Hasil untuk "Orthopedic surgery"

Emma Most, Jonas Hein, Frédéric Giraud et al.

Advances in computer vision, particularly in optical image-based 3D reconstruction and feature matching, enable applications like marker-less surgical navigation and digitization of surgery. However, their development is hindered by a lack of suitable datasets with 3D ground truth. This work explores an approach to generating realistic and accurate ex vivo datasets tailored for 3D reconstruction and feature matching in open orthopedic surgery. A set of posed images and an accurately registered ground truth surface mesh of the scene are required to develop vision-based 3D reconstruction and matching methods suitable for surgery. We propose a framework consisting of three core steps and compare different methods for each step: 3D scanning, calibration of viewpoints for a set of high-resolution RGB images, and an optical-based method for scene registration. We evaluate each step of this framework on an ex vivo scoliosis surgery using a pig spine, conducted under real operating room conditions. A mean 3D Euclidean error of 0.35 mm is achieved with respect to the 3D ground truth. The proposed method results in submillimeter accurate 3D ground truths and surgical images with a spatial resolution of 0.1 mm. This opens the door to acquiring future surgical datasets for high-precision applications.

Lexiang Xiong, Chengyu Liu, Jingwen Ye et al.

Concept erasure in text-to-image diffusion models is crucial for mitigating harmful content, yet existing methods often compromise generative quality. We introduce Semantic Surgery, a novel training-free, zero-shot framework for concept erasure that operates directly on text embeddings before the diffusion process. It dynamically estimates the presence of target concepts in a prompt and performs a calibrated vector subtraction to neutralize their influence at the source, enhancing both erasure completeness and locality. The framework includes a Co-Occurrence Encoding module for robust multi-concept erasure and a visual feedback loop to address latent concept persistence. As a training-free method, Semantic Surgery adapts dynamically to each prompt, ensuring precise interventions. Extensive experiments on object, explicit content, artistic style, and multi-celebrity erasure tasks show our method significantly outperforms state-of-the-art approaches. We achieve superior completeness and robustness while preserving locality and image quality (e.g., 93.58 H-score in object erasure, reducing explicit content to just 1 instance, and 8.09 H_a in style erasure with no quality degradation). This robustness also allows our framework to function as a built-in threat detection system, offering a practical solution for safer text-to-image generation.

Netta Palez, Léonie Straß, Sebastian Meller et al.

Canine gait analysis using wearable inertial sensors is gaining attention in veterinary clinical settings, as it provides valuable insights into a range of mobility impairments. Neurological and orthopedic conditions cannot always be easily distinguished even by experienced clinicians. The current study explored and developed a deep learning approach using inertial sensor readings to assess whether neurological and orthopedic gait could facilitate gait analysis. Our investigation focused on optimizing both performance and generalizability in distinguishing between these gait abnormalities. Variations in sensor configurations, assessment protocols, and enhancements to deep learning model architectures were further suggested. Using a dataset of 29 dogs, our proposed approach achieved 96% accuracy in the multiclass classification task (healthy/orthopedic/neurological) and 82% accuracy in the binary classification task (healthy/non-healthy) when generalizing to unseen dogs. Our results demonstrate the potential of inertial-based deep learning models to serve as a practical and objective diagnostic and clinical aid to differentiate gait assessment in orthopedic and neurological conditions.

Levent Kostem, Fikret Oztop, Ahmet Sebik et al.

Abstract In eight of a total of 53 diagnostic arthroscopy cases, cartilage lesions and additional meniscus lesions resulting frorm intaraticular corticosteroid injections were identified between September 1987 and July 1988.Three of the cases were active sportsmen and all three had necrosis of the meniscus due to local corticosteroid administration following trauma. Mean time span for the onset of symptoms were determined to be eight months after local corticosteroid administration. ÖzetKortizonun uzun süreli sistemik kullanımından sonra veya diz içine lokal uygulanmasından sonra diz ekleminde, özellikle femur kondillerinde kıkırdak nekrozu oluşması çok görülmektedir. Özellikle lokal uygulamada kortizonun meniskus içine yapılması sonucunda meniskuslardaki lezyonlar ortaya çıkmaktadır. Eylül 1987-Temmuz 1988 ayları arasında uyguladığımız toplam 53 tanısal artroskopi olgusunun 8inde intraartiküler kortizon enjeksiyonlarına bağlı kıkırdak lezyonu ve ilave meniskus lezyonları saptadık. 3 olgumuz aktif sporcu olup, her ikisinde de travmayı takiben lokal kortizon uygulaması sonucu meniskusta nekroz ve her iki eklem yüzeylerinde de kıkırdak lezyonları mevcuttu. Olgularda, lokal kortizon uygulamalarından sonra yakınmaların ortaya çıkması ortalama 8 ay olarak saptandı.

