International orthopaedics
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Traditional fluoroscopic techniques during percutaneous fixation of the posterior pelvic ring at times cannot adequately visualize errant or malpositioned iliosacral screws. Intra-operative fluoroscopic techniques have been advanced using multi-dimensional fluoroscopy to generate computed tomography-like images. This provides the surgeon not only the ability to assess iliosacral screw placement, but also the opportunity to assess reduction. We present a case series of four patients in which the Ziehm RFD multi-dimensional fluoroscopy was used to assess reduction and guidepin placement prior to definitive iliosacral screw fixation. ⋯ This retrospective case series demonstrates the direct impact that the Ziehm RFD 3D technology provides in surgical management of patients with complex posterior pelvic ring injuries.
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Review Case Reports
Fat emboli syndrome and the orthopaedic trauma surgeon: lessons learned and clinical recommendations.
Fat emboli syndrome is a rare but well-described complication of long-bone fractures classically characterised by a triad of respiratory failure, mental status changes and petechial rash. In this paper, we present the case of a patient who sustained bilateral femoral fractures and subsequently developed FES. Our aim was to review and summarise the current literature regarding the pathophysiology and management of fat emboli syndrome (FES) and propose an algorithm for treating patients with bilateral femoral fractures to reduce the risk of FES. ⋯ Our algorithm for managing bilateral femoral fractures prioritises early stabilisation with external fixation, staged intramedullary nailing and conversion to plate fixation if FES develops. This protocol is meant to be the basis of future investigations of optimal treatment strategies.
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Early post-operative exercise and weight-bearing activities are found to improve the functional recovery of patients with displaced intra-articular calcaneal fractures (DIACFs). We hypothesized that early functional exercise after surgery might have a secondary reduction effect on the subtalar joint, in particular the smaller fracture fragments that were not fixed firmly. A prospective study was conducted to verify this hypothesis. ⋯ Early functional exercise and weight bearing activity can smooth and shape the subtalar joint and reduce the residual displacement of the articular surface, improving functional recovery of the affected foot. Therefore, early rehabilitation functional exercise can be recommended in clinical practice.
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No functional outcome related to 3-D CT evaluations for calcaneal fractures has been presented. The aims of this study are to analyze the post-operative morphological parameters of calcaneal fractures in 3-D space and to correlate the 3-D morphological parameters with functional outcomes. ⋯ The predictable functional outcome is related to the reconstruction of post-operative morphological characteristics of the calcaneus as evaluated on 3-D CT, especially the Böhler's angle and Gissane's angle. Despite post-operative step-off of the posterior facet exiting, the clinical outcomes appear to be not related to the posterior facet congruity.
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Comparative Study
Comparison of traditional surgery and surgery assisted by three dimensional printing technology in the treatment of tibial plateau fractures.
This study was conducted to compare traditional surgery and surgery assisted by 3D printing technology in the treatment of tibial plateau fractures. In addition, we also investigated the effect of 3D printing technology on the communication between doctors and patients. ⋯ This study suggested the clinical feasibility of 3D printing technology in treatment of tibial plateau fractures.