among them. Currently, no specific template guide to reproduce these angulations has been reported in the literature, and the success of the technique still depends on the experience of the surgeon. The aim of this study is to analyze the accuracy and reliability of 3D-printed patient-specific instrumentation (PSI) for lateral and medial anatomical knee reconstructions. Ten cadaveric knees were scanned by computed tomography (CT). Using specific computer software, anatomical femoral attachments were identified: (1) on the lateral side the lateral collateral ligament (LCL) and the popliteal tendon (PT) and (2) on the medial side the medial collateral ligament (MCL) and the posterior oblique ligament (POL). Four bone tunnels were planned for each knee, and PSI with different directions were designed as templates to reproduce the planned tunnels during surgery. Twenty 3D-printed PSI were used: ten were tailored to the medial side for reconstructing MCL and POL tunnels, and the other ten were tailored to the lateral side for reconstructing LCL and PT tunnels. Postoperative CT scans were made for each cadaveric knee. The accuracy of the use of 3D-printed PSI was assessed by superimposing post-operative CT images onto pre-operative images and analyzing the deviation of tunnels performed based on the planning, specifically the entry point and the angular deviations. The median entry point deviations for the tunnels were as follows: LCL tunnel, 1.88 mm (interquartile range (IQR) 2.2 mm); PT tunnel, 2.93 mm (IQR 1.17 mm); MCL tunnel, 1.93 mm (IQR 4.26 mm); and POL tunnel, 2.16 mm (IQR 2.39). The median angular deviations for the tunnels were as follows: LCL tunnel, 2.42° (IQR 6.49°); PT tunnel, 4.15° (IQR 6.68); MCL tunnel, 4.50° (IQR 6.34°); and POL tunnel, 4.69° (IQR 3.1°). No statistically significant differences were found in either the entry point or the angular deviation among the different bone tunnels. The use of 3D-printed PSI for lateral and medial anatomical knee reconstructions provides accurate and reproducible results and may be a promising tool for use in clinical practice

Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article

Influència de la impressió 3D en la categorització de les fractures d'húmer proximal