Duy Nguyen Anh Tran, Bao Tu Thai Nguyen, Hoan Le Nguyen et al.

Background: Preoperative cognitive function (PCF) is gaining attention as a predictor of surgical outcomes due to its association with muscle function and recovery. Its role in postoperative recovery following transforaminal lumbar interbody fusion (TLIF), however, remains unclear. Objectives: This study aimed to evaluate the impact of PCF on functional and quality-of-life outcomes after TLIF surgery. Materials and Methods: A prospective study of 89 patients undergoing TLIF assessed PCF preoperatively using the Short Portable Mental Status Questionnaire. Outcomes, including Japanese Orthopaedic Association (JOA) and EuroQol 5-Dimensions 3-Level (EQ-5D-3L) scores, were measured at baseline, 3, 6, and 12 months postsurgery. Generalized estimating equations analyzed the associations between PCF and recovery. Results: JOA and EQ-5D-3L scores improved significantly at all postoperative time points, reflecting enhanced functional and quality-of-life outcomes after TLIF. PCF showed a weak-to-moderate negative correlation with JOA and EQ-5D-3L scores across all time points. Greater PCF impairment was associated with lower postoperative JOA (β = −1.432, P = 0.036) and EQ-5D-3L (β = −0.065, P = 0.016) scores. Conclusions: PCF significantly affects postoperative outcomes following TLIF, particularly in early recovery. Assessing and addressing PCF preoperatively could enhance recovery trajectories.

Daniel Suter, Aidana Massalimova, Christoph Johannes Laux et al.

Abstract One of the most established approaches to navigate pedicle screws is the planning and alignment (PA) method. Thereby a trajectory and associated entry point (EP) is planned and navigated after referencing to patient anatomy. However, deviations from the planned EP potentially lead to an altered screw position. The aim of this study was to investigate the influence of these EP deviations and to examine possible alternative methods. The merits of two new points of reference (screw tip point STP and midpoint MP) were therefore analyzed. STP represents the point on the optimal screw tip, MP the point at the center/midportion of the pedicle at its narrowest portion. The adapted screw trajectory was defined as the directional vector from any chosen EP to the STP or MP. First, computer simulations were used to evaluate the performance of these new approaches. Subsequently, the navigation technique yielding more acceptable screws in case of an EP deviation was analyzed on phantom-sawbone models. Both new methods showed a significantly larger number of possible screw trajectories in the simulations (p < 0.01). Even with a deliberate deviation of 4.5 mm (IQR 3.3) from the optimal EP, a perforation-free screw diameter of 4.9 mm (IQR 5.7 mm) could be achieved using the new navigation techniques. The simulated perforations were mainly located laterally with a median of 8.45 mm (IQR 3.95) distance to the medial pedicle wall. The PA method seems to be susceptible to EP deviations. The STP and MP methods are possible improvement mechanisms to overcome this disadvantage.

Chen Chen, Qikai Zou, Yuhang Song et al.

Current orthopedic robotic systems largely focus on navigation, aiding surgeons in positioning a guiding tube but still requiring manual drilling and screw placement. The automation of this task not only demands high precision and safety due to the intricate physical interactions between the surgical tool and bone but also poses significant risks when executed without adequate human oversight. As it involves continuous physical interaction, the robot should collaborate with the surgeon, understand the human intent, and always include the surgeon in the loop. To achieve this, this paper proposes a new cognitive human-robot collaboration framework, including the intuitive AR-haptic human-robot interface, the visual-attention-based surgeon model, and the shared interaction control scheme for the robot. User studies on a robotic platform for orthopedic surgery are presented to illustrate the performance of the proposed method. The results demonstrate that the proposed human-robot collaboration framework outperforms full robot and full human control in terms of safety and ergonomics.

Tiancheng Li, Peter Walker, Danial Hammoud et al.

