Prevalence of radiographic findings in chronic osteomyelitis.

BACKGROUND: Simple radiography in conjunction with pertinent medical history and a comprehensive physical examination is typically adequate for diagnosing chronic osteomyelitis (CO). However, radiographic manifestations of CO lack specificity; therefore, the concordance among specialists in this regard has not been systematically assessed. This study aimed to compare and evaluate the proficiency of orthopedic surgeons and radiologists in identifying radiographic indicators present in simple radiographs for diagnosing CO. METHODS: This cross-sectional study was a correlational investigation utilizing plain radiographs obtained from a cohort of 60 patients diagnosed with CO. Comprehensive assessments of the demographic and clinical characteristics, comorbidities, and microbiological parameters were conducted. Additional variables included the anatomical location of the CO, existence of fistulas, disease duration, and presence of pseudoarthrosis. This study meticulously documented the presence or absence of six specific findings: bone destruction, which incorporates erosion and radiolucencies around implants; bone sclerosis; cortical thinning concomitant with erosion; cortical thickening; sequestrum formation; and soft-tissue swelling. RESULTS: Most patients were men (75%), with a mean age of 45.1 years. Hematogenous etiology of CO represented 23%. Bone sclerosis (71.3%) and cortical thickening (67.7%) were the most common radiographic findings, followed by soft-tissue swelling (51.3%), sequestration (47.3%), bone destruction (33.3%), and cortical erosion (30.3%). The mean agreement was 74.2%, showing a marked disagreement rate of 25.8% among all radiographic findings. The presence or absence of soft tissue edema, a prominent radiographic finding that was more important than the other findings, showed the greatest disagreement. CONCLUSIONS: Radiographic findings in CO were universally observed in all patients, demonstrating a high degree of concordance among specialists, with the exception of soft tissue swelling.

Application of 3D Printing Technology in the Treatment of Hoffa's Fracture Nonunion.

Objective To evaluate a proposed three-dimensional (3D) printing process of a biomodel developed with the aid of fused deposition modeling (FDM) technology based on computed tomography (CT) scans of an individual with nonunion of a coronal femoral condyle fracture (Hoffa's fracture). Materials and Methods Thus, we used CT scans, which enable the evaluation of the 3D volumetric reconstruction of the anatomical model, as well as of the architecture and bone geometry of sites with complex anatomy, such as the joints. In addition, it enables the development of the virtual surgical planning (VSP) in a computer-aided design (CAD) software. This technology makes it possible to print full-scale anatomical models that can be used in surgical simulations for training and in the choice of the best placement of the implant according to the VSP. In the radiographic evaluation of the osteosynthesis of the Hoffa's fracture nonunion, we assessed the position of the implant in the 3D-printed anatomical model and in the patient's knee. Results The 3D-printed anatomical model showed geometric and morphological characteristics similar to those of the actual bone. The position of the implants in relation to the nonunion line and anatomical landmarks showed great accuracy in the comparison of the patient's knee with the 3D-printed anatomical model. Conclusion The use of the virtual anatomical model and the 3D-printed anatomical model with the additive manufacturing (AM) technology proved to be effective and useful in planning and performing the surgical treatment of Hoffa's fracture nonunion. Thus, it showed great accuracy in the reproducibility of the virtual surgical planning and the 3D-printed anatomical model.

An Overview of 3D Anatomical Model Printing in Orthopedic Trauma Surgery.

Introduction: 3D object printing technology is a resource increasingly used in medicine in recent years, mainly incorporated in surgical areas like orthopedics. The models made by 3D printing technology provide surgeons with an accurate analysis of complex anatomical structures, allowing the planning, training, and surgery simulation. In orthopedic surgery, this technique is especially applied in oncological surgeries, bone, and joint reconstructions, and orthopedic trauma surgeries. In these cases, it is possible to prototype anatomical models for surgical planning, simulating, and training, besides printing of instruments and implants. Purpose: The purpose of this paper is to describe the acquisition and processing from computed tomography images for 3D printing, to describe modeling and the 3D printing process of the biomodels in real size. This paper highlights 3D printing with the applicability of the 3D biomodels in orthopedic surgeries and shows some examples of surgical planning in orthopedic trauma surgery. Patients and Methods: Four examples were selected to demonstrate the workflow and rationale throughout the process of planning and printing 3D models to be used in a variety of situations in orthopedic trauma surgeries. In all cases, the use of 3D modeling has impacted and improved the final treatment strategy. Conclusion: The use of the virtual anatomical model and the 3D printed anatomical model with the additive manufacturing technology proved to be effective and useful in planning and performing the surgical treatment of complex articular fractures, allowing surgical planning both virtual and with the 3D printed anatomical model, besides being useful during the surgical time as a navigation instrument.

