Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

AIM: To compare the postoperative mechanical alignment achieved after total knee arthroplasty(TKA) using computer tomography(CT) based patient specific blocks(PSB) to conventional instruments(CI).METHODS: Total 80 knees were included in the study, with 40 knees in both the groups operated using PSB and CI. All the knees were performed by a single surgeon using the same cruciate sacrificing implants. In our study we used CT based PSB to compare with CI. Postoperative mechanical femoro-tibial angle(MFT angle) was measured on long leg x-rays using picture archiving and communication system(PACS). We compared mechanical alignment achieved using PSB and CI in TKA using statistical analysis.RESULTS: The PSB group(group 1) included 17 females and seven males while in CI group(group 2) there were 15 females and eight males. The mean age of patients in group 1 was 60.5 years and in group 2 it was 60.2 years. The mean postoperative MFT angle measured on long-leg radiographs in group 1 was 178.23°(SD = 2.67°, range: 171.9° to 182.5°) while in group 2, the mean MFT angle was 175.73°(SD = 3.62°, range: 166.0° to 179.8°). There was significant improvement in postoperative mechanical alignment(P value = 0.001), in PSB group compared to CI. Number of outliers were also found to be less in group operated with PSB(7 Knee) compared to those operated with CI(17 Knee).CONCLUSION: PSB improve mechanical alignment after total knee arthroplasty, compared to CI. This may lead to lower rates of revision in the PSB based TKA as compared to the conventional instrumentation.

Nonunion of coronal shear fracture of femoral condyle

大腿骨的髁的孤立的花冠破裂在成年人是稀罕的并且 Hoffa 骨折不属于工会被报导仅仅在文学的一些时间。我们分析了六个案例在三年的一个时期上的 Hoffa 破裂不属于工会。三个病人保存地被对待，三个病人有固定失败。表示的延期是到一年的 2 个月。治疗协议与膝 arthrolysis 一起由开的减小， pseudoarthrosis 的切除，骨头 grafting 和内部固定组成了。联合在平均数 16 星期在所有病人被完成。治疗 Hoffa 破裂不属于工会要求小心的外科手术前的计划和过细的外科的技术。关于在破裂管理和外科的技术的争吵的文学被考察。

Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma

Purpose:The technology of 3D printing(3DP)exists for quite some time,but it is still not utilized to its full potential in the field of orthopaedics and traumatology,such as underestimating its worth in virtual preoperative planning(VPP)and designing various models,templates,and jigs.It can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated complications.Methods:An observational study was done including 91 cases of complex trauma presented in our institution requiring operative fixation.Virtual preoperative planning and 3DP were used in the management of these fractures.Surgeons managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative data.Results:In all the 91 cases,where VPP and 3DP were used,the surgeons were satisfied with the outcome which they got intraoperatively and postoperatively.Surgical time was reduced,with a better outcome.Three dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and fixation.The average score of the questionnaire was 4.5,out of a maximum of 6,suggesting a positive role of 3DP in orthopaedics.Conclusion:3DP is useful in complex trauma management by accurate reduction and placement of implants,reduction of surgical time and with a better outcome.Although there is an initial learning curve to understand and execute the VPP and 3DP,these become easier with practice and experience.

A Galeazzi-variant type fracture-dislocation in adults

有在近似或远侧的桡尺骨的关节(DRUJ ) 的脱臼任何一个的半径或尺骨的 ObjectiveFracture 不是普通损害并且内在地是不稳定的。这里，我们报导一个案例系列，与与 DRUJ 的脱臼联系的两个骨头前臂破裂，作为 Galeazzi 变体的类型破裂脱臼，并且试着分析学习基于 6 个病人有的这损害 pattern.MethodsThe 不同年龄(20 ～ 45 年) 的 Galeazzi 变体的类型破裂脱臼。所有破裂是关上的类型。二破裂包含了一样的水平，三破裂在半径和尺骨柄的不同层次。在彻底的检查和调查以后，他们与有限接触被对待没有为 DRUJ.ResultsAll 案例的另外的固定的动态压缩板被跟随在上面为 24 个星期。最大的发生发生在在 31 和 40 年之间的年龄组。半径和尺骨的所有破裂在 12 个星期的平均时间被统一。在最后的后续的手腕和肘，旋后和内转的运动的范围是正常的。没有在任何在成年人的 cases.ConclusionGaleazzi 变体的 DRUJ 的随后的 re-subluxation 或脱臼是有手腕损害的前臂的一个新 undescribed 模式。稳定的开的减小和两个骨头前臂破裂的内部固定是强制的，为破坏 DRUJ 愈合在一个演员组到 3 ～ 4 星期固定列在后面。

Periprosthetic subtrochanteric femoral fracture in a megaprosthesis of the knee

我们在膝的 megaprosthesis 以后报导腿节的 subtrochanteric 区域的 periprosthetic posttraumatic 骨折的一个稀罕案例，做为抵抗有在 51 岁人的第二等的 osteoarthrosis 的远侧的腿节不属于工会。有锁住的治疗大腿骨的板能与好结果完成主要联合。

Bilateral segmental pelvic and femoral fractures in a young female： A rare case report

尽管有前进，多重复杂受伤病人的管理在现代医疗保健仍然是大挑战。我们在场与双边的部分大腿骨的柄联系的双边的不稳定的骨盆的破裂的一个稀罕案例断裂。我们建议了如此的复杂损害模式的机制并且讨论了管理的计划。在稳定病人的医学上帮助了我们的病人克服这些严重、致命的损害后不久，我们相信修理所有专业的及时、好攻击的外科的干预断裂。由进行为如此的复杂破裂的管理建立一个最佳的协议是必要的未来并且 multicentric 以后学习。