Use of External Fixators as a 3-Dimensional Navigation Drill Guide for Arthroscopic Ankle Arthrodesis

In this article, we describe a novel technique using external fixators and cannulated screws to construct a 3-dimensional navigation drill guide to predict the screw trajectory before screw insertion that can prevent screw collision during arthroscopic ankle arthrodesis. Four orthopedic residents who had no prior experience of ankle arthrodesis were instructed on how to use the 3-dimensional navigation drill guide and where to insert the screws for ankle arthrodesis. Each resident inserted 6.5 cannulated screws on 8 sawbone ankle models using the device and the C-arm fluoroscopy. An experienced attending surgeon also inserted the same screws on 2 sawbone ankle models to find out if there is any difference between the experienced and inexperienced surgeons. All four residents and an attending surgeon did not experience any collision of screws for the three cannulated screws. Notably, one resident had collision of the 4th screw on his first sawbone model. On the second saw bone model, all surgeons could insert 5 screws without redrilling. A 3-dimensional navigation drill guide constructed with external fixators can assist surgeons in implementing percutaneous screws for arthroscopic ankle arthrodesis

Use of a life-size three-dimensional-printed spine model for pedicle screw instrumentation training

Abstract Background Training beginners of the pedicle screw instrumentation technique in the operating room is limited because of issues related to patient safety and surgical efficiency. Three-dimensional (3D) printing enables training or simulation surgery on a real-size replica of deformed spine, which is difficult to perform in the usual cadaver or surrogate plastic models. The purpose of this study was to evaluate the educational effect of using a real-size 3D-printed spine model for training beginners of the free-hand pedicle screw instrumentation technique. We asked whether the use of a 3D spine model can improve (1) screw instrumentation accuracy and (2) length of procedure. Methods Twenty life-size 3D-printed lumbar spine models were made from 10 volunteers (two models for each volunteer). Two novice surgeons who had no experience of free-hand pedicle screw instrumentation technique were instructed by an experienced surgeon, and each surgeon inserted 10 pedicle screws for each lumbar spine model. Computed tomography scans of the spine models were obtained to evaluate screw instrumentation accuracy. The length of time in completing the procedure was recorded. The results of the latter 10 spine models were compared with those of the former 10 models to evaluate learning effect. Results A total of 37/200 screws (18.5%) perforated the pedicle cortex with a mean of 1.7 mm (range, 1.2–3.3 mm). However, the latter half of the models had significantly less violation than the former half (10/100 vs. 27/100, p < 0.001). The mean length of time to complete 10 pedicle screw instrumentations in a spine model was 42.8 ± 5.3 min for the former 10 spine models and 35.6 ± 2.9 min for the latter 10 spine models. The latter 10 spine models had significantly less time than the former 10 models (p < 0.001). Conclusion A life-size 3D-printed spine model can be an excellent tool for training beginners of the free-hand pedicle screw instrumentation

Modified Broström Procedure for Chronic Ankle Instability with Generalized Joint Hypermobility

Category: Sports Introduction/Purpose: Chronic ankle instability with generalized joint hypermobility (GJH) is considered a contraindication for the modified Broström procedure. The most widely accepted definition of GJH is a Beighton-Horan score of ≥4 on a 9-point scale. However, it is not clear if this criterion can be applied to determine the GJH that would lead to a poor outcome after the modified Broström procedure. Methods: The modified Broström procedure was performed in 32 patients with chronic ankle instability with GJH, if the contralateral uninjured ankle showed a normal varus talar tilt and anterior talar translation during the stress tests. We hypothesized that when the contralateral uninjured ankle shows a normal varus talar tilt and anterior talar translation during stress tests in patients with GJH, GJH may have a smaller effect on the ankle ligaments, and the modified Broström procedure in these cases may have satisfactory outcomes. The mean patient age at surgery was 21.7 years. The mean follow-up duration was 27.4 months. Results: The Karlsson-Peterson ankle score significantly improved from 63.6 ± 7.1 points (p< 0.001; 95% CI, 22.1 – 29.7) preoperatively to 90.4 ± 6.7 points at the final postoperative follow-up. Sixteen patients were very satisfied with the results, 10 patients were satisfied, 3 patients rated their satisfaction as fair, and 1 patient was dissatisfied with the results. We stratified the clinical outcomes according to the Beighton scores. There was no correlation between the Beighton scores and the Karlsson- Peterson ankle scores at the last follow-up (Spearman’s correlation coefficient, -0.11; p= 0.591). However, 1 patient with a Beighton score of 8 points and 1 patient with a score of 9 points had lower Karlsson-Peterson ankle scores (82 and 85, respectively) compared to the average scores at the last follow-up. Conclusion: The modified Broström procedure was successful in patients with chronic ankle instability with GJH, if the contralateral uninjured ankle showed a normal varustalar tilt and anterior talar translation during the stress tests. The repaired ligaments may eventually stretch out in patients with GJH secondary to connective tissue disorders such as Marfan syndrome as these patients have been found to have inherent connective tissue extensibility. However, GJH includes mild joint hypermobility without any symptoms or problems except increased joint range of motion. When the contralateral normal ankle shows negative stress tests that the modified Broström procedure may be successful

Effect of Weight-Bearing in Conservative and Operative Management of Fractures of the Base of the Fifth Metatarsal Bone

Background. There is no established principle regarding weight-bearing in conservative and operative management of fifth metatarsal base fractures. Methods. We reviewed 86 patients with acute fifth metatarsal base fractures. Conservatively treated late or early weight-bearing patients were assigned to Group A or C, respectively. Operatively treated late or early weight-bearing patients were assigned to Group B or D, respectively. Results were evaluated by clinical union, bone resorption, and the American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS) scores. Results. All 4 groups had bone union at a mean of 6.9 weeks (range, 5.1–15.0). There were no differences between the groups in the AOFAS and VAS scores. In the early weight-bearing groups, there were fewer cases of bone resorption, and the bone unions periods were earlier. Conclusions. Early weight-bearing may help this patient population. Moreover, conservative treatment could be an option in patients with underlying diseases