Fast and accurate distal locking of interlocked intramedullary nails using computer-vision and a 3D printed device.

INTRODUCTION: Distal locking is a challenging and time-consuming step in interlocked intramedullary nailing of long bone fractures. Current methods have limitations in terms of simplicity, universality, accuracy, speed, and safety. We propose a novel device and software for distal locking using computer vision. METHODS AND MATERIALS: The device consists of an universal ancillary clamp, a telescopic arm, a viewfinder clamp, and a radio-opaque cross. The software uses a camera photo from the C-arm intensifier and adjusts for geometric projection deformities. The software employs edge detection, Hough transform, perspective interpolation, and vector calculation algorithms to locate the distal hole center. The device and software were designed, manufactured, and tested using 3D CAD, FEM, DRR, and performance testing on phantom bones. RESULTS: The device and software showed high accuracy and precision of 98.7% and 99.2% respectively in locating the distal hole center and calculating the correctional vector. The device and software also showed high success ratio in drilling the hole and inserting the screw. The device and software reduced the radiation exposure for the surgeon and the patient. The success ratio of the device and software was validated by the physical testing, which simulated the real clinical scenario of distal locking. The radiation exposure was as low as 5 s with a radiation dose of 0.2mSv, drastically reducing radiation exposure during distal locking. DISCUSSION: Our device and software have several advantages over other distal locking methods, such as simplicity, universality, accuracy, speed, and safety. Our device and software also have some disadvantages, such as reliability and legislation. Our device and software can be compared with other distal locking methods based on these criteria. Our device and software have some limitations and challenges that need to be addressed in the future, such as clinical validation, and regulatory approval. CONCLUSION: The device showed promising results in terms of low-cost, reusability, low radiation exposure, high accuracy, fast distal locking, high stiffness, and adaptability. The device has several advantages over other distal locking techniques, such as free-hand technique, mechanical aiming devices, electromagnetic navigation systems, and computer-assisted systems. We believe that our device and software have the potential to revolutionize the distal locking technique and to improve the outcomes and quality of life of the patients with long bone fractures.

Management of periprosthetic hip fractures: current status and prospects; experience of the traumatology and orthopedics department of Mohammed VI University Hospital, Marrakech.

INTRODUCTION: The increase in hip arthroplasties predicts a rise in periprosthetic fractures in Morocco, posing challenges for orthopedic surgeons. Therapeutic strategies vary considerably, highlighting the absence of a universally accepted treatment protocol. AIM: To analyze the management of per-prosthetic hip fractures, while addressing the challenges associated with them. METHODS: This was a retrospective study, conducted in the trauma-orthopedics department between December 2015 and November 2022. Nineteen patients who presented to the hospital with fractures around a hip prosthesis were included. RESULT: Nineteen periprosthetic fractures were observed. The majority of patients (68%) were women, with an average age of 68. The Vancouver classification showed that 52.6% of the fractures were type B1, and 21.1% type C, while the other fracture types were distributed differently. These fractures were mainly associated with diagnoses such as femoral neck fracture (63.2%) and coxarthrosis (31.6%). We observed variations in treatment recommendations and results between the different series analyzed. We noted discrepancies with certain series concerning fracture types and therapeutic choices. However, in our series, we achieved satisfactory results, with successful consolidation and the absence of complications in all patients. CONCLUSION: These results underline the importance of an individualized approach to fracture management, taking into account the specificities of each case.

Navigating diagnostic challenges-distinguishing malignant melanoma and clear cell sarcoma of soft tissues: a case report and review of the literature.

BACKGROUND: Within the spectrum of melanocytic-differentiated tumors, the challenge faced by pathologists is discerning accurate diagnoses, with clear cell sarcoma of soft tissues standing out as a rare and aggressive neoplasm originating from the neural crest. Accounting for 1% of all soft tissue sarcomas, clear cell sarcoma of soft tissues poses diagnostic complexities, often misidentified owing to its phenotypic resemblance to malignant melanoma. This chapter delves into the intricacies of clear cell sarcoma of soft tissues, its epidemiology, characteristic manifestations, and the imperative need for a comprehensive diagnostic approach involving immunohistochemical and molecular analyses. CASE PRESENTATION: A compelling case unfolds as a 25-year-old male from Morocco, initially misdiagnosed with malignant melanoma, experiences tumor recurrence on the second toe. With no history of trauma or familial neoplasia, the patient's clinical journey is explored, emphasizing the importance of detailed clinical examinations and radiological assessments. The chapter elucidates the histopathological findings, immunohistochemical spectrum, and the correlation between clinical parameters and diagnostic inference, ultimately leading to metatarsal amputation. This clinical vignette highlights the multidimensional diagnostic process in soft tissue neoplasms, emphasizing the synergistic role of clinical, radiological, and histopathological insights. CONCLUSION: The diagnostic challenges inherent in melanocytic-differentiated tumors, exemplified by the rarity of soft tissue clear cell sarcoma, underscore the essential role of an integrated diagnostic approach. This concluding chapter emphasizes the perpetual collaboration required across pathology, clinical medicine, and radiology for nuanced diagnostic precision and tailored therapeutic strategies. The rarity of these soft tissue malignancies necessitates ongoing interdisciplinary engagement, ensuring the optimization of prognosis and treatment modalities through a comprehensive understanding of the diagnostic intricacies presented by clear cell sarcoma of soft tissues.

Challenges in the management of severe cutaneous mucormycosis: A case of rapid progression in uncontrolled diabetes mellitus with polymicrobial implications.

Mucormycosis, a rare but life-threatening fungal infection, poses significant challenges in clinical management, particularly in patients with uncontrolled diabetes mellitus. This case report presents the clinical journey of a 44-year-old woman who developed a rapidly progressing Mucorales infection following a domestic knife injury. Her condition, complicated by diabetic ketoacidosis and co-infection with Candida albicans, led to severe hand phlegm and sepsis. Despite aggressive intervention, the infection continued to advance, ultimately resulting in the patient's demise.

[Anterior-superior dislocation of the shoulder: case report and review of the literature]. / Luxation antéro-supérieure de l´épaule: à propos d´un cas et revue de la littérature.

Traumatic dislocations of the shoulder joint are generally described as an antero-inferior dislocations. Anterior-superior dislocations are extremely rare. We report a rare case of traumatic dislocation of the anterior-superior shoulder in a 45-year-old patient whose physical examination showed an anterior-superior subcutaneous protrusion of the head filling the subacromial space. The diagnosis was radiologically confirmed. MRI showed total rupture of the supraspinatus and subscapularis tendons. Shoulder instability occurred after reduction of the dislocation. Temporary glenohumeral arthrodesis was subsequently performed with good functional results.

Madura's foot: reasons for the delay in diagnosis and consequences for the management (a case report).

Madura foot, relatively easy to diagnose in tropical countries, is very rare and unrecognized in Morocco, causing diagnostic delays. We present the case of a 54-year-old patient with mycetoma for 3 years who initially consulted two general practitioners, then an endocrinologist and finally a dermatologist in order to be diagnosed correctly. The diagnosis of mycetoma based on biological criteria was established at a late stage of irreversible bone lesions; requiring amputation by the orthopedic team. Mycetomas are fungal or bacterial. Delays in diagnosis and care are frequent in Morocco. The diagnosis is based on biology; however, radiological examinations are necessary to assess the extension. The initial treatment is medicinal. Surgery takes place in late stages.