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Usefulness of Three-dimensional Full-scale Models for Simulating and Facilitating Corrective Osteotomy of Malunited Forearm Bones
PAPER 50 4BUVSEBZ 4FQUFNCFS t". $MJOJDBM1BQFS4FTTJPO$PNQVUFST BOE5FDIOPMPHZ
Usefulness of Three-dimensional Full-scale Models for Simulating and Facilitating Corrective Osteotomy of Malunited Forearm Bones
46.."3: Three-dimensional full-scale models provided helpful assistance to surgeons performing corrective osteotomies of malunited forearm bones.
3&'&3&/$& Spine (Phila Pa 1976). 2007 Aug 15;32(18):E532-6. (http://www.ncbi.nlm.nih.gov/pubmed/17700435)
Level 4 Evidence v Kazuki Kuniyoshi, MD, PhD Shinobu Saito, MD Jin Takahashi, MD Takane Suzuki, MD Nahoko Iwakura, MD Ryo Hiwatari, MD Kenichi Murakami, MD Yusuke Matsura, MD Ken Hashimoto, MD
a.
b.
):105)&4*4 Forearm malunions often disturb forearm rotation, and the correction of complicated malunions remains a technically demanding procedure. Recently, 3D computed tomography (CT) data have been employed to create three-dimensional full-scale models, which surgeons then can use to simulate a planned osteotomy and shape the fixation plate preoperatively.
c.
.&5)0% The study comprised 11 patients (9 males, 2 females) with a mean age of 19 years (range: 6-47 years) and a malunion of one or both forearm bones in the diaphyseal to metaphyseal region that limited the range of forearm rotation. Three-dimensional full-scale models created by a rapid prototyping technique using the binder jet method based on 3DCT data were utilized to confirm the deformity and to simulate corrective osteotomy. The model located the center of deformation by comparison with a mirror image model of the uninjured side, after which open-wedge or closed-wedge osteotomy was performed at the center of the deformation. The fixation plate was then shaped to fit onto the osteotomized model, and the shaped plate subsequently was used in the actual surgery. The mean time from injury to surgery was 16 months (range: 4-44 months), and the mean follow-up period was 42 months (range: 36-54 months).
d.
Figure 1. a), b) Radiographs of a case with both bones of forearm bowing by a roller machine. The patient was 21 year-old male whose pronation was limited to 0 degree. c) Note that the distance between the both bones are markedly enlarged during pronation in the injured model compared to the mirror image model of the uninjured side (d) in the same position. Then it can be understood that the interosseous membrane will limit pronation further than the position at which the distance becomes greater than the maximum value of the uninjured.
3&46-54 All patients experienced successful correction of their deformities in accord with their surgical plans. The mean pronation-supination arc significantly (p<0.05, Wilcoxon signed-rank test) improved from 86 degrees (range: 15-130 degrees) preoperatively to 161 degrees (range: 115-180 degrees) postoperatively. The only complication was a plate breakage at the radius in one case two months after surgery; this patient achieved bony union following additional surgery of the iliac bone graft and re-plating.
44
v Speaker has nothing of financial value to disclose
):105)&4*4 Sensory and motor manifestations in carpal tunnel syndrome (CTS) are well documented, whereas the associated autonomic dysfunction is often overlooked. The hypothesis of this study is that autonomic dysfunction of the CTS hands can be quantified by measuring skin capacitance and therefore helpful as a diagnostic tool. a.
b.
.&5)0%4 Patients with clinical and electrophysiological signs of idiopathic CTS meeting the inclusion criteria were recruited. The patients were also scored based on the Brigham carpal tunnel severity score. Skin capacitance was measured using Corneometer CM825 (C&K Electronic, GmbH). The measurements were taken from the palmar aspect of distal phalanx of the index and little finger of the affected hand. Normal healthy patients with no signs and symptoms of carpal tunnel syndrome were recruited as controls and skin capacitance was measured in a similar fashion as the CTS group.
3&46-54 c.
d. Figure 2. a) The center of deformation was confirmed in the radiograph. b), c) The fixation plates were shaped and fit onto the osteotomized model. d) The plates were actually used in the operation.
PAPER 51 4BUVSEBZ 4FQUFNCFS t". $MJOJDBM1BQFS4FTTJPO$PNQVUFST BOE5FDIOPMPHZ
Measurement Of Skin Capacitance: A Novel Method of Diagnosing Autonomic Dysfunction in Carpal Tunnel Syndrome
The CTS group consisted of 78 hands in 50 patients and with an average age of 59.2 years (33-85 years). The mean symptom severity score was 2.80 (1.27 - 4.18; SD 0.82) and functional status score was 2.53 (1 - 4.26; SD 1.08). The mean ratio of skin hydration between the index and little finger was 0.85 (0.24-1.92; SD 0.25). Using the paired t-test to determine paired differences between index and little finger measurements, the mean difference was 8.92 (p<0.001). An age and sex matched control group demonstrated a mean ratio of skin hydration between the index and little finger was 0.97 (0.77-1.42 SD 0.105). Using the paired t-test to determine differences between index and little finger measurements, the mean difference was 1.31 (p=0.317). The difference in skin hydration between the index and little finger was directly compared between the controls and CTS group, this difference was statistically significant, p=0.002.
46.."3:10*/54 ∙
∙
A rapid, simple and reliable quantitative method to determine dysautonomia, has demonstrated statistically significant differences in skin capacitance in patients with CTS. We recommend that this test be used as a potential screening tool in patients with possible CTS and so could reduce the dependence on electrophysiological studies.
