Value of an orthopaedic admission proforma.

BACKGROUND: Admission notes are an important aspect of clinical practice and a vital means of communication among healthcare professionals. Incomplete or poor clinical documentation on admission can lead to delayed surgery. PATIENTS AND METHODS: A retrospective analysis of 20 consecutive admission notes to our department was compared against the Royal College of Surgeons standards (GSP 2014). A new admission proforma was designed, and after the introductory period, two further retrospective cycles were performed. RESULTS: In total, 60 admission notes were analysed. Following the introduction of the proforma, there was an overall improvement in the documentation of the quality and quantity of notes studied. CONCLUSION: Our study demonstrated that a well-structured admission protocol can improve the overall quality of admission notes.

The biomedical applications of nanozymes in orthopaedics based on regulating reactive oxygen species.

Nanozymes, a category of nanomaterials with enzyme-like activity, have garnered growing interest in various biomedical contexts. Notably, nanozymes that are capable of regulating reactive oxygen species levels by emulating antioxidant or prooxidant enzymes within cells hold significant therapeutic potential for a range of disorders. Herein, we overview the catalytic mechanisms of four exemplary nanozymes within the orthopedic domain. Subsequently, we emphasize recent groundbreaking advancements in nanozyme applications in orthopaedics, encompassing osteoarthritis, osteoporosis, intervertebral disc degeneration, bone defects, spinal cord injury, gout, rheumatoid arthritis, osteosarcoma and bone infection. Furthermore, we discuss the emerging area's future prospects and several noteworthy challenges in biomedical application. This review not only fosters the ongoing development of nanozyme research but also fosters the emergence of more potent nanozymes for the treatment of orthopaedical diseases in the future.

Survey of the POSNA Membership Reveals Variability in Use of Tibialis Anterior Tendon Transfer for Recurrent Clubfoot.

PURPOSE: The aim of this project was to survey members of the Pediatric Orthopaedic Society of North America (POSNA) regarding the use of tibialis anterior tendon transfer (TATT) in the management of recurrent clubfoot with dynamic supination and no deformity. We aimed to assess which techniques for TATT are most utilized by pediatric orthopedists. As there has been no general consensus in the literature regarding best methods, we hypothesized that treatment methods would vary widely among POSNA members. METHODS: The online survey, designed using Research Electronic Data Capture (REDCap) survey software, consisted of 15 initial questions, some of which had conditional follow-up questions that appeared if the respondent selected a specific answer choice, with a potential total of 22 questions. The survey was approved by the Evidence Based Practice Committee of POSNA and distributed to their 1,370 members. RESULTS: Only the responses of POSNA members who treated clubfoot and performed TATT were included in the analysis. The 228 survey respondents reached a consensus (75% agreement) on a small number of topics: use of the Ponseti treatment method for clubfoot (94%), transfer of the tibialis anterior tendon to the lateral cuneiform (77%), transfer of only the whole tibialis anterior tendon (79%), and the use of an ankle foot orthoses (94%) among those who reported using postoperative braces. However, the remaining survey questions revealed a marked amount of variability in the performance of TATT. CONCLUSIONS: Many of the questions garnered varied responses, which suggests differing opinions of POSNA members regarding how and when TATT should be performed for recurrent clubfoot with dynamic supination and no deformity. This is one of the first compilations of information about the treatment variations for TATT and may lead to further studies examining ways to standardize and optimize its use.

Comprehensive review of deep learning in orthopaedics: Applications, challenges, trustworthiness, and fusion.

