Preoperative templating in orthopaedic fracture surgery: The past, present and future.

Preoperative planning in orthopaedic fracture surgery corroborates with the goal of establishing the best possible surgical result and ensuring a functioning limb for the patient. From placing sketches on overhead projector paper and measuring lengths from anatomical landmarks, ways of preoperative planning have evolved rapidly over the last 100 years. Today, preoperative planning includes methods such as advanced 3-Dimensional (3D) printed models and software programs incorporating entire libraries of osteosynthesis materials that can be shaped and rotated to fit a patient's specific anatomy. Relevant literature was evaluated to review the development of preoperative templating from the past and present, in order to assess its impact on the future of osteosynthesis.We identified studies on 3D-imaging, computer-assisted systems, and 3D-printed fractured bones and drill guides. The use of some of these systems resulted in a reduction in operation time, blood loss, perioperative fluoroscopy and hospital stay, as well as better placement of osteosynthesis material. Only few studies have identified differences in patient morbidity and mortality. Future techniques of preoperative templating are on the rise and the potential is vast. The cost-effectiveness and usefulness of certain methods need to be evaluated further, but the benefit of preoperative templating has the potential of being revolutionary, with the possibility of radical advances within orthopaedic surgery.

Impact of focused cardiac ultrasound in vascular surgery patients: A prospective observational study.

PURPOSE: We aimed to evaluate the diagnostic and logistical consequences of routine preoperative focused cardiac ultrasound (FOCUS) in patients scheduled for elective vascular surgery. METHODS: In a prospective, observational study, FOCUS was performed in all patients seen in the vascular surgery outpatient clinic from January 14 to May1, 2019, unless a full echocardiography had been conducted in the preceding 12 months or the patient was already referred to an echocardiography by the vascular surgeons. FOCUS followed a stringent protocol and referrals for a full echocardiography followed predefined criteria. RESULTS: Preoperative FOCUS was performed in 55 (60%) patients. Of these, 12 patients (22%) revealed cardiac pathology and were referred to a full echocardiography. Coronary angiography was subsequently performed in one of these patients but was without a further consequence. All patients underwent surgery. CONCLUSION: FOCUS disclosed cardiac pathology in the outpatient clinic but with little clinical consequence. This study does not support routine FOCUS as a part of the preoperative patient cardiovascular assessment before vascular surgery. However, larger studies are warranted to further evaluate the relevance of preoperative FOCUS in a larger sample size.

The efficacy of midline catheters-a prospective, randomized, active-controlled study.

OBJECTIVES: This study was performed to investigate whether an intravenous (IV) strategy based on new-generation midline catheters is an efficacious alternative to a conventional IV strategy consisting of peripheral venous catheters and central venous catheters, for patients needing IV therapy exceeding 5 days. METHODS: This was a prospective, randomized, controlled study. Patients requiring more than 5 days of IV treatment were randomized to either a midline catheter-based IV strategy or a conventional strategy. The primary endpoint was the composite of the insertion of a central venous catheter (CVC) or the need for four or more peripheral venous catheter (PVC) insertions. The secondary outcomes included catheter dwell times and reasons for premature removal. RESULTS: One hundred and twenty patients were included. The fraction of patients receiving four or more PVCs or having a CVC inserted was 12/58 (21%) in the midline group versus 38/58 (66%) in the conventional group (p < 0.001); the number needed to treat was 2.2. The median overall catheter dwell time was 7 days (range 0-60 days) in the midline group and 4 days (range 0-84 days) in the conventional group (p = 0.002). CONCLUSION: In patients requiring more than 5 days of IV therapy, a midline catheter strategy reduced the need for insertion of a CVC or four or more PVCs.