Three-Dimensional Patient-Matched Template Guides Are Able to Increase Mean Diameter and Length and to Improve Accuracy of Cortical Bone Trajectory Screws: A 5-Year International Experience.

OBJECTIVE: To analyze whether significant differences exist between free-hand three-dimensional (3D) planning-guided cortical bone trajectory (CBT) screw placement and 3D-printed template-guided CBT screw positioning in terms of accuracy, size of screws, and potential complications. METHODS: In this retrospective study, data of adult patients in whom CBT screws were placed for lumbar degenerative pathologies were extracted from a prospectively collected database and analyzed. Patients in whom screws were placed using free-hand 3D planning-guided technique were compared with patients in whom screws were positioned using customized 3D-printed templates. Size of the screws, accuracy, clinical outcomes, and complications were analyzed. RESULTS: The study evaluated 251 patients (1004 screws). The free-hand 3D planning-guided group included 158 patients (632 screws), and the 3D-printed template-guided group included 93 patients (372 screws). The 3D-printed template-guided group involved screws of larger size from L3 to S1. Differences between the 2 groups in terms of accuracy parameters reached statistical significance (P ≤ 0.05). CONCLUSIONS: With the use of 3D patient-matched template guides, mean diameter and length of CBT screws could be safely increased due to improved accuracy of screw placement. Based on previous evidence regarding CBT biomechanical properties, these advantages could allow increased fixation strength over traditional convergent pedicle screw trajectories. Further biomechanics studies are needed.

Recurrent chordoma of the L2 vertebra: a case report.

Chordoma is a rare slow-growing, locally invasive primary malignant bone tumour arising from notochord remnants. It is characterised by a high local recurrence rate. Most chordomas (60%) are found in the sacrococcygeal region: only 15% originate in the mobile spine. CT-scan and MRI can help evaluate the tumour extension. En bloc resection of the tumour mass is the standard treatment. The main prognostic factor is tumour-negative surgical margins. Due to the location of spinal chordomas, adjacent to vital neural and vascular structures, this can be difficult to achieve. Therefore radiotherapy has been used when adequate excision is not possible and in case of local recurrence. We report the case of a 72-year-old female with a recurrent chordoma of the L2 vertebra, previously treated with resection and radiotherapy. The recurrent chordoma was resected using a right-sided thoraco-phreno-laparotomy as the tumour could not be resected using the left anterior approach or posterior approach due to extensive fibrosis following surgery and radiotherapy.

Conservative management of minimally displaced isolated fractures of the ulnar shaft.

The purpose of this prospective study was to compare three different ways of conservative management of isolated fractures of the ulnar shaft: immediate mobilisation, below-elbow plaster cast and above-elbow plaster cast immobilisation. Over a 24-month period, 102 minimally displaced isolated fractures of the distal two-thirds of the ulnar shaft were treated on an outpatient basis. Thirty-two fractures were immobilised with an above-elbow plaster cast for 3 weeks and a below-elbow plaster cast for an additional 3 weeks. Thirty-six fractures were immobilised with a below-elbow plaster cast for 6 weeks. The remaining 34 fractures were managed with immediate mobilisation. Radiological healing, range of motion of the wrist, and pain were assessed. Results were good and were comparable in terms of healing, time to healing, pain and range of motion of the wrist.

Laparoscopic arcuate line hernia repair.

Arcuate line hernia is considered a surgical rarity. This type of hernia is characterized by protrusion of intraperitoneal structures in a concave parietal fold in the abdominal wall. In this report, we aim to describe the diagnostic images of 2 cases of arcuate line hernia. Laparoscopic repair using a polypropylene mesh with a preattached inflatable balloon has been illustrated as well.

Bipartite atlas mimicking traumatic atlantoaxial instability following a rugby tackle.

We report a very rare case of a congenital cervical spine anomaly. The low occurrence rate of this anatomic variant combined with the high frequency of cervical injuries in sports medicine made this case a diagnostic challenge on both emergency and orthopaedic departments. After reading, it should give the clinician a more consistent view in differentiating the traumatic or congenital origin of the disorder seen on radiographs, as well as what can be expected in the future when diagnosis is set.