Deep learning (DL) in orthopaedics has gained significant attention in recent years. Previous studies have shown that DL can be applied to a wide variety of orthopaedic tasks, including fracture detection, bone tumour diagnosis, implant recognition, and evaluation of osteoarthritis severity. The utilisation of DL is expected to increase, owing to its ability to present accurate diagnoses more efficiently than traditional methods in many scenarios. This reduces the time and cost of diagnosis for patients and orthopaedic surgeons. To our knowledge, no exclusive study has comprehensively reviewed all aspects of DL currently used in orthopaedic practice. This review addresses this knowledge gap using articles from Science Direct, Scopus, IEEE Xplore, and Web of Science between 2017 and 2023. The authors begin with the motivation for using DL in orthopaedics, including its ability to enhance diagnosis and treatment planning. The review then covers various applications of DL in orthopaedics, including fracture detection, detection of supraspinatus tears using MRI, osteoarthritis, prediction of types of arthroplasty implants, bone age assessment, and detection of joint-specific soft tissue disease. We also examine the challenges for implementing DL in orthopaedics, including the scarcity of data to train DL and the lack of interpretability, as well as possible solutions to these common pitfalls. Our work highlights the requirements to achieve trustworthiness in the outcomes generated by DL, including the need for accuracy, explainability, and fairness in the DL models. We pay particular attention to fusion techniques as one of the ways to increase trustworthiness, which have also been used to address the common multimodality in orthopaedics. Finally, we have reviewed the approval requirements set forth by the US Food and Drug Administration to enable the use of DL applications. As such, we aim to have this review function as a guide for researchers to develop a reliable DL application for orthopaedic tasks from scratch for use in the market.

Non invasive techniques for direct muscle quality assessment after exercise intervention in older adults: a systematic review.

BACKGROUND: The aging process induces neural and morphological changes in the human musculoskeletal system, leading to a decline in muscle mass, strength and quality. These alterations, coupled with shifts in muscle metabolism, underscore the essential role of physical exercise in maintaining and improving muscle quality in older adults. Muscle quality's morphological domain encompasses direct assessments of muscle microscopic and macroscopic aspects of muscle architecture and composition. Various tools exist to estimate muscle quality, each with specific technical requirements. However, due to the heterogeneity in both the studied population and study methodologies, there is a gap in the establishment of reference standards to determine which are the non-invasive and direct tools to assess muscle quality after exercise interventions. Therefore, the purpose of this review is to obtain an overview of the non-invasive tools used to measure muscle quality directly after exercise interventions in healthy older adults, as well as to assess the effects of exercise on muscle quality. MAIN TEXT: To address the imperative of understanding and optimizing muscle quality in aging individuals, this review provides an overview of non-invasive tools employed to measure muscle quality directly after exercise interventions in healthy older adults, along with an assessment of the effects of exercise on muscle quality. RESULTS: Thirty four studies were included. Several methods of direct muscle quality assessment were identified. Notably, 2 studies harnessed CT, 20 utilized US, 9 employed MRI, 2 opted for TMG, 2 adopted myotonometry, and 1 incorporated BIA, with several studies employing multiple tests. Exploring interventions, 26 studies focus on resistance exercise, 4 on aerobic training, and 5 on concurrent training. CONCLUSIONS: There is significant diversity in the methods of direct assessment of muscle quality, mainly using ultrasound and magnetic resonance imaging; and a consistent positive trend in exercise interventions, indicating their efficacy in improving or preserving muscle quality. However, the lack of standardized assessment criteria poses a challenge given the diversity within the studied population and variations in methodologies.. These data emphasize the need to standardize assessment criteria and underscore the potential benefits of exercise interventions aimed at optimizing muscle quality.

Use of allograft bone matrix in clinical orthopedics.

Clinical orthopedics continuously aims to improve methods for bone formation. Clinical applications where bone formation is necessary include critical long bone defects in orthopedic trauma or tumor patients. Though some biomaterials combined with autologous stem cells significantly improve bone repair, critical-size damages are still challenged with the suitable implantation of biomaterials and donor cell survival. Extracellular matrix (ECM) is the fundamental structure in tissues that can nest and nourish resident cells as well as support specific functions of the tissue type. ECM also plays a role in cell signaling to promote bone growth, healing and turnover. In the last decade, the use of bone-derived ECMs or ECM-similar biomaterials have been widely investigated, including decellularized and demineralized bone ECM. In this article, we reviewed the current productions and applications of decellularized and demineralized bone matrices. We also introduce the current study of whole limb decellularization and recellularization.

[Box: see text].

Impact and torsional behavior of additive layer-manufactured biopolymer: An advancement for orthopedic applications.