Application of 3D Printing Technology in the Treatment of Hoffa's Fracture Nonunion / Aplicação da tecnologia de impressão 3D no tratamento da pseudartrose da fratura de Hoffa

Abstract Objective To evaluate a proposed three-dimensional (3D) printing process of a biomodel developed with the aid of fused deposition modeling (FDM) technology based on computed tomography (CT) scans of an individual with nonunion of a coronal femoral condyle fracture (Hoffa's fracture). Materials and Methods Thus, we used CT scans, which enable the evaluation of the 3D volumetric reconstruction of the anatomical model, as well as of the architecture and bone geometry of sites with complex anatomy, such as the joints. In addition, it enables the development of the virtual surgical planning (VSP) in a computer-aided design (CAD) software. This technology makes it possible to print full-scale anatomical models that can be used in surgical simulations for training and in the choice of the best placement of the implant according to the VSP. In the radiographic evaluation of the osteosynthesis of the Hoffa's fracture nonunion, we assessed the position of the implant in the 3D-printed anatomical model and in the patient's knee. Results The 3D-printed anatomical model showed geometric and morphological characteristics similar to those of the actual bone. The position of the implants in relation to the nonunion line and anatomical landmarks showed great accuracy in the comparison of the patient's knee with the 3D-printed anatomical model. Conclusion The use of the virtual anatomical model and the 3D-printed anatomical model with the additive manufacturing (AM) technology proved to be effective and useful in planning and performing the surgical treatment of Hoffa's fracture nonunion. Thus, it showed great accuracy in the reproducibility of the virtual surgical planning and the 3D-printed anatomical model.

Resumo Objetivo Avaliar uma proposta de processo de impressão tridimensional (3D) de um biomodelo preparado com o auxílio da tecnologia de modelagem por deposição de material fundido (fused deposition modeling, FDM, em inglês) a partir de imagens de tomografia computadorizada (TC) de um indivíduo com pseudartrose de fratura coronal do côndilo femoral (fratura de Hoffa). Materiais e Métodos Para tanto, utilizamos imagens de TC, que permitem estudar a reconstrução volumétrica 3D do modelo anatômico, além da arquitetura e geometria óssea de sítios de anatomia complexa, como as articulações. Também permite o planejamento cirúrgico virtual (PCV) em um programa de desenho assistido por computador (computer-aided design, CAD, em inglês). Essa tecnologia possibilita a impressão de modelos anatômicos em escala real que podem ser utilizados em simulações cirúrgicas para o treinamento e a escolha do melhor posicionamento do implante de acordo com o PCV. Na avaliação radiográfica da osteossíntese da pseudartrose de Hoffa, verificou-se a posição do implante no modelo anatômico impresso em 3D e no joelho do paciente. Resultados O modelo anatômico impresso em 3D apresentou características geométricas e morfológicas semelhantes às do osso real. O posicionamento dos implantes em relação à linha de pseudartrose e pontos anatômicos foram bastante precisos na comparação do joelho do paciente com o modelo anatômico impresso em 3D. Conclusão A utilização do modelo anatômico virtual e do modelo anatômico impresso em 3D com a tecnologia de manufatura aditiva (MA) foi eficaz e auxiliou o planejamento e a realização do tratamento cirúrgico da pseudartrose da fratura de Hoffa. Desta forma, foi bastante preciso na reprodutibilidade do planejamento cirúrgico tanto virtual quanto no modelo anatômico impresso em 3D.

Comparative analysis of tibial plateau fracture osteosynthesis: A finite element study.