In computer-assisted orthopedic surgery (CAOS), accurate pre-operative to intra-operative bone registration is an essential and critical requirement for providing navigational guidance. This registration process is challenging since the intra-operative 3D points are sparse, only partially overlapped with the pre-operative model, and disturbed by noise and outliers. The commonly used method in current state-of-the-art orthopedic robotic system is bony landmarks based registration, but it is very time-consuming for the surgeons. To address these issues, we propose a novel partial-to-full registration framework based on gradient-SDF for CAOS. The simulation experiments using bone models from publicly available datasets and the phantom experiments performed under both optical tracking and electromagnetic tracking systems demonstrate that the proposed method can provide more accurate results than standard benchmarks and be robust to 90% outliers. Importantly, our method achieves convergence in less than 1 second in real scenarios and mean target registration error values as low as 2.198 mm for the entire bone model. Finally, it only requires random acquisition of points for registration by moving a surgical probe over the bone surface without correspondence with any specific bony landmarks, thus showing significant potential clinical value.

Jari Dahmen MD, Julian Hollander Bsc, Kishan Ramsodit et al.

Category: Ankle Introduction/Purpose: The aim of this study is to assess the return to sports rate and times after treatment of osteochondral lesions of the ankle in elite level athletes. Methods: All elite level athletes treated for an OLT(P) were selected from a cross-sectional database consisting of consecutive patients with cartilage injuries of the ankle and subsequently underwent prospective follow-up. Outcomes included return to sports outcomes, patient reported outcomes and a qualitative assessment regarding mental health Results: 26 patients with a median age of 22 years (IQR: 19.0 – 24.5) were included with a median follow-up time of 48 months (IQR: 34.5 – 71.0). Seven patients (27%) underwent conservative treatment and 19 patient (73%) operative treatment. Conservative treatment yielded a return to sport rate at any level of 86%, return to pre-injury and return to performance level of both 57%. For operative treatment these rates were 100%, 74% and 63% respectively. Mean time to return to pre-injury level overall was 8.3 months. At latest follow-up only 11 patients (44%) were still active at an elite level of sport. Conclusion: Both conservative and surgical treatment for osteochondral lesions of the ankle yielded return to sport rates above 86% in elite level athletes. The results of this study can be used in the decision-making process between the physician and the elite athlete to inform them about the expected return to sport rates and times for the different treatment options for OLT(P)s. As most athletes at the time of injury and treatment are still highly motivated and disciplined to return to their sport at the same level and be able to compete at the highest level available in their sport.

Soheyla Amirian, Luke A. Carlson, Matthew F. Gong et al.

While artificial intelligence (AI) has made many successful applications in various domains, its adoption in healthcare lags a little bit behind other high-stakes settings. Several factors contribute to this slower uptake, including regulatory frameworks, patient privacy concerns, and data heterogeneity. However, one significant challenge that impedes the implementation of AI in healthcare, particularly in orthopedics, is the lack of explainability and interpretability around AI models. Addressing the challenge of explainable AI (XAI) in orthopedics requires developing AI models and algorithms that prioritize transparency and interpretability, allowing clinicians, surgeons, and patients to understand the contributing factors behind any AI-powered predictive or descriptive models. The current contribution outlines several key challenges and opportunities that manifest in XAI in orthopedic practice. This work emphasizes the need for interdisciplinary collaborations between AI practitioners, orthopedic specialists, and regulatory entities to establish standards and guidelines for the adoption of XAI in orthopedics.

Ruibang Wu, Leizhen Huang, Qinghong Xia et al.

Intervertebral disc degeneration (IDD) is a major contributing factor to both lower back and neck pain. As IDD progresses, the intervertebral disc (IVD) loses its ability to maintain its disc height when subjected to axial loading. This failure in the weight-bearing capacity of the IVD is a characteristic feature of degeneration. Natural polymer-based hydrogel, derived from biological polymers, possesses biocompatibility and is able to mimic the structure of extracellular matrix, enabling them to support cellular behavior. However, their mechanical performance is relatively poor, thus limiting their application in IVD regeneration. In this study, we developed an injectable composite hydrogel, namely, Mel-MBG/SA, which is similar to natural weight-bearing IVD. Mesoporous bioactive glasses not only enhance hydrogels, but also act as carriers for melatonin (Mel) to suppress inflammation during IDD. The Mel-MBG/SA hydrogel further provides a mixed system with sustained Mel release to alleviate IL-1β-induced oxidative stress and relieve inflammation associated with IDD pathology. Furthermore, our study shows that this delivery system can effectively suppress inflammation in the rat tail model, which is expected to further promote IVD regeneration. This approach presents a novel strategy for promoting tissue regeneration by effectively modulating the inflammatory environment while harnessing the mechanical properties of the material.