Distal ulna locking bone plates (DLBPs) are commonly employed in the treatment of distal ulna fractures. However, commercially available metallic bone plates experience stress shielding and lack corrosion resistance. Poly lactic acid (PLA) is highly favored biopolymer due to its biocompatible and bioabsorbable nature with human tissues. The use of additive layer manufacturing (ALM) is gaining attention for creating customized implants with intricate structures tailored to patient autonomy. ALM-based PLA bone plates must provide high resistance against impact and torsional forces, necessitating the adjustment of printing process parameters. This study focuses on examining the influence of key printing parameters, on the impact strength and torque-withstanding capability of DLBPs. Experimental results, along with microscopic images, reveal that an increase in infill density (IF) and wall thickness imparts strong resistance to layers against crack propagation under impact and torsional loads. On the contrary, an increase in layer height and printing speed leads to delamination and early fracture of layers during impact and torsional testing. IF significantly contributes to improving the impact strength and torque-withstanding capability of DLBPs by 70.53% and 80.65%, respectively. The study highlights the potential of the ALM technique in developing DLBPs with sufficient mechanical strength for biomedical applications.

Insuficiente aplicación de Medicina Natural y Tradicional en afecciones relacionadas con la ortopedia y la traumatología / Unsatisfactory Application of Natural and Traditional Medicine in Conditions Related with Orthopedics and Traumatology

La Medicina Natural y Tradicional aplica sus diferentes modalidades en la práctica médica moderna, segura, económica, inocua y simple; y con pocos efectos colaterales resuelve grandes problemas de salud en situaciones especiales o de desastres con recursos limitados. De ahí que el egresado de programas de especialización de las ciencias médicas cuenta con sólidos conocimientos para su aplicación, especialmente en las afecciones osteomioarticulares, donde la especialidad de ortopedia y traumatología tiene un papel primordial para identificar las causas y consecuencias de la insuficiencia de su aplicación en pacientes portadores de afecciones relacionadas con esta especialidad. A través de un estudio crítico reflexivo basado en el análisis y la síntesis, así como de la constatación de la validez de los puntos de vista asumidos como referentes en el proceso de superación del especialista de ortopedia y traumatología, se pudo mostrar cómo se ha concebido la superación profesional en el Hospital General Dr. Juan Bruno Zayas Alfonso, al integrar adecuadamente los conocimientos y las competencias. Esto se expresó en la elaboración e implementación de una estrategia de superación profesional, que permitió la actualización de relevantes conocimientos necesarios en el campo de la MNT para el desempeño de este profesional. Se concluyó que era insuficiente el nivel de conocimiento de los contenidos, como también los cursos ofertados para su desarrollo, lo que trajo como consecuencia una atención médica sin calidad(AU)

Natural and traditional medicine applies its different modalities in modern, safe, economical, innocuous and simple medical practice; with few collateral effects, it solves major health problems in special or disaster situations with limited resources. Hence, the graduate of specialization programs in medical sciences possesses solid knowledge for its application, especially in osteomyoarticular conditions, in which the specialty of orthopedics and traumatology has a key role in identifying the causes and consequences of its unsatisfactory application in patients with conditions related to this specialty. Through a reflexive and critical study based on analysis and synthesis, as well as the verification of the validity of the viewpoints assumed as referents in the process of improvement of the orthopedics and traumatology specialist, it was possible to show how professional improvement has been conceived at Hospital General Dr. Juan Bruno Zayas Alfonso, by adequately integrating knowledge and competences. This was expressed through the elaboration and implementation of a professional improvement strategy, which allowed updating relevant knowledge necessary in the field of natural and traditional medicine for the performance of this professional. The level of knowledge about the contents was concluded to be insufficient, while the courses offered for its development were so, which resulted in a medical care without quality(AU)

Telemedicine After COVID-19: Incorporating Virtual Visits Into Your Practice.

The use of telemedicine services within orthopaedics increased rapidly as a result of the COVID-19 pandemic. Telemedicine may improve access to care and save time and money for patients and clinicians; however, limitations such as technical issues and limited physical examination may reduce its widespread adoption. Virtual visits generally produce equivalent satisfaction and clinical outcomes compared with those performed in person. Although telemedicine has served many different roles within orthopaedic practices, its main utility is for patients who have to travel significant distances and for visits that do not require physical examination to determine a treatment plan. Several regulations govern the use of telemedicine. Most notably, clinicians must be licensed to practice medicine in the state in which the patient is located during the appointment. Although compliance issues remain a potential source of legal issues, experts cite misdiagnosis from limited physical examination as the most likely reason for medical liability. Clinicians should be familiar with techniques for virtual physical examination and should provide instruction to patients before the visit to optimize data obtained.