Level 3 Evidence v Sujay K. Dheerendra, MRCS Inji W. Ibrahim Wasim S. Khan, MRCS, PhD Peter Smitham, MRCS, PhD Nicholas J. Goddard, FRCS
v Speaker has nothing of financial value to disclose
45
Usefulness of Three-dimensional Full-scale Models for Simulating and Facilitating Corrective Osteotomy of Malunited Forearm Bones
46.."3: Three-dimensional full-scale models provided helpful assistance to surgeons performing corrective osteotomies of malunited forearm bones.
3&'&3&/$& Spine (Phila Pa 1976). 2007 Aug 15;32(18):E532-6. (http://www.ncbi.nlm.nih.gov/pubmed/17700435)
Level 4 Evidence v Kazuki Kuniyoshi, MD, PhD Shinobu Saito, MD Jin Takahashi, MD Takane Suzuki, MD Nahoko Iwakura, MD Ryo Hiwatari, MD Kenichi Murakami, MD Yusuke Matsura, MD Ken Hashimoto, MD
a.
b.
):105)&4*4 Forearm malunions often disturb forearm rotation, and the correction of complicated malunions remains a technically demanding procedure. Recently, 3D computed tomography (CT) data have been employed to create three-dimensional full-scale models, which surgeons then can use to simulate a planned osteotomy and shape the fixation plate preoperatively.
c.
.&5)0% The study comprised 11 patients (9 males, 2 females) with a mean age of 19 years (range: 6-47 years) and a malunion of one or both forearm bones in the diaphyseal to metaphyseal region that limited the range of forearm rotation. Three-dimensional full-scale models created by a rapid prototyping technique using the binder jet method based on 3DCT data were utilized to confirm the deformity and to simulate corrective osteotomy. The model located the center of deformation by comparison with a mirror image model of the uninjured side, after which open-wedge or closed-wedge osteotomy was performed at the center of the deformation. The fixation plate was then shaped to fit onto the osteotomized model, and the shaped plate subsequently was used in the actual surgery. The mean time from injury to surgery was 16 months (range: 4-44 months), and the mean follow-up period was 42 months (range: 36-54 months).
d.
Figure 1. a), b) Radiographs of a case with both bones of forearm bowing by a roller machine. The patient was 21 year-old male whose pronation was limited to 0 degree. c) Note that the distance between the both bones are markedly enlarged during pronation in the injured model compared to the mirror image model of the uninjured side (d) in the same position. Then it can be understood that the interosseous membrane will limit pronation further than the position at which the distance becomes greater than the maximum value of the uninjured.
3&46-54 All patients experienced successful correction of their deformities in accord with their surgical plans. The mean pronation-supination arc significantly (p<0.05, Wilcoxon signed-rank test) improved from 86 degrees (range: 15-130 degrees) preoperatively to 161 degrees (range: 115-180 degrees) postoperatively. The only complication was a plate breakage at the radius in one case two months after surgery; this patient achieved bony union following additional surgery of the iliac bone graft and re-plating.
44
v Speaker has nothing of financial value to disclose
):105)&4*4 Sensory and motor manifestations in carpal tunnel syndrome (CTS) are well documented, whereas the associated autonomic dysfunction is often overlooked. The hypothesis of this study is that autonomic dysfunction of the CTS hands can be quantified by measuring skin capacitance and therefore helpful as a diagnostic tool. a.
b.
.&5)0%4 Patients with clinical and electrophysiological signs of idiopathic CTS meeting the inclusion criteria were recruited. The patients were also scored based on the Brigham carpal tunnel severity score. Skin capacitance was measured using Corneometer CM825 (C&K Electronic, GmbH). The measurements were taken from the palmar aspect of distal phalanx of the index and little finger of the affected hand. Normal healthy patients with no signs and symptoms of carpal tunnel syndrome were recruited as controls and skin capacitance was measured in a similar fashion as the CTS group.
3&46-54 c.
d. Figure 2. a) The center of deformation was confirmed in the radiograph. b), c) The fixation plates were shaped and fit onto the osteotomized model. d) The plates were actually used in the operation.
PAPER 51 4BUVSEBZ 4FQUFNCFS t". $MJOJDBM1BQFS4FTTJPO$PNQVUFST BOE5FDIOPMPHZ
Measurement Of Skin Capacitance: A Novel Method of Diagnosing Autonomic Dysfunction in Carpal Tunnel Syndrome
The CTS group consisted of 78 hands in 50 patients and with an average age of 59.2 years (33-85 years). The mean symptom severity score was 2.80 (1.27 - 4.18; SD 0.82) and functional status score was 2.53 (1 - 4.26; SD 1.08). The mean ratio of skin hydration between the index and little finger was 0.85 (0.24-1.92; SD 0.25). Using the paired t-test to determine paired differences between index and little finger measurements, the mean difference was 8.92 (p<0.001). An age and sex matched control group demonstrated a mean ratio of skin hydration between the index and little finger was 0.97 (0.77-1.42 SD 0.105). Using the paired t-test to determine differences between index and little finger measurements, the mean difference was 1.31 (p=0.317). The difference in skin hydration between the index and little finger was directly compared between the controls and CTS group, this difference was statistically significant, p=0.002.
46.."3:10*/54 ∙
∙
A rapid, simple and reliable quantitative method to determine dysautonomia, has demonstrated statistically significant differences in skin capacitance in patients with CTS. We recommend that this test be used as a potential screening tool in patients with possible CTS and so could reduce the dependence on electrophysiological studies.
Level 3 Evidence v Sujay K. Dheerendra, MRCS Inji W. Ibrahim Wasim S. Khan, MRCS, PhD Peter Smitham, MRCS, PhD Nicholas J. Goddard, FRCS
v Speaker has nothing of financial value to disclose
45