Zakaria Chabihi

The study aimed to develop and validate a 3D-printed foot length scale for predicting intramedullary nail lengths in long bone fractures. The device utilizes the European (EU) foot length scale and regression models derived from retrospective patient data to estimate nail lengths for the femur, tibia, and humerus. The study involved two phases: (1) retrospective data collection and analysis to establish correlations between foot length and nail length, and (2) design, development, and validation of the 3D-printed device. Retrospective data were collected from 205 patients who underwent intramedullary nailing. The device was designed to measure foot length and estimate nail length based on the derived regression models. The device was prospectively validated in a clinical setting. The retrospective analysis showed strong correlations between foot length and nail length for the femur (R2 = 0.98), tibia (R2 = 0.91), and humerus (R2 = 0.85). The prospective validation demonstrated high accuracy of the device, with mean absolute errors (MAE) of 0.67 cm, 0.74 cm, and 0.62 cm for femur, tibia, and humerus nail length predictions, respectively. The 3D-printed foot length scale offers a practical and accurate method for predicting intramedullary nail lengths, potentially streamlining preoperative planning and improving surgical outcomes.

Introduction: Hydatid cyst disease, caused by the larval stage of Echinococcus granulosus, is a zoonotic parasitic infection that is endemic in many regions of the world. Musculoskeletal involvement, particularly in the thigh, is rare, accounting for approximately 1–4 % of all hydatid cyst cases. This case series aims to contribute valuable information by presenting three distinct cases of hydatid cyst affecting different compartments of the thigh. Cases presentation: We detail the diagnostic process, surgical and medical management strategies, and outcomes observed during the follow-up period for each patient. The patients, including two livestock breeders from rural areas with close contact with sheep and dogs and one housewife from an urban area with no known animal contact, presented with a slowly enlarging mass in the thigh. Diagnosis involved clinical evaluation, advanced imaging techniques such as ultrasound and MRI, and serological testing. MRI revealed multiple cystic lesions with internal septations and daughter cysts in all cases. Serological tests for E. granulosus antibodies using ELISA were positive in two cases but initially negative in one. Treatment included pre-operative and post-operative albendazole therapy (10–15 mg/kg/day) and surgical excision of the cysts, with careful technique to avoid spillage and the use of scolicidal agents such as hypertonic saline, hydrogen peroxide, and povidone-iodine. Discussion: Hydatid cyst of the thigh is a rare condition that often poses diagnostic challenges, as illustrated by an initial misdiagnosis of a Baker's cyst in one case. A high index of suspicion is necessary, especially in individuals from endemic regions or those with a history of animal contact, although cases can occur in urban residents with no known exposure. MRI is the gold standard for evaluating soft tissue hydatid cysts. Management requires a combined medical and surgical approach, with antihelminthic therapy and complete surgical excision of the cyst being critical components. Conclusion: This case series highlights the diagnostic and management considerations for hydatid cyst of the thigh. The successful management of these three cases, with no recurrence observed during follow-up periods ranging from one to 1.5 years, underscores the importance of a multidisciplinary approach, early diagnosis, meticulous surgical technique, appropriate medical therapy, and diligent long-term follow-up for achieving favorable outcomes. Highlights:

The management of distal ulna fractures remains a subject of considerable debate within orthopedic practice. This systematic review and meta-analysis aims to evaluate the efficacy of surgical versus non-surgical management strategies for distal ulna fractures and their impact on functional outcomes. This study followed PRISMA guidelines and involved a systematic search of databases like PubMed, Scopus, and Web of Science for relevant studies published in English up to December 2023. The search included keywords such as “ulnar styloid fracture”, “non-surgical management”, “surgical management”, and “treatment outcomes”. Studies were selected based on predefined inclusion and exclusion criteria, and data were extracted on patient demographics, fracture characteristics, treatment details, functional outcomes, patient-reported outcomes, complications, and follow-up duration. The methodological quality of included studies was assessed using the GRADE system. The meta-analysis used standardized mean differences for continuous outcomes and log odds ratios for dichotomous outcomes. The initial search yielded 1253 studies, which were narrowed down to 12 studies suitable for review after removing duplicates and irrelevant articles. These studies included a total of 709 patients, with 422 receiving non-surgical management and 287 undergoing surgical treatment. The results showed no significant differences in grip strength, DASH score, or VAS score between surgical and non-surgical management. However, a higher union rate was observed with surgical management. The moderate quality of the included studies and the moderate to high heterogeneity among them are noted as limitations, indicating a need for more standardized research methodologies in this area. While surgical management may offer a higher union rate, the choice of treatment should be individualized, balancing the potential benefits against the risks of surgery, as ORIF implants are typically associated with higher ulnar-sided pain rates and limited ulnar deviation due to implant prominence. Future research should focus on standardizing study designs to improve the quality of evidence in the management of distal ulna fractures. Evidence from a meta-analysis and systematic review from all relevant studies.