An update on the advances in the field of nanostructured drug delivery systems for a variety of orthopedic applications.

Nanotechnology has made significant progress in various fields, including medicine, in recent times. The application of nanotechnology in drug delivery has sparked a lot of research interest, especially due to its potential to revolutionize the field. Researchers have been working on developing nanomaterials with distinctive characteristics that can be utilized in the improvement of drug delivery systems (DDS) for the local, targeted, and sustained release of drugs. This approach has shown great potential in managing diseases more effectively with reduced toxicity. In the medical field of orthopedics, the use of nanotechnology is also being explored, and there is extensive research being conducted to determine its potential benefits in treatment, diagnostics, and research. Specifically, nanophase drug delivery is a promising technique that has demonstrated the capability of delivering medications on a nanoscale for various orthopedic applications. In this article, we will explore current advancements in the area of nanostructured DDS for orthopedic use.

Revisión bibliográfica de resultados obtenidos utilizando la Técnica de Masquelet en lesiones complicadas con osteomielitis: a propósito de un caso clínico / Bibliographic review of results obtained using Masquelet's technique in complicated lesions with osteomyelitis: apropos of a clinical case

SUMMARY: The Masquelet technique or membrane induction is considered new in many ways, born under the need to seek therapeutic options in patients with extensive bone lesions. Since this technique was proposed, hopeful and reproducible results have been reported to different centers throughout the world. That is why in this work we seek to collect information from different authors and their case reports, in addition to presenting a case handled in the O'higgins region with this technique. OBJECTIVES: To review the literature regarding general results in bone consolidation in cases similar to the one exposed, in addition to exposing the Masquelet Technique as management in a patient with extensive bone loss, due to a firearm wound. METHODS: descriptive observational study, in addition to a systematic review in databases such as PubMed/MEDLINE, Elsevier, Cochrane and manually through the Internet in journals and public bodies. This work seeks to collect information from different authors and their case reports, in addition to delving into the technique itself, evaluating its indications, contraindications and protocol to follow. The patient's signature of an informed consent was requested, which is explicitly voluntary, in which he authorizes the review of his file, his background and the use of images and / or x-rays pertinent to the research. RESULTS: Inclusion and exclusion criteria were defined to analyze the characteristics of the selected articles. We present the clinical case of a 27-year-old male patient who suffers high-energy injury by firearm in the middle third of the right leg with exposure and loss of musculoskeletal tissue of 12 cm in diameter, polyfragmentary fracture of the proximal third of tibia and fibula, initially damage control is performed which is complicated by presenting osteomyelitis in said limb. It is handled with Masquelet technique. The induction time was approximately 4 months, after the second surgical time the lesion is consolidated in three months showing results similar to the literature studied.

Telemedicine in orthopaedics and trauma surgery during the first year of COVID pandemic: a systematic review.

PURPOSE: Prior to the COVID-19 pandemic, telemedicine in orthopaedics and trauma surgery had mostly developed for joint arthroplasty, fracture management, and general pre- and postoperative care including teleradiology. With the corona-outbreak, telemedicine was applied on a broad scale to prevent assemblage and to guarantee access to medical care protecting critical areas. The purpose of the present study was to give an overview of the spectrum of clinical applications and the efficacy of telemedicine in orthopaedic and trauma surgery as published in times of the COVID-19 pandemic. METHODS: All published studies investigating the application of telemedicine related to orthopaedics and trauma during the COVID-19 pandemic were accessed and screened for suitability. The primary outcome of interest was the efficacy of telemedicine in various clinical applications. The secondary outcome of interest was the spectrum of different applications in which telemedicine applications were investigated. RESULTS: The literature search resulted in 1047 articles. After the removal of duplicates, 894 articles were screened of which 31 finally met the inclusion criteria. Dimensions that were described by studies in the literature to have positive effects were preoperative patient optimisation, the usefulness of telemedicine to correctly diagnose a condition, conservative treatment, willingness to and feasibility for telemedicine in patients and doctors, and postoperative/post-trauma care improvement. The efficacy of telemedicine applications or interventions thereby strongly varied and seemed to depend on the exact study design and the research question addressed. CONCLUSION: Various successful applications of telemedicine have already been reported in orthopaedics and trauma surgery, with a strong increase in scientific output during the COVID-19 years 2020-2021. Whether the advantages of such an approach will lead to a relevant implementation of telemedicine in everyday clinical practice should be monitored after the COVID-19 pandemic.

