Three-dimensional reconstruction of the upper limb from anatomical slices of the Korean visible human: simulation and educational application.

PURPOSE: Digital anatomy is a novel emerging discipline. Use of virtual reality brings a revolution in educational anatomy by improving retention and learning outcomes. Indeed, virtual dissection is a new learning tool for students and surgeons. Three-dimensional vectorial models of the human body can be created from anatomical slices obtained by lengthy series of cryosection from the visible human projects. The aim of this paper is to show how these mesh models could be embedded into an Acrobat® 3dpdf interface, to produce an easy-to-use fully interactive educational tool. METHODS: The learning of this method and its practical application were evaluated on a multicentric cohort of 86 people divided into 3 groups, according to the duration of their training (1, 2 or 3 days, respectively). Participants learned how to use the Mesh tool and how to model 3D structures from anatomical sections. At the end of the training, they were given a survey form. Participants were also asked to rate the training (Poor; Average; Good; Very Good; Excellent). RESULTS: Ninety four percent of the subjects rated the device as excellent and would continue to use digital anatomy in their practice. CONCLUSION: This result is the Diva3d® virtual dissection table, a powerful educational tool for anatomists and students. It could also be the basis of future simulation tools for hand surgeons training.

Benefits of WALANT in palliative upper limb surgery after nerve injury.

Wide-Awake Local Anesthesia No Tourniquet (WALANT) may be a satisfactory anesthesia alternative for the management of upper limb peripheral nerve palsy sequelae. The main advantages are the possibility of active patient cooperation through intraoperative active mobilization, comfort and cost reduction. The legislation about WALANT in France remains unclear; the modalities of lidocaine epinephrine injection should be redefined. For palliative upper limb surgery, WALANT allows the surgeon to adjust the tension on the tendon transfer intraoperatively. Level 1 studies are needed to evaluate the effectiveness of WALANT relative to standard anesthesia techniques (regional/general anesthesia).

Primary digital localization of extra-axial extra-osseous soft-tissue chordoma: A case report.

We report a case of digital extra-axial extra-osseous soft-tissue chordoma located in a flexor synovial sheath of the little finger of the left hand. Histology-immunohistochemistry (brachyury) analysis after broad en-bloc resection confirmed the diagnosis. Exhaustive MRI assessment of the entire spine, skull and pelvis found no other locations. No recurrence was reported at last follow-up. Hand surgeons should be aware of the diagnosis and treatment of brachyury-positive extra-axial soft-tissue chordomas, whence the importance of recognizing its typical and differential characteristics to guide optimal therapeutic strategy.

Traumatic Posterior Shoulder Dislocation during Judo in a Child and Literature Review.

INTRODUCTION: Traumatic posterior dislocation of the shoulder is exceedingly rare in pediatric patients. Main causes are obstetrical brachial plexus injury; congenital abnormalities of the glenohumeral joint; and voluntary dislocation, which are often multidirectional. Treatment is not consusual and depends on early diagnosis. CASE REPORT: Posterior shoulder dislocation was diagnosed in a 9-year-old boy while practicing judo. His right upper limb was held adducted and internally rotated and could not be externally rotated. Bloom-Obata axial view and computed tomography-scan allowed us to make the diagnosis. Reduction was performed under general anesthesia. No injuries were detected on post-reduction magnetic resonance imaging. At 18 months patient had recovered all his shoulder mobility. CONCLUSION: Traumatic posterior shoulder dislocation is exceedingly rare in pediatric patients. Treatment is easy and effective at the acute phase. Awareness of the presentation of posterior shoulder dislocation is crucial to allow the early diagnosis and treatment.