This study presents a comparative structural finite element analysis between two different fixation methods for high-energy tibial plateau fractures: limited contact dynamic compression plate (LC-DCP) and locking compression plate (LCP). Several computational methods were employed to obtain an accurate finite element bone model with non-homogeneous properties. The goal is to evaluate the mechanical behavior of the fractured bone under each type of treatment within the scope of a single case study. Based on Computed Tomography (CT) images from the human lower limbs, the bones and implants were modeled using Computer-Aided-Design (CAD) with Autodesk Fusion 360©. Afterwards, finite element analysis was carried out in both assemblies. Altair HyperWorks© was used for pre- and post-processing the analysis and Abaqus CAE© was chosen as solver. The finite element model was built considering the boundary conditions foreseen in the specific bibliography and the assembly was submitted to a vertical compressive load based on the human Body Weight (BW). The results of both simulations were compared regarding the independent motion of the bone fragments over the fracture site. Smaller relative displacement between the bone fragments leads to shorter recovery time since this condition provides more stability and low tissue strain, which are required to generate bone. The osteosynthesis with LCP achieved the best results since it presented reduced independent motion in the fracture site, as foreseen in literature.

Detecting bone lesions in the emergency room with medical infrared thermography.

INTRODUCTION: Low- to high-energy impact trauma may cause from small fissures up to extended bone losses, which can be classified as closed or opened injuries (when they are visible at a naked eye). OBJECTIVE: The aim of this study was to investigate the feasibility of clinical diagnosis of bone trauma through medical infrared thermography, in a hospital emergency room. METHODS: Forty-five patients with suspected diagnosis of bone fracture were evaluated by means of medical infrared images, and the data correlated with the gold standard radiographic images, in the anteroposterior, lateral, and oblique views, at the orthopedic emergency department. The control group consisted of thermal images of the contralateral reference limb of the volunteers themselves. Data were acquired with a medical grade infrared camera in the regions of interest (ROIs) of leg, hand, forearm, clavicle, foot, and ankle. RESULTS: In all patients evaluated with a diagnosis of bone fracture, the mean temperature of the affected limb showed a positive difference greater than 0.9 °C (towards the contralateral), indicating the exact location of the bone trauma according, while the areas diagnosed with reduced blood supply, showed a mean temperature with a negative variation. CONCLUSION: Clinical evaluation using infrared imaging indicates a high applicability potential as a tool to support quick diagnosis of bone fractures in patients with acute orthopedic trauma in an emergency medical setting. The thermal results showed important physiological data related to vascularization of the bone fracture and areas adjacent to the trauma well correlated to radiographic examinations.

Forehead, Temple and Wrist Temperature Assessment of Ethnic Groups using Infrared Technology.

Non-contact infrared sensors are widely used as a diagnostic tool for elevated body temperature during initial screening for coronaviruses. The aim of this study was to investigate the thermal differences at three anatomical points: temple, forehead, and wrist, in the initial screening for temperature indicative of febrile and non-febrile states in skin pigmentation variations in Black, Half-Black and Caucasian skins, correlated with height and weight variables. Temperatures were obtained by means of an infrared thermometer in 289 volunteers with mean age of 18.30 ± 0.76, in a controlled environment according to Singapore Standard, SS582 part 1 and 2, normative standard IEC 80601-2-59, with standard technical protocols established by the International Organization for Standardization, ISO / TR 13154. The data were processed in MATLAB® R2021a, and data normality verified by Kolmogorov-Smirnov test, non-parametric data paired between temple / forehead / wrist were compared using the Wilcoxon signed-rank test. The results show different median temperatures in these anatomical regions, 37.2°C at the temple, 36.8°C at the forehead and 36.4°C at the wrist. As the temple region presents a temperature higher than the other investigated regions and, therefore, close to the core temperature, it should be considered for the initial screening of SARS-CoV-2 when using non-contact infrared thermometers. Furthermore, no significant changes were found due to variation in skin tone, height, or weight.

Evaluation of Tibia Bone Healing by Infrared Thermography: A Case Study.

