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A 3D-CT Analysis of Femoral Symmetry-Surgical Implications.

ABSTRACT: BACKGROUND:Mirroring the image of the affected side is a widely used technique for surgical planning in orthopedic surgery, especially for fractures and custom-made prostheses. Our objective is to evaluate the three-dimensional symmetry of the femurs using finite element analysis and manual alignment. METHODS:Using the computed tomography of 15 patients without lower limb pathology, 30 3D biomodels of their femurs were obtained. The error obtained through image manipulation was calculated and broken down into a rendering error and a manual overlay error. The Hausdorff-Besicovitch method was applied to obtain the total asymmetry. The manipulation error was theb subtracted from it to obtain the intrapersonal asymmetry. RESULTS:The mean intrapersonal asymmetry was 0.93 mm. It was obtained by subtracting the error derived from rendering and alignment of 0.59 mm (SD 0.17 mm) from the overall mean error of 1.52 mm (SD 1.45). CONCLUSIONS:Intrapersonal femoral asymmetry is low enough to use the mirror image of the healthy side as a reference for three-dimensional surgical planning. This type of planning is especially useful in deformity surgery when the objective of the surgery is not to restore only one specific parameter but to obtain a general functional morphology when a healthy contralateral femur is available.

SUBMITTER: Ferras-Tarrago J

PROVIDER: S-EPMC7693666 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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A 3D-CT Analysis of Femoral Symmetry-Surgical Implications.

Ferràs-Tarragó Joan J Sanchis-Alfonso Vicente V Ramírez-Fuentes Cristina C Roselló-Añón Alejandro A Baixauli-García Francisco F

Journal of clinical medicine 20201103 11

<h4>Background</h4>Mirroring the image of the affected side is a widely used technique for surgical planning in orthopedic surgery, especially for fractures and custom-made prostheses. Our objective is to evaluate the three-dimensional symmetry of the femurs using finite element analysis and manual alignment.<h4>Methods</h4>Using the computed tomography of 15 patients without lower limb pathology, 30 3D biomodels of their femurs were obtained. The error obtained through image manipulation was ca ...[more]

PMID: 33153138

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Project description:Background: Femoral head fractures are rare injuries with or without traumatic dislocations. The management of these fractures is crucial to prevent the development of severe complications and to achieve optimal functional outcomes. Wide treatment options for Pipkin 1 femoral head fractures range from fragment excision, fixation following open reduction with internal fixation, or conservative treatment such as close reduction alone after fracture dislocation. However, the best decision making remains controversial not only due to lack of large trials, but also inconsistent results reported. Therefore, we aim to compare the operative with nonoperative outcomes of Pipkin type 1 patients. Patients and Methods: We systemically searched MEDLINE, EMBASE, Cochrane library, In-Process & Other Non-Indexed Citations to identify studies assessing outcomes of Pipkin type 1 patients after conservative treatment, and open reduction with excision or fixation. Data on comparison of clinical outcomes of each