Value of three-dimensional printing of fractures in orthopaedic trauma surgery

Objective Information technology-based innovation is playing an increasingly key role in healthcare systems. The use of three-dimensional (3D)-printed bone fracture replicas in orthopaedic clinical practice could provide a new tool for fracture simulations and treatment, and change the interaction between patient and surgeon. We investigated the additional value of 3D-printing in the preparation and execution of surgical procedures and communication with patients, as well as its teaching and economic implications. Methods Fifty-two patients with complex articular displaced fractures of the calcaneus, tibial plateau, or distal radius were enrolled. 3D-printed real-size models of the fractured bone were obtained from computed tomography scans and exported to files suitable for 3D-printing. The models were handled by trauma surgeons, residents, and patients to investigate the potential advantages and procedural improvements. The patients' and surgeons' findings were recorded using specific questionnaires. Results 3D-printed replicas of articular fractures facilitated surgical planning and preoperative simulations, as well as training and teaching activities. They also strengthening the informed consent process and reduced surgical times and costs by about 15%. Conclusion 3D-printed models of bone fractures represent a significant step towards more-personalized medicine, with improved education and surgeon-patient relationships

Serious Delayed Hair Toe Tourniquet Syndrome with Bone Erosion and Flexor Tendon Lesion

Hair toe tourniquet syndrome (HTTS) is an uncommon pediatric condition occurring when the toe is circumferentially strangulated by human hair or fibers. An 8-week-old little girl was admitted to the Emergency Department because of the worsening swelling in the right second and third toes, which had been been previously treated with a local antibiotic thinking of an infection. An unrecognized HTTS was leading the third toe to necrosis. An urgent release of the constricting band on the two toes was performed and bone erosion and partial flexor tendon lesion on the third toe were detected. We would like to raise awareness in the community and in colleagues about HTTS in children, because early recognition and urgent treatment are mandatory to provide an adequate management and prevent severe complications

Emilin-1 controls arterial blood pressure by regulating contractility of vascular smooth muscle cells

Emilin-1 is a protein of the elastic extracellular matrix (ECM) expressed in interstitial connective tissue and in the cardiovascular system. Emilin1 null mice display hypotrophic remodeling of the wall of conductance arteries and increased blood pressure. The protein regulates the bioavailability of TGF-b by inhibiting proteolysis of the proTGF-b precursor to LAP/TGF-b, a complex from which the growth factor can be subsequently released for receptor binding. In the absence of Emilin-1, the amount of active TGF-b is increased. As Emilin-1 is expressed in blood vessels starting from early stages of embryonic development to adulthood, a key question concerning the function of the protein is whether the Emilin1-/- phenotype is the result of a developmental defect or the function of the protein is required for the regulation of blood pressure and arterial structure also in the adult. The conditional gene targeting procedure chosen to inactivate the Emilin1 gene in smooth muscle cells (SMCs) of adult mice included the use of floxed Emilin1 and CreERT2 (a tamoxifen inducible Cre recombinase) under the control of the smooth muscle myosin heavy chain (Smmhc) promoter. Tamoxifen administration induced activity of Cre specifically in vascular and visceral SMCs, as revealed by X-gal staining of tissues from animals with the Rosa26R mutation. When Emilin1flox/flox mice carrying the Smmhc-CreERT2 transgene were given tamoxifen for 7 days, Emilin-1 disappeared completely in 10-12 days from start of treatment. In the same time, blood pressure increased of about 20 mmHg, a level that was stably maintained thereafter. The myogenic response of second branch meseteric arteries, evaluated using a pressure myograph, was found to be increased in Emilin1-/- mice. Additional experiments with aorta and mesenteric artery SMC cultures from control and mutant mice showed that lack of Emilin-1  enhanced phosphorylation of myosin light chain 20 when cells were stimulated with the a1-adrenergic receptor agonists phenylephrine or with angiotensin II. Moreover, basal cytosolic Ca2+ levels and calcium transients induced by stimulation with phenylephrine and angiotensin II were increased in SMCs from Emilin1-/- mutants. The data suggest that Emilin-1 expression is continuously required for regulation of blood pressure and that the increase of TGF-b activity induced by diminished Emilin-1  stimulates, likely through alteration of intracellular calcium homeostasis, contractility of vascular SMC to mechanical and chemical stimuli with ensuing hypertension

Delayed Bleeding and Pelvic Haematoma after Low-Energy Osteoporotic Pubic Rami Fracture in a Warfarin Patient: An Unusual Cause of Abdominal Pain

Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described. Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED) with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma. Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with “benign” osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications

Serious delayed hair toe tourniquet syndrome with bone erosion and flexor tendon lesion.

Hair toe tourniquet syndrome (HTTS) is an uncommon pediatric condition occurring when the toe is circumferentially strangulated by human hair or fibers. An 8-week-old little girl was admitted to the Emergency Department because of the worsening swelling in the right second and third toes, which had been been previously treated with a local antibiotic thinking of an infection. An unrecognized HTTS was leading the third toe to necrosis. An urgent release of the constricting band on the two toes was performed and bone erosion and partial flexor tendon lesion on the third toe were detected. We would like to raise awareness in the community and in colleagues about HTTS in children, because early recognition and urgent treatment are mandatory to provide an adequate management and prevent severe complications

Three-Dimensional Printing of Bone Fractures: A New Tangible Realistic Way for Preoperative Planning and Education.

We would like to present the first report in the literatureof the use of 3-dimensional (3D) printed models ofbone fractures.Actually, X-rays and computed tomography (CT) areused today to evaluate bone fractures. Understanding thedislocation of fragments, the amount of displacement,and the joint involvement is necessary for a successfultreatment.Three-dimensional printing is a new low-cost technologythat uses a 3D computer representation to create solidobjects1; 3D-printed models for orthopedic conditionscan improve understanding of anatomy and pathology bymeans of tactile and visual experience to complementimages displayed on a computer monitor

Repliche anatomiche stampate in 3D: un nuovo strumento per la pianificazione chirurgica e il consenso informato

Le nuove tecnologie in sanit\ue0 hanno incrementato sempre pi\uf9 la qualit\ue0 del servizio offerto al paziente. Alla loro continua evoluzione va ricollegata l\u2019introduzione della stampa 3D in ambito medico. Le applicazioni cliniche della stampa 3D spaziano dalla fabbricazione di repliche anatomiche per il planning prechirurgico alla costruzione di dispositivi medici su misura e alla creazione di tessuto biologico. Tale potenziamento dell\u2019esperienza tattile e visiva ha permesso l\u2019uso dei modelli in 3D anche in supporto alla comunicazione medico-paziente e alla formazione dei chirurghi

3D Printed models of distal radius fractures

3D printing, also known as additive manufacturing or ‘‘rapid prototyping’’, is a low cost technology that uses a 3D computer representation to create solid objects from a feedstock material. In the literature studies report that 3D printed models for orthopedic conditions can improve surgeons’ evaluation of patient-specific anatomy and pathology by way of tactile and visual experience [1–4]. However, it has not been analysed yet how far models may support the surgeon by selecting the most adequate surgical procedure, and which effect they may have on patient’s understanding (and in some cases on their approval) of the surgical procedure they will undergo. In this paper, we present our initial experience preparing and using 3D printed models of the bony anatomy of distal radius fractures and we describe their effect on surgical planning and patient information