Stephen Doxey, DO, Arthur J. Only, MD, Michael Milshteyn, MD et al.

Abstract. Objectives:. The purpose of this study was to obtain information on Canadian orthopaedic trauma surgeon practices and salary demographics. It was hypothesized that most of the practicing surgeons recognize specific practice aspects (compensation, call schedule, operating room availability, and provided support staff) as key factors in employment opportunity evaluation. Design:. Cross-sectional survey study. Setting:. Orthopaedic Trauma Association (OTA) practice surveys. Participants:. All active Canadian members of the OTA were eligible to participate. Main Outcome Measurement:. A 50-question survey was sent through email to OTA members assessing physician, practice, and compensation metrics of Canadian orthopaedic traumatologists. Results:. Fifty-two of 113 Canadian OTA members participated giving a response rate of 46%. All surgeons worked in an academic practice, either for a university (83%) or community hospital (17%). Only 2% of surgeons have changed jobs in the last 5 years, and over 73% of surgeons maintain the same place of employment during their careers. Most had an available dedicated orthopaedic trauma operating room (73%). The majority indicated having residents (71%) and fellows (63%) as support staff. Many reported completing 300–500 cases per year (42%), which decreased during COVID-19 for 50% of surgeons. The most common reported compensation was between $400,000 and $600,000 US dollars (25%) with many working 4–6 call shifts a month (48%) and 51–70 hours a week (48%). Conclusion:. This study demonstrated the varying practice and physician economic variables currently in Canada. The identification and continued surveillance of these employment variables will allow for transparency in job market evaluation by applicants. Level of Evidence:. Level V.

Michael M.H. Yang, MD, MSc, MBiotech, Jay Riva-Cambrin, MD, MSc, Jonathan Cunningham, MD, MSc et al.

Background: Approximately 30% to 64% of patients experience inadequate pain control following spine surgery. The Calgary postoperative pain after spine surgery (CAPPS) score was developed to identify this subset of patients. The impact of preoperative insomnia on postoperative pain control is unknown. This study aimed to investigate the relationship between preoperative insomnia and poor pain control after spine surgery, as well as improve the predictive accuracy of the CAPPS score. Methods: A prospective cohort study was conducted in patients undergoing elective spine surgery. Poor pain control was defined as a mean numeric rating scale pain score >4 at rest within the first 24-hours after surgery. Patients were evaluated using the CAPPS score, which included 7 prognostic factors. A multivariable logistic regression model was used to examine the association between preoperative insomnia severity index (ISI) and poor pain control, adjusting for the CAPPS score. The Modified CAPPS score was derived from this model. Results: Of 219 patients, 49.7% experienced poorly controlled pain. Prevalence of clinical insomnia (ISI≥15) was 26.9%. Preoperative ISI was independently associated with poor pain control (odds ratio [OR] 1.09, [95%CI=1.03–1.16], p=.004), after adjusting for the CAPPS score (OR 1.61, [95%CI=1.38–1.89], p<.001). The model exhibited good discrimination (c-statistics 0.80, [95%CI=0.74–0.86]) and calibration (Hosmer-Lemeshow chi-square=8.95, p=.35). The Modified CAPPS score also demonstrated good discrimination (c-statistic 0.78, [95%CI=0.72–0.84]) and calibration (Hosmer-Lemeshow chi-square=2.92, p=.57). Low-, high-, and extreme-risk groups stratified by the Modified CAPPS score had 17.3%, 49.1%, and 80.7% predicted probability of experiencing inadequate pain control compared to 32.0%, 64.0%, and 85.1% in the CAPPS score. Conclusions: Preoperative insomnia is prevalent and is a modifiable risk factor for poor pain control following spine surgery. Early identification and management of preoperative insomnia may lead to improved postoperative pain outcomes. Future external validation is needed to confirm the accuracy of the Modified CAPPS score.

Yoshiharu Shimozono MD, Hiromu Ito, Hayato Ryoki et al.

