Homemade 3D mirror imaging models utility for surgical treatment of complex fractures of scapula.

The treatment of complex articular scapular fractures requires obtaining an anatomic reduction. The experience of the surgeon and the surgical skills needed are still the most important aspect in this surgical field. 3D printed models at a 1:1 scale provides tactile and visual experience. We used a specular healthy scapula (reverse engineering) as a reliable template for preoperative planning. We pre-contour plates directly over a printed mold, for direct application, without further corrections during the surgical procedure. This reduces improvisation during surgery, the risks of complications and the total costs while improving the accuracy of the anatomical restoration of the native glenopolar angle derived from the indirect reduction of the fracture. Until recently, the use of RP (rapid prototyping) models for managing complex fractures required contracting the services provided by external companies, with the constraints posed on cost and time. We made the whole process ourselves in a DIY mode: from the post-processed radiological images to the 3D model printing, pre contoured plates and surgical simulation.

Coxa vara with proximal femoral growth arrest as a possible consequence of extracorporeal membrane oxygenation: a case report.

Coxa vara is an abnormality of the proximal femur with a decreased neck-shaft angle and resulting leg-length discrepancy, has been associated with conditions such as congenital coxa vara, traumatic injury, sepsis, rickets, vascular damage, or metabolic disorders; however its possible relationship with extracorporeal membrane oxygenation has been recently reported.A full term girl was born with a total infradiaphragmatic anomalous pulmonary venous drainage, at the age of 12 days, an anastomosis of the pulmonary venous trunk with the left auricle and closure of the auricular septal defect was performed; during this procedure extracorporeal membrane oxygenation was used during 104 minutes, no neonatal sepsis was developed. She had no orthopedic issues until she was 3 years and 10 months old, when she presented with limp related to the right lower limb, with no pain. She had a leg-length discrepancy of 2 cm (right - left), limited right hip abduction to 25 degrees , and internal rotation to 5 degrees , also had a positive Trendelenburg test. No flexion/extension abnormalities. Anteroposterior radiographs and magnetic resonance revealed coxa vara with proximal femoral growth arrest. A valgus osteotomy with greater trochanteric epiphysiodesis was performed. At the eight month follow-up, she had no hip pain, better hip range of motion, no difficulties with recreational activities and the osteotomy healed.Another four similar cases had been reported with similar outcome, we think that it will be recommendable to take images in patients with this background and limb leg-length discrepancy or abnormal range of motion.

Posterolateral elbow dislocation with entrapment of the medial epicondyle in children: a case report.

INTRODUCTION: Elbow dislocations in children are uncommon injuries. Dislocations with associated fractures or so-called complex dislocations of the elbow can be challenging to diagnose and treat. CASE PRESENTATION: A 14-year-old male had a posterolateral elbow dislocation after a fall. Closed reduction with traction was performed. Radiographs after initial reduction showed a fragment entrapped into the humero-cubital joint. Computerized tomography scan showed the fragment belonging to the medial epicondyle. Open reduction and internal fixation with a 3.0 millimeter cannulated screw was performed, with restoring of the normal function of the elbow at final follow up. CONCLUSION: Elbow dislocations in children can be associated with bone lesions. These injuries must be suspected to avoid misleading diagnosis and achieve good results.