Injury
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Diaphyseal fractures of the clavicle had until recently the reputation to always heal with abundant callus formation, except if operated, due to a reported high rate of nonunion after plate fixation by older series. The reason would be that the bone has only periosteal vascularization, easily destroyed by periosteal stripping for implant apposition. ⋯ Are these classical considerations still valid nowadays? The purposes of this article focusing only on diaphyseal clavicular fractures are to review the vascularization of the bone, the rate of nonunion after nonoperative treatment, the indications and techniques of osteosynthesis, and the treatment possibilities of an established nonunion. This article will not deal with the specific problems of the lateral clavicular fractures, which are equivalent to acromio-clavicular fracture-dislocations, nor of medial fractures, close to the sterno-clavicular joint.
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The training to learn how to perform perforator flaps requires practice on a living model to optimize dissection and to evaluate outcome. The purpose of this study was to describe a training model that optimizes the use of animals in order to perform the maximum number of exercises per animal. ⋯ The training sequence proposed offers a wide range of exercises and allows four trainees, divided in two teams, to work and learn on the same animal. They can perform a wide range of flaps and also harvest the internal mammary vessels. The living model allows for evaluation of the quality of the surgical performance, judged by the difficulties and complications encountered during dissection, and finally through the feedback of flap perfusion.
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Three-dimensional (3D) printing has emerged as an innovative technology to derive a maximum benefit from high-resolution tomography images and virtual 3D reconstructions. The present study describes a novel technique using a 3D printed model for harvesting osteochondral medial femur condyle (MFC) flap to replace the proximal pole of the scaphoid in case of proximal avascular pole. MFC bone grafting has already proved to be reasonable surgical method for this indication. ⋯ In summary, 3D printing is an innovative, feasible technology to aid in various surgical steps while performing a MFC flap for posttraumatic avascular proximal scaphoid pole. It enhances the surgeon's perception of complex patient-specific pathologies and intraoperative accuracy. Especially, we emphasize the benefit of a handlebar on the 3D model, because it enormously improves its maneuverability and usability.