A novel patient-specific 3D printed guide for accurate femoral derotation osteotomies: a case report.

Background: Femoral malrotation errors are prevalent after intramedullary (IM) nailing for femur fractures. Supposing fracture consolidation has occurred, only a derotation osteotomy can offer a solution to this complication, despite in situ nail interference. The authors present a novel case-based surgical technique using 3D technology to obtain an accurate derotation correction and desired clinical outcome while facilitating surgery technics. Case Description: A 32-year-old woman was referred to our clinic with ongoing right anterior groin pain. Three months earlier, she sustained a high energy fall resulting in a subtrochanteric femur fracture. This was treated with a long IM femoral nail (PFNA™, Synthes, Solothurn, Switzerland) elsewhere. Postoperatively, she developed a limping gait pattern with 'toeing-in' and persistent hip pain during walking. In supine position, a notable axial malalignment towards endo-rotation was visible as compared to the contralateral side. CT-scan showed a side to side difference of 36° anteversion. It was decided to perform a subtrochanteric femoral derotation osteotomy. Outcomes concerning restoration of painless gait and bony healing were successfully obtained at 4 months. Conclusions: The application of a 3D guide with uni-cortical K-wire placement for derotation osteotomies provides additional correction control during surgery and accurate outcome, while facilitating the flow of this technically demanding procedure.

The importance of adequate diagnosis of pediatric forearm bowing fractures: A case report.

INTRODUCTION: Correct diagnosis of pediatric bowing fractures has proven to be challenging. Consequently, these entities are often underdiagnosed both at the initial presentation and at further follow-up. We present a case of an ulnar fracture with subsequent non-union and initially missed associated plastic deformity of the radius to highlight the importance of adequate diagnosis of bowing fractures and obtaining appropriate imaging in pediatric forearm trauma to prevent sequelae. CASE PRESENTATION: A 13-year old male sustained a diaphyseal fracture of the left ulna after a fall on the outstretched hand which was treated conservatively. A non-impact incident (push up on outstretched arm) 4.5 months after the initial trauma caused an ulnar fracture at the same location and was initially considered a simple refracture. Operative treatment was decided on due to significant clinical forearm valgus alignment. Intraoperatively however, a mobile non-union of the ulna was found and anatomic reduction was not possible due to radial bowing. Exploration of the radius showed a clear malalignment with periosteal callus reaction, indicative of a mal-union of the radial bone as a result of the initial injury. To correctly restore alignment, a closing wedge osteotomy of the radius was necessitated followed by plate and screw fixation of both the radius and the ulna. CONCLUSION: In this patient, failure of recognizing the associated plastic deformity of the radius during the initial presentation led to radial malunion and non-union of the ulna. As a result of this complication, an osteotomy was necessary which probably could have been prevented if an adequate initial diagnosis had been made.

Treatment of acute spondylolysis in elite athletes. Literature review and presentation of a new percutaneous grafting technique.

The initial treatment of acute spondylolysis in young elite athletes is conservative. Excellent clinical results are seen when there is osseous healing of the defect. When there is no osseous healing, repetitive and maximal loading of the lumbar spine often remain painful. Osseous healing is more likely when lesions are diagnosed and treated early. When no signs of healing are present at computed tomography (CT-scan) after 4 months of conservative treatment and when pain persists, percutaneous surgical treatment can be considered in elite athletes. We present a new percutaneous bone grafting technique for young elite athletes with acute spondylolysis. Osseous healing was achieved and the patient was able to resume competitive sport activities within 6 months after surgery. This technique can improve fracture biology without muscle damage and without affecting the normal mobility of the spine, eventually leading to osseous healing.