BACKGROUND: Thermal imaging has been used as a clinical follow-up technique in several medical specialties. PURPOSE: The aim of this study was to investigate the feasibility of using medical thermography in the diagnosis and follow-up assessment of a severe orthopedic trauma that requires the use of an external circular fixator. PATIENTS AND METHODS: Twenty clinical follow-ups of thermal imaging correlated with X-ray images were performed in a male volunteer, diagnosed with bone nonunion, during 11 months of treatment, in the hospital trauma and reconstruction department. Data were acquired in the regions of interest of the proximal tibia, diaphysis and distal, with a Flir T530 medical grade infrared camera from Flir Systems®, and the data processed by the Matlab® 2019 custom made software. RESULTS: Statistical analysis was performed by Wilcoxon signed-rank test. The results showed a median temperature of 22.2°C, and thus some periods of interruption in the healing process between the third and twentieth clinical follow-up, and a significant increase of the temperature to 34.6°C synchronous with a diagnosis of bone infection by the eleventh clinical follow-up. The thermal images acquired during the 20 clinical follow-ups allow a correlation with the data from the X-ray exams and also with the contralateral limb of the evaluated patient, showing thermal alterations greater than 0.3°C, which are significant of physiological abnormality. CONCLUSION: The thermography exam can be a useful tool for applying on the follow-up of patients after trauma or bone fracture. The results showed important physiological data related to the vascularization necessary for bone repairing, being therefore a good indicator of the healing process. In addition, as infrared thermography does not use ionizing radiation, it can be used countlessly, in complement to the traditional X-ray exams that focus on anatomical data analysis.

Avaliação da variação da temperatura cutânea, proteína C reativa e velocidade de hemossedimentação na artroplastia total do joelho primária, isenta de complicações / Evaluation of skin temperature, reactive C protein, and hemosedimentation speed variation in uncomplicated primary knee total arthroplasty

OBJETIVO: Estudar a variação dos valores da temperatura cutânea (deltaT) do sítio operatório, da proteína C reativa (PCR) e da velocidade de hemossedimentação (VHS) em pacientes submetidos a artroplastia total do joelho (ATJ) primária, tentando estabelecer correlação entre suas curvas ao longo do tempo. MATERIAL E MÉTODOS: Esse estudo clínico prospectivo, avaliou 29 pacientes acompanhados por 12 semanas, sendo aferida a temperatura cutânea em ambos os joelhos e realizada dosagem sérica da PCR e VHS. RESULTADOS: Após a comparação entre as variáveis testadas (deltaT, PCR e VHS), observou-se tanto para o teste de Pearson (avaliação paramétrica), quanto para o de Spearman (avaliação não-paramétrica) que não houve correlação estatística entre elas. A variação da temperatura cutânea segue um padrão diferente do observado tanto para a PCR quanto para a VHS, não existindo correlação entre as curvas. Foi estabelecida a curva padrão das três variáveis, verificando-se redução estatisticamente significativa nos valores da PCR e da VHS entre o pré e o pós-operatório. CONCLUSÃO: Não foi observada correlação entre a temperatura cutânea e os níveis de VHS e PCR em pacientes submetidos a ATJ primária, isenta de complicações.

OBJECTIVE: To study the variation of skin temperature values (deltaT) on operative site, of reactive C protein (RCP) and of hemosedimentation speed (HSS) in patients submitted to primary knee total arthroplasty (KTA), in an attempt to establish a correlation among its curves over time. MATERIALS AND METHODS: This prospective clinical study evaluated 29 patients followed up during 12 weeks, with measurements of skin temperature in both knees and RCP and HSS serum dosages. RESULTS: After comparing the variables tested (deltaT, RCP and HSS), no statistical correlation was observed for both the PearsonÆs test (parametric test) and the SpearmanÆs test (non-parametric test) among variables. Skin temperature variation follows a different pattern from that observed both for RCP and for HSS, with no correlation among curves. A standard curve was established for the three variables, and a statistically significant reduction was seen in RCP and HSS values from pre- to post-operative period. CONCLUSION: No correlation was observed between skin temperature and HSS and RCP levels in patients submitted to uncomplicated primary KTA.