Els sistemes de classificació de les fractures d'húmer proximal han demostrat de manera reiterada una baixa concordança interobservador. Aquests sistemes són importants per estandarditzar el procés diagnòstic i facilitar la comunicació i les decisions terapèutiques. També ens permeten predir i comparar els resultats en funció del tractament realitzat (maneig quirúrgic o ortopèdic) i per a compartir-lo amb la comunitat medico-científica. Les raons d'aquest nivell baix de concordança interobservador són diverses: la tècnica d'imatge utilitzada, l'experiència de l'observador, els tipus de classificacions, etc. La interpretació de les imatges mèdiques en dues dimensions ha suposat durant molts anys (i encara és al dia d'avui), el punt de partida en el procés diagnòstic i de tractament de les patologies de l'aparell locomotor. La seva correcta interpretació està condicionada per la capacitat d'abstracció de la imatge de cadascú. La impressió 3D està revolucionant, no només el sector industrial, sinó també el món de la medicina. Davant de les múltiples aplicacions clíniques de la impressió 3D, els models anatòmics 3D es postulen principalment com una eina docent i diagnòstica en cirurgia ortopèdica i traumatologia. Com que es tracta d'una tecnologia relativament nova, en la literatura encara es troben poques evidències científiques dels seus beneficis. Davant de l'emergent impacte de la impressió 3D en cirurgia ortopèdica i traumatologia, i atès a que la concordança interobservador en la classificació de les fractures d'húmer proximal segueix sent un problema sense resoldre, en aquest treball es pretenen aportar evidències de com influeix l'ús de models anatòmics impresos en 3D de fractures d'húmer proximal a l'hora de la seva classificació. Tanmateix, es proposa un nou tipus de classificació quantitativa basada en el 3D, que podria millorar el problema existent en la classificació de fractures d'húmer proximal.Los sistemas de clasificación de las fracturas de húmero proximal han demostrado de forma reiterada una baja concordancia interobservador. Estos sistemas son importantes para estandarizar el proceso diagnóstico y facilitar la comunicación y las decisiones terapéuticas. También nos permiten predecir y comparar los resultados en función del tratamiento realizado (manejo quirúrgico u ortopédico) y para compartirlo con la comunidad médico-científica. Las razones de este nivel bajo de concordancia interobservador son diversas: la técnica de imagen utilizada, la experiencia del observador, los tipos de clasificaciones, etc. La interpretación de las imágenes médicas en dos dimensiones ha supuesto durante muchos años (y todavía es el día de hoy), el punto de partida en el proceso diagnóstico y de tratamiento de las patologías del aparato locomotor. Su correcta interpretación está condicionada por la capacidad de abstracción de la imagen de cada uno. La impresión 3D está revolucionando, no sólo el sector industrial, sino también el mundo de la medicina. Ante las múltiples aplicaciones clínicas de la impresión 3D, los modelos anatómicos 3D se postulan principalmente como una herramienta docente y diagnóstica en cirugía ortopédica y traumatología. Como se trata de una tecnología relativamente nueva, en la literatura aún se encuentran pocas evidencias científicas de sus beneficios. Ante la emergente impacto de la impresión 3D en cirugía ortopédica y traumatología, y dado a que la concordancia interobservador en la clasificación de las fracturas de húmero proximal sigue siendo un problema sin resolver, en este trabajo se pretenden aportar evidencias de cómo influye el uso de modelos anatómicos impresos en 3D de fracturas de húmero proximal a la hora de su clasificación. Además, se propone un nuevo tipo de clasificación cuantitativa basada en el 3D, que podría mejorar el problema existente en la clasificación de fracturas de húmero proximal.Classification systems for proximal humerus fractures have repeatedly demonstrated a low level of interobserver agreement. These systems are important for standardizing the diagnostic process and facilitating communication and therapeutic decisions. They also allow us to predict and compare results based on the treatment performed (surgical or orthopedic management) and to share it with the medical-scientific community. The reasons for this low level of inter-observer agreement are diverse: the imaging technique used, the experience of the observer, the types of classifications, etc. The interpretation of medical images in two dimensions has been for many years (and still is today), the starting point in the diagnostic and treatment process of pathologies of the locomotor system. Its correct interpretation is conditioned by the capacity of abstraction of the image of each one. 3D printing is revolutionizing not only the industrial sector, but also the world of medicine. In view of the multiple clinical applications of 3D printing, 3D anatomical models are mainly postulated as a teaching and diagnostic tool in orthopedic surgery and traumatology. As this is a relatively new technology, there is still little scientific evidence of its benefits in the literature. Given the emerging impact of 3D printing in orthopedic surgery and traumatology, and given that interobserver agreement in the classification of proximal humerus fractures remains an unresolved problem, this work aims to provide evidence of how the use of 3D printed anatomical models of proximal humerus fractures influences their classification. Furthermore, a new type of quantitative classification based on 3D is proposed, which could improve the existing problem in the classification of proximal humerus fractures.Universitat Autònoma de Barcelona. Programa de Doctorat en Cirurgia i Ciències Morfològique

Teaching Patients How to Reduce a Shoulder Dislocation: A Randomized Clinical Trial Comparing the Boss-Holzach-Matter Self-Assisted Technique and the Spaso Method