Distal locking is a challenging and time-consuming step in interlocked intramedullary nailing of long bone fractures. Current methods have limitations in terms of simplicity, universality, accuracy, speed, and safety. We propose a novel device and software for distal locking using computer vision. The device consists of an universal ancillary clamp, a telescopic arm, a viewfinder clamp, and a radio-opaque cross. The software uses a camera photo from the C-arm intensifier and adjusts for geometric projection deformities. The software employs edge detection, Hough transform, perspective interpolation, and vector calculation algorithms to locate the distal hole center. The device and software were designed, manufactured, and tested using 3D CAD, FEM, DRR, and performance testing on phantom bones. The device and software showed high accuracy and precision of 98.7% and 99.2% respectively in locating the distal hole center and calculating the correctional vector. The device and software also showed high success ratio in drilling the hole and inserting the screw. The device and software reduced the radiation exposure for the surgeon and the patient. The success ratio of the device and software was validated by the physical testing, which simulated the real clinical scenario of distal locking. The radiation exposure was as low as 5 s with a radiation dose of 0.2mSv, drastically reducing radiation exposure during distal locking. Our device and software have several advantages over other distal locking methods, such as simplicity, universality, accuracy, speed, and safety. Our device and software also have some disadvantages, such as reliability and legislation. Our device and software can be compared with other distal locking methods based on these criteria. Our device and software have some limitations and challenges that need to be addressed in the future, such as clinical validation, and regulatory approval. The device showed promising results in terms of low-cost, reusability, low radiation exposure, high accuracy, fast distal locking, high stiffness, and adaptability. The device has several advantages over other distal locking techniques, such as free-hand technique, mechanical aiming devices, electromagnetic navigation systems, and computer-assisted systems. We believe that our device and software have the potential to revolutionize the distal locking technique and to improve the outcomes and quality of life of the patients with long bone fractures.

Introduction Achieving accurate alignment in operative fracture treatment is crucial. Various techniques, including external maneuvers, traction devices, and intramedullary devices, aim to accomplish this while preserving fracture hematoma and promoting biological healing. However, these methods often require extended maintenance of reduction and raise concerns about radiation exposure. This study was inspired by the F-tool and aimed to develop an external mount system to maintain fracture reduction throughout the procedure, mitigating risks associated with existing techniques. Methods and Materials The F-tool, a modular set of stainless-steel rods forming an F-shape for fracture reduction, served as the basis for our design. Using FreeCAD software, a CAD model was created for the external mount system. The system comprised a reduction-maintaining component and a static part, with 3D resin slicers used for model preparation and FEM modeling for mechanical stress analysis. Results The developed external mount system consists of a dual-sided pole for reduction maintenance and various rods with clamps for attachment to the surgery table or floor. Mechanical stress simulations indicated promising stiffness. Different assembly configurations, including C-shaped or L-shaped static parts, were designed to prevent C-arm interference during procedures. Discussion Existing techniques for fracture reduction pose challenges such as prolonged maintenance of reduction and radiation exposure. The novel F-tool mount system addresses these issues by offering maintained reduction, low radiation exposure, and minimal surgical morbidity at a low manufacturing cost. Comparative analysis with established techniques highlights the F-tool mount's advantages in providing consistent, controlled reduction without extensive manual manipulation or invasive procedures. The system aims to streamline the reduction process, potentially reducing operative duration and risks associated with longer procedures or nonunion rates reported with some techniques.