Der Unfallchirurg
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Possible use of 3D-printing technology in orthopedic surgery ranges from preoperative planning to dedicated counselling with patients by the use of individual 3D models, intraoperative surgery tools or implants and various other applications. This article describes a technique for the creation of intraoperative tools with which the process from computed tomography (CT) images to 3D-printed tools in trauma surgery can safely be administered. ⋯ The standard triangulation file created in this way (file ending: .stl) must subsequently be post-processed. By the use of the digital casts from bone and fractures in computer-aided design (CAD) programs implants and patient individual tools are created, which can range from ortheses to protheses to intraoperative saw guides.
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The incidence and character of civil mass casualty incidents (MCI) has changed in the last decades, in particular because of the rising number of terrorist attacks. As a result, the question arises whether commonly used tools of prevention and prehospital planning, including the distribution of triage categories (T1 severely injured/T2 seriously injured/T3 slightly injured) with 15%/20%/60% have to be modified. The rescue workers make the classification of the triage categories in MCIs at the scene. The aim of this article is to verify the planning size of variable distribution of the triage categories. ⋯ An incidence of 10% T1, 17% T2, 49% T3 and 5% deaths was detected (median). Due to the previously use of the average of the triage categories in the contingency plan, the calculation showed a slightly different distribution from 15%/30%/55%. Of the events 7 were natural disasters, 227 terrorist attacks, 9 accidents and 1 mass panic. Natural disasters showed a higher than average death rate (11%), especially landslide incidents (67%). Civilian accidents showed a distribution of T of 10%/17%/55%, with train derailments having twice as many T1 patients and plane crashes just under twice as many T2 patients. In the case of terrorist attacks, the expected planning parameters were not quite achieved with 14%/15%/39%. Especially "combined hits" and amok driving had high incidences of T1 patients (18% and 21%, respectively). In addition, the T2 patients with 42% in amok driving and 48% in mass panics were well above the planning size of 20% and 30%, respectively. Calculation of the severity factor according to deBoer for amok driving and the result that at S ≥ 1.5 many seriously injured persons can be suspected, amok driving showed the highest degree of severity (S = 1.8) in our study. This indicates the severity of a disaster depending on the number of casualties per triage category.
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The use of 3D printing (synonyms "rapid prototyping" and "additive manufacturing") has played an increasing role in the industry for many years and finds more and more interest and application in musculoskeletal surgery, especially orthopedic trauma surgery. In this article the current literature is systematically reviewed, presented and evaluated in a condensed and comprehensive way according to anatomical (upper and lower extremities) and functional aspects. As many of the publications analyzed were feasibility studies, the degree of evidence is low and methodological weaknesses are obvious and numerous; however, this pioneering work is extremely stimulating and important for further development because the technical, medical and economic potential of this technology is huge and interesting for all those involved in the treatment of musculoskeletal problems.
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There are numerous orthopaedic applications of three-dimensional (3D) printing for the pelvis and acetabulum. The authors reviewed recently published articles and summarized their experience. 3D printed anatomical models are particularly useful in pelvic and acetabular fracture surgery for planning, implant templating and for anatomical assessment of pathologies such as CAM-type femoroacetabular impingement and rare deformities. Custom-made metal 3D printed patient-specific implants and instruments are increasingly being studied for pelvic oncologic resection and reconstruction of resected defects as well as for revision hip arthroplasties with favourable results. This article also discusses cost-effectiveness considerations when preparing pelvic 3D printed models from a hospital 3D printing centre.