BACKGROUND: There are many different techniques for reducing acute anterior dislocations of the shoulder, and their use depends on surgeon preference. The objective of this study was to compare the pain experienced by a patient performing a self-reduction technique with the pain felt during a reduction performed by a trained physician. METHODS: The study was carried out at the emergency department of a tertiary referral center. Patients between 18 and 60 years of age with an acute anterior shoulder dislocation were randomly allocated into 2 groups. In 1 group the emergency doctor actively guided the reduction process with the Spaso technique (Sp group), and in the other group the patient used the Boss-Holzach-Matter (also known as Davos or Aronen) self-reduction technique (BHM group). The pain experienced by the patient during the reduction was recorded by means of a visual analogue scale (VAS) ranging from 0 to 10. Other recorded data included demographic characteristics, reduction time, and success rate. RESULTS: Of 378 patients assessed for eligibility from May 2015 until February 2017, 197 did not meet the inclusion criteria, 58 met exclusion criteria, 22 declined to participate, and 41 withdrew before randomization. Sixty acute anterior shoulder dislocations were randomized into the Sp group (n = 30) or the BHM group (n = 30). The BHM group experienced significantly less pain during reduction than the Sp group (p = 0.047), with mean pain scores of 3.57 (standard deviation [SD] = 2.1]) and 5.26 (SD = 2.9), respectively. No significant difference between groups was found with respect to reduction time (105 seconds [range, 10 to 660 seconds] in the Sp group and 90 seconds [range, 5 to 600 seconds] in the BHM group; p = 0.6) or success rate (67% and 77%, respectively; p = 0.39). CONCLUSIONS: The self-reduction technique results in less pain than, and is as efficient in achieving reduction of anterior shoulder dislocations as, the Spaso technique. These findings favor the use of the self-assisted method as an effective first-line treatment for shoulder dislocations seen in the emergency department as well as its use by patients with recurrent dislocation

Integrated 3D printing solution to mitigate shortages of airway consumables and personal protective equipment during the COVID-19 pandemic

Background: To cope with shortages of equipment during the COVID-19 pandemic, we established a nonprofit end-to-end system to identify, validate, regulate, manufacture, and distribute 3D-printed medical equipment. Here we describe the local and global impact of this system. Methods: Together with critical care experts, we identified potentially lacking medical equipment and proposed solutions based on 3D printing. Validation was based on the ISO 13485 quality standard for the manufacturing of customized medical devices. We posted the design files for each device on our website together with their technical and printing specifications and created a supply chain so that hospitals from our region could request them. We analyzed the number/type of items, petitioners, manufacturers, and catalogue views. Results: Among 33 devices analyzed, 26 (78·8%) were validated. Of these, 23 (88·5%) were airway consumables and 3 (11·5%) were personal protective equipment. Orders came from 19 (76%) hospitals and 6 (24%) other healthcare institutions. Peak production was reached 10 days after the catalogue was published. A total of 22,135 items were manufactured by 59 companies in 18 sectors; 19,212 items were distributed to requesting sites during the busiest days of the pandemic. Our online catalogue was also viewed by 27,861 individuals from 113 countries. Conclusions: 3D printing helped mitigate shortages of medical devices due to problems in the global supply chain

Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Introduction: Cluster randomized crossover trials are often faced with a dilemma when selecting an optimal model of consent, as the traditional model of obtaining informed consent from participant's before initiating any trial related activities may not be suitable. We describe our experience of engaging patient advisors to identify an optimal model of consent for the PREP-IT trials. This paper also examines surrogate measures of success for the selected model of consent. Methods: The PREP-IT program consists of two multi-center cluster randomized crossover trials that engaged patient advisors to determine an optimal model of consent. Patient advisors and stakeholders met regularly and reached consensus on decisions related to the trial design including the model for consent. Patient advisors provided valuable insight on how key decisions on trial design and conduct would be received by participants and the impact these decisions will have. Results: Patient advisors, together with stakeholders, reviewed the pros and cons and the requirements for the traditional model of consent, deferred consent, and waiver of consent. Collectively, they agreed upon a deferred consent model, in which patients may be approached for consent after their fracture surgery and prior to data collection. The consent rate in PREP-IT is 80.7%, and 0.67% of participants have withdrawn consent for participation. Discussion: Involvement of patient advisors in the development of an optimal model of consent has been successful. Engagement of patient advisors is recommended for other large trials where the traditional model of consent may not be optimal