Involvement of orthopaedic surgeons for cancer patients in orthopaedic training facilities certified by the Japanese Orthopaedic Association - A nationwide survey.

BACKGROUND: In order to improve cancer care in Japan further, it is now required for orthopaedic surgeons to get actively involved in managing locomotive organs such as bones, muscles and nerves in cancer patients. In 2018, the Japanese Orthopaedic Association (JOA) conducted a questionnaire survey to investigate the current status of cancer treatment at the orthopaedic training facilities certified by the JOA. We analyzed the results of that questionnaire survey, focusing on the data from the core hospitals for cancer care (designated cancer hospitals), to clarify the involvement of orthopaedic surgeons in cancer treatment. MATERIALS AND METHODS: A nationwide survey was conducted in the orthopaedic training facilities certified by the JOA using an online questionnaire from March 15th to 31st, 2018. To clarify the involvement of orthopaedic surgeons in cancer treatment, we analyzed the results of that questionnaire survey, focusing on the data from the designated cancer hospitals in Japan. RESULTS: From the questionnaire survey, it became clear that 24% of the orthopaedic training facilities certified by the JOA are designated cancer hospitals. There were significant differences concerning cancer treatment and the prospect of orthopaedic surgeons' involvement in the treatment for bone metastases between institutions classified according to number of both certified orthopaedic surgeons by the JOA and specialists for bone and soft tissue tumors. In addition, in 45% of the designated cancer hospitals, orthopaedic surgeons treated bone metastases that occur in cancer patients, but in the rest of the institutions, orthopaedic surgeons did not yet adequately respond. CONCLUSION: In order to further improve the locomotive function and quality of life (QOL) in cancer patients, it was seemed to be necessary that all medical professionals engaged in cancer treatment, including orthopaedic surgeons, recognize the importance of locomotive management for cancer patients. In addition, the results of this study suggested that the presence of more than six certified orthopaedic surgeons by the JOA, including one or more specialists for bone and soft tissue tumors, may be able to create an environment conducive to the involvement of orthopaedic surgeons in cancer treatment at the facility.

Improved Agreement With American Academy of Orthopaedic Surgeons Clinical Practice Guidelines on Carpal Tunnel Syndrome.

The American Academy of Orthopaedic Surgeons (AAOS) publishes clinical practice guidelines on the diagnosis and management of carpal tunnel syndrome (CTS). Previous versions made controversial recommendations, which failed to yield universal endorsement. Updated guidelines were published in 2016, and we aimed to evaluate agreement with their highest-strength recommendations among members of the American Society for Surgery of the Hand. An online questionnaire was sent to American Society for Surgery of the Hand members. There were 22 questions that inquired about respondents' specialty, experience level, and practice patterns. We sought to determine their level of agreement with 6 of the highest-strength recommendations in the guidelines. We also investigated their awareness of the guidelines and perceived barriers to their use in clinical practice. The response rate was 17%. The typical respondent was a private practice orthopedic surgeon with at least 10 years of practice. The majority of respondents were aware of the AAOS guidelines. Approximately half (55%) felt that there were no significant barriers to their implementation into clinical practice. Overall, our study demonstrated that nearly half of the respondents agreed with the highest-strength recommendations. There is an improved agreement with the current AAOS guidelines on CTS, perhaps because they reflect a more accurate role in assisting physicians with their independent medical judgment, rather than as fixed protocols. We believe that all surgeons managing CTS should be familiar with the AAOS guidelines. [Orthopedics. 2023;46(2):114-120.].