Category: Arthroscopy; Ankle; Arthroscopy; Sports Introduction/Purpose: Arthroscopic techniques have been increasingly used to repair the anterior talofibular ligament (ATFL) for lateral ankle instability, however there are still concerns on complications, such as nerve injury, iatrogenic cartilage damage and wound scar. Additionally, standard suture anchors can cause prominent knots. Recently, a novel needle-arthroscopic system (NanoScope TM ) has been introduced, with a 1.9-mm diameter arthroscope and semirigid frame, which can reduce conventional arthroscopic-related complications by minimizing the skin incisions and provide excellent visualization without ankle distraction due to its small and semirigid features. The purpose of this surgical technical note is to describe a new, very minimally invasive surgical technique for the ATFL repair using this needle-arthroscopy with a knotless suture anchor, which has the potential to reduce both conventional arthroscopic-related and knot-related complications. Methods: We have developed a novel surgical treatment of the ATFL repair for lateral ankle instability in a cadaveric model. The arthroscopic system (NanoScope TM , Arthrex, Naples, FL) is used during the procedures. The handpiece tube is 9.5-cm long, semi-rigid and has a 1.9-mm outer diameter. The scope's direction of view is 0°, with a 120° field of view. The patient is placed in a supine position and no distraction is applied to the ankle joint. Standard anteromedial and anterolateral portals are first used. An accessory anterolateral (AAL) portal is then created around 1.5 cm anterior to the tip of the fibula, of which the portal position is determined under the visualization through the anterolateral portal. Results: Almost all of the talar and tibial surfaces are reachable without distraction, due to its small and semirigid features. There is no difficulty problem obtaining proper visualization of the ATFL and the surrounding structures during the whole procedures, due to a wide 120°-field of view. The major steps of the procedure are (1) suture anchor insertion into the distal fibula through the AAL portal using a Knotless SutureTak Anchor (Arthrex), (2) penetration of suture string into the ATFL remnant using a Micro SutureLasso TM (Arthrex), (3) capture of the ATFL remnant using a suture-relay technique, (4) reattachment of the ATFL remnant by pulling out the passing wire without knot-tying, in the dorsiflexed ankle position (Figure). All skin-incisions are tiny and require only paper skin closures. This method requires neither blunt dissection of subcutaneous tissue to pass the suture nor knot-tying to reattach the ATFL. Conclusion: Our technique is a simple, feasible, and very minimally invasive anatomic repair of the ATFL for lateral ankle instability using a 1.9-mm diameter needle-arthroscopy with a knotless suture anchor. However, the long-term clinical results need to be evaluated in future studies.

FELIPE RAMALHO GUEDES, FERNANDA MINUTTI NAVARRO, RODRIGO YUITI NAKAO et al.

ABSTRACT Objective: To evaluate the prevalence of low back pain in nurses at a university hospital in São Paulo and establish a relationship with social aspects. Methods: A cross-sectional study was carried out, through the application of a questionnaire containing social questions(weight, age, height, work sector, working hours, physical activity, presence and frequency of low back pain) in addition to the Oswestry questionnaire. Results: One hundred fifty-three nurses participated in the study. Of these, 92.30% of the women and 73.91% of the men presented low back pain, with a third classifying the pain as sporadic. In relation to BMI, pain is lower in those who are underweight (60%) and higher among those who are overweight (96.77%). Most of the sample was sedentary (66%), and of these, 96% had low back pain. There was no difference in the comparison by working hours, in relation to work sector, pain was more present in the following sectors: coordination (100%); children’s ward (92%); adult emergency room (90%) and adult ICU (31%). Thirty nurses worked double shifts, and of these, 90% reported low back pain, while among those who worked only at the university hospital, 89.4% reported pain. In relation to working hours, the longer the working day, the greater the pain. In the function assessment (Oswestry), 99 participants obtained a value of up to 30% disability. Conclusion: Based on the results of this work, it is concluded that there is a high prevalence of low back pain in nurses at the Hospital Universitário; however, it was not possible to determine a direct risk factor associated with this high prevalence. Level of Evidence IV; Cross-sectional study.

Kay Hutchinson, Zongyu Li, Leigh A. Cantrell et al.