Tratamento funcional das fraturas de tornozelo Weber B com carga e mobilização imediatas / Functional treatment of Weber B ankle fractures with weight-bearing and immediate mobilization

Introdução: As fraturas do tornozelo são lesões comuns, apesar de ocorrer em todas as idades, são mais comuns entre homens jovens e mulheres idosas, constituem cerca de 9% de todas as fraturas, com uma incidência de 107 a 187 por 100.000 pessoas por ano. A abordagem de tratamento selecionada ocorrerá de acordo com as condições do paciente e a opção do médico de acordo com cada situação em específico. Objetivo: Avaliar o desfecho do tratamento não cirúrgico e funcional de pacientes com fraturas estáveis e sem desvio do maléolo lateral tipo Weber B, com carga e mobilização articular imediatas. Método: estudo retrospectivo de uma série de pacientes com fratura estável e sem desvio do maléolo lateral tipo Weber B, que foram tratados de forma não cirúrgica com carga e mobilização articular imediatas, de janeiro 2016 a julho 2022. Os pacientes dessa pesquisa foram provenientes do Hospital do Servidor Público Municipal de São Paulo e da Clínica de Ortopedia e Traumatologia Ortocity. Resultados: Os pacientes tinham idade média de 54,7 anos, diagnosticados após eventos traumáticos (quedas, acidentes, etc.) por meio de exames radiográficos, 50% da amostra com comorbidades, especialmente HAS, 73,3% com desvio de 1mm, mais de 50% com consolidação em até 8 semanas, mais de 60% retornaram às atividades normais em até 16 semanas, as complicações ocorreram em aproximadamente 70% da amostra, porém todas leves e sem necessidade de nova abordagem de tratamento posterior. Conclusão: Nesse sentido, pode-se afirmar que a abordagem conservadora associado à mobilização e carga imediatas formam uma alternativa viável de tratamento, com bons resultados de recuperação funcional, semelhantes aos pacientes tratados por abordagens cirúrgicas, conforme a literatura levantada para este estudo. Palavras-chave: Fratura de tornozelo. Abordagem conservadora. Weber B. Resultados funcionais.

Research trends of mesenchymal stem cells application in orthopedics: A bibliometric analysis of the past 2 decades.

Background: Bibliometric analysis and visualization tools were used to determine the development trend of mesenchymal stem cells (MSCs) in orthopedics in the past 20 years, so as to guide researchers to explore new directions and hotspots in the field in the future. Methods: In the Web of Science Core Collection, all articles about the application of MSCs in orthopedics from 2002 to 2021 were searched. The qualitative and quantitative analysis was performed based on Web of Science and CiteSpace software. Results: A total of 2,207 articles were retrieved. After excluding non-article articles such as review and letter and non-English language articles, 1,489 articles were finally included. Over the past 2 decades, the number of publications on the application of MSCs in orthopedic diseases increased. Among them, the United States, China, Japan and the United Kingdom have made significant contributions in this field. The most productive institution was Shanghai Jiao Tong University. Journal of Orthopedic Research published the largest number of publications. The journal with the highest citation frequency was Experimental Hematology. The authors with the highest output and the highest citation frequency on average were Rochy S. Tuan and Scott A. Rodeo, respectively. "Mesenchymal stem cell", "in vitro" and "Differentiation" were the top three keywords that appeared. From the keyword analysis, the current research trend indicates that the primary research hotspots of MSCs in orthopedics are the source of MSCs, in vitro experiments and the differentiation of MSCs into bone and cartilage. The frontiers of this field are the combination of MSCs and platelet-rich plasma (PRP), the treatment of knee diseases such as osteoarthritis, osteogenic differentiation, and the application of biological scaffolds combined with MSCs. Conclusion: Over the past 2 decades, the application of MSCs in orthopedic diseases has received increasing attention. Our bibliometric analysis results provide valuable information and research trends for researchers in the field to understand the basic knowledge of the field, identify current research hotspots, potential collaborators, and future research frontiers.

Validación de los modelos de impresión 3D paciente-específicos para cirugía ortopédica oncológica pélvica / Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery

Introducción: Los tumores del anillo pélvico suponen un reto por la dificultad de obtener márgenes quirúrgicos adecuados. Herramientas como la navegación quirúrgica o la impresión 3D para la fabricación de plantillas de posicionamiento quirúrgico paciente-específicas ayudan en la planificación preoperatoria y la ejecución intraoperatoria. Su correcta colocación es fundamental en localizaciones complejas como la pelvis, por lo que es necesario identificar los errores de posicionamiento. El objetivo de este estudio es demostrar la fiabilidad en la colocación de plantillas 3D para la realización de osteotomías en el anillo pélvico. Material y métodos: Estudio experimental en cadáver con 10 hemipelvis. Se realiza TC para la obtención del modelo tridimensional, planificación de osteotomías, diseño de plantillas de posicionamiento en rama isquiopubiana (I), iliopubiana (P), supracetabular (S) y cresta iliaca (C); y un marcador de posicionamiento (rigid-body) sobre las plantillas C y S para la navegación. Las plantillas y el rigid-body son impresos en 3D y se colocan según planificación previa. La navegación permite comprobar la posición final de las plantillas y de las osteotomías. Resultados: El posicionamiento de las plantillas respecto a la planificación preoperatoria varió dependiendo de la localización, siendo mayor el error en las de cresta iliaca. Utilizando la navegación, la media de error de distancia al plano de corte está en 3,5mm, excepto en pubis (5-8mm), estando condicionado por la posición del rigid body. Conclusión: El uso de plantillas paciente-específicas impresas en 3D es una herramienta fiable para la realización de osteotomías en cirugía oncológica pélvica.(AU)

Introduction: Pelvic ring tumors pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. Material and methods: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. Results: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis 5-8mm), being conditioned by the position of the rigid body. Conclusion: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.(AU)

[Translated article] Validation of patient-specific 3D impression models for pelvic oncological orthopedic surgery / Validación de los modelos de impresión 3D paciente-específicos para cirugía ortopédica oncológica pélvica

Introducción: Los tumores del anillo pélvico suponen un reto por la dificultad de obtener márgenes quirúrgicos adecuados. Herramientas como la navegación quirúrgica o la impresión 3D para la fabricación de plantillas de posicionamiento quirúrgico paciente-específicas ayudan en la planificación preoperatoria y la ejecución intraoperatoria. Su correcta colocación es fundamental en localizaciones complejas como la pelvis, por lo que es necesario identificar los errores de posicionamiento. El objetivo de este estudio es demostrar la fiabilidad en la colocación de plantillas 3D para la realización de osteotomías en el anillo pélvico. Material y métodos: Estudio experimental en cadáver con 10 hemipelvis. Se realiza TC para la obtención del modelo tridimensional, planificación de osteotomías, diseño de plantillas de posicionamiento en rama isquiopubiana (I), iliopubiana (P), supracetabular (S) y cresta iliaca (C); y un marcador de posicionamiento (rigid-body) sobre las plantillas C y S para la navegación. Las plantillas y el rigid-body son impresos en 3D y se colocan según planificación previa. La navegación permite comprobar la posición final de las plantillas y de las osteotomías. Resultados: El posicionamiento de las plantillas respecto a la planificación preoperatoria varió dependiendo de la localización, siendo mayor el error en las de cresta iliaca. Utilizando la navegación, la media de error de distancia al plano de corte está en 3,5mm, excepto en pubis (5-8mm), estando condicionado por la posición del rigid body. Conclusión: El uso de plantillas paciente-específicas impresas en 3D es una herramienta fiable para la realización de osteotomías en cirugía oncológica pélvica.(AU)

Introduction: Pelvic ring tumors pose a challenge due to the difficulty in obtaining adequate surgical margins. Tools such as surgical navigation or 3D printing for the fabrication of patient-specific surgical positioning templates help in preoperative planning and intraoperative execution. Their correct positioning is essential in complex locations such as the pelvis, so it is necessary to identify positioning errors. The aim of this study is to demonstrate the reliability of 3D template placement for pelvic ring osteotomies. Material and methods: Experimental study in cadaver with 10 hemipelvis. CT was performed to obtain the three-dimensional model, planning of osteotomies, design of positioning templates in ischiopubic (I), iliopubic (P), supracetabular (S) and iliac crest (C) branches; and a positioning marker (rigid-body) on the C and S templates for navigation. The templates and rigid-body are 3D printed and positioned according to pre-planning. Navigation allows the final position of the inserts and osteotomies to be checked. Results: The positioning of the templates with respect to the preoperative planning varied depending on the location, being greater the error in those of the iliac crest. Using navigation the mean error of distance to the cutting plane is 3.5mm, except in pubis 5-8mm), being conditioned by the position of the rigid body. Conclusion: The use of patient-specific templates printed in 3D is a reliable tool for performing osteotomies in pelvic cancer surgery.(AU)