Background Analyzing kinematic and video data can help identify potentially erroneous motions that lead to sub-optimal surgeon performance and safety-critical events in robot-assisted surgery. Methods We develop a rubric for identifying task and gesture-specific Executional and Procedural errors and evaluate dry-lab demonstrations of Suturing and Needle Passing tasks from the JIGSAWS dataset. We characterize erroneous parts of demonstrations by labeling video data, and use distribution similarity analysis and trajectory averaging on kinematic data to identify parameters that distinguish erroneous gestures. Results Executional error frequency varies by task and gesture, and correlates with skill level. Some predominant error modes in each gesture are distinguishable by analyzing error-specific kinematic parameters. Procedural errors could lead to lower performance scores and increased demonstration times but also depend on surgical style. Conclusions This study provides insights into context-dependent errors that can be used to design automated error detection mechanisms and improve training and skill assessment.

Nitish Maharjan, Abeer Alsadoon, P. W. C. Prasad et al.

Background and aim: Image registration and alignment are the main limitations of augmented reality-based knee replacement surgery. This research aims to decrease the registration error, eliminate outcomes that are trapped in local minima to improve the alignment problems, handle the occlusion, and maximize the overlapping parts. Methodology: markerless image registration method was used for Augmented reality-based knee replacement surgery to guide and visualize the surgical operation. While weight least square algorithm was used to enhance stereo camera-based tracking by filling border occlusion in right to left direction and non-border occlusion from left to right direction. Results: This study has improved video precision to 0.57 mm~0.61 mm alignment error. Furthermore, with the use of bidirectional points, for example, forwards and backwards directional cloud point, the iteration on image registration was decreased. This has led to improve the processing time as well. The processing time of video frames was improved to 7.4~11.74 fps. Conclusions: It seems clear that this proposed system has focused on overcoming the misalignment difficulty caused by movement of patient and enhancing the AR visualization during knee replacement surgery. The proposed system was reliable and favorable which helps in eliminating alignment error by ascertaining the optimal rigid transformation between two cloud points and removing the outliers and non-Gaussian noise. The proposed augmented reality system helps in accurate visualization and navigation of anatomy of knee such as femur, tibia, cartilage, blood vessels, etc.

Sanjay Bhalchandra Londhe, Ravi Vinod Shah, Meghana Patwardhan et al.

Abstract Purpose The aim of this prospective study was to understand the fear and apprehension factors that play on patient’s mind before total knee arthroplasty. Methods This retrospective cohort study included 500 consecutive patients (375 females and 125 males) who were scheduled to undergo total knee arthroplasty the next day. The patients were asked to list the most important fear in their mind regarding the operation in descending order of importance. They were given a questionnaire form which contained several capture points, including age, gender, educational background, occupation, and provision of help at home. Preoperative pain was measured by using the visual analog score, and its influence on the patients’ fear and apprehension factors was also measured. Results In this study, 58% of patients (50 males, 40%; 240 females, 64%) were fearful of the pain that they would experience after surgery and during the postoperative physiotherapy. The female patients showed more fear of pain than their male counterparts (P < 0.05). 18% of the patients (40 males, 32%; 50 females, 13%) listed whether they will be able to walk and perform activities of daily living after surgery as the most important fear. The male patients had more fear of returning to normal walking (P < 0.05). 20% of the patients (30 males, 24%; 70 females, 19%) were fearful about getting adequate home help after discharge from hospital (P > 0.05). 4% of patients were concerned about withstanding such a major operation. There was no difference between male and female patients (P > 0.05). Conclusion The majority of the patients experience apprehension of pain in the perioperative period of TKA. Preoperative counseling benefits pain management by alleviating the patient’s concerns about the fear of postoperative pain and apprehension of returning to normal walking.

Turker Ozkan, Fatih Kabakas, Atakan Aydin et al.

Abstract Objectives: We evaluated the long-term results of patients who underwent reconstruction with pedicled flaps for soft tissue and sensory restoration. \nMethods: The study included 30 patients (26 males, 4 females; mean age 33 years; range 16 to 62 years) who underwent sensory restorations of the thumb (n=24), the index finger (n=3), and the little finger (n=3). Twenty-seven patients received neurovascular island flaps and three patients received radial innervated cross-finger flaps. Disconnection-reconnection of the nerve was performed in 11 patients receiving a neurovascular island flap. Sensory evaluations were made with two-point discrimination and the Semmes-Weinstein monofilament test. The mean follow-up was 29.2 months (range 5 to 144 months). \nResults: There were no cases of flap loss. Contractures of donor digits were seen in four patients (14.8%) treated with neurovascular island flaps. Neuroma formation was noted in two patients (18.2%) in whom the disconnection-reconnection technique was used. Static and moving two-point discrimination test results were 9.1 mm and 7.4 mm with the disconnection-reconnection technique, 8.3 mm and 7 mm with the original technique, and 10.3 mm and 8.6 mm with radial innervated cross finger flaps, respectively. Sensation was at the recipient site in all the patients who underwent disconnection-reconnection. Of those in whom the original technique was employed, nine patients (56.3%) localized sensation at the recipient site, three patients (18.8%) at the donor site, while four patients (25%) showed double sensibility.\nConclusion: Pedicled flaps are reliable and satisfactory alternatives for soft tissue and sensory restoration of hand injuries and disconnection-reconnection of the nerve is effective in preventing double sensibility. Özet Amaç: Elde duyu ve yumuşak doku restorasyonu için pediküllü fleplerle onarım yapılan hastaların geç dönem sonuçları değerlendirildi.\nÇalışma planı: Çalışmaya 30 hasta (26 erkek, 4 kadın; ort. yaş 33; dağılım 16-62) alındı. Yirmi dört hastada başparmak, üçünde işaret parmağı, üçünde beşinci parmak ulnar taraf duyu restorasyonu yapıldı. Yirmi yedi hastada damarlı ve sinirli ada flebi, üç hastada duyulu çapraz parmak flebi kullanıldı. Onarımda damarlı ve sinirli ada flebi kullanılan hastaların 11’inde sinir ayırma ve tekrar birleştirme tekniği uygulandı. Duyu değerlendirmesi Semmes-Weinstein monofilaman testi ve iki nokta ayrım testiyle yapıldı. Ortalama izlem süresi 29.2 ay (dağılım 5-144 ay) idi.\nSonuçlar: Hiçbir hastada flep kaybı gözlenmedi. Damarlı ve sinirli ada flebi uygulanan dört hastada (%14.8) donör parmaklarda kontraktür oluştu. Ayırma-tekrar birleştirme yöntemi uygulanan iki hastada (%18.2) tenar alanda nöroma oluşumu gözlendi. Statik ve hareketli iki nokta ayrım testleri, ayırma-tekrar birleştirme yapılan hastalarda sırasıyla ortalama 9.1 mm ve 7.4 mm, orijinal tekniğin uygulandığı hastalarda 8.3 mm ve 7 mm, duyulu çapraz parmak flebi uygulanan hastalarda ise 10.3 mm ve 8.6 mm olarak ölçüldü. Ayırma-tekrar birleştirme yapılan tüm hastalarda duyu lokalizasyonu alıcı sahada algılandı. Orijinal tekniğin uygulandığı 16 hastanın dokuzu (%56.3) duyuyu alıcı sahada lokalize ederken, üçü (%18.8) verici sahada algıladı. Dört hastada (%25) ise çapraz duyarlılık gözlendi.\nÇıkarımlar: Pediküllü flepler, parmaklarda hem yumuşak doku hem de duyu restorasyonu açısından oldukça güvenilir ve tatminkar seçeneklerdir. Ayırma-tekrar birleştirme işlemi çapraz duyarlılığı engellemek açısından oldukça başarılıdır.

Yuqi Zhang, Minxun Lu, Li Min et al.

Abstract Background This study is to describe the design and surgical techniques of three- dimensional-printed porous implants for proximal giant cell tumors of bone and evaluate the short-term clinical outcomes. Methods From December 2016 to April 2020, 8 patients with giant cell tumor of bone in the proximal tibia underwent intralesional curettage of the tumor and reconstruction with bone grafting and three-dimensional-printed porous implant. Detailed anatomy data were measured, including the size of lesion and thickness of the subchondral bone. Prostheses were custom-made for each patient by our team. All patients were evaluated regularly and short-term clinical outcomes were recorded. Results The mean follow-up period was 26 months. According to the different defect sizes, the mean size of the plate and mean length of strut were 35 × 35 mm and 20 mm, respectively. The mean affected subchondral bone percentage was 31.5%. The average preoperative and postoperative thickness of the subchondral bone was 2.1 mm and 11.1 mm, respectively. There was no wound infection, skin necrosis, peroneal nerve injury, or other surgical related complications. No degeneration of the knee joint was found. Osseointegration was observed in all patients. The MSTS improved from an average of 12 preoperatively to 28 postoperatively. Conclusion The application of three-dimensional-printed printed porous prosthesis combined autograft could supply enough mechanical support and enhance bone ingrowth. The design and operation management lead to satisfactory subchondral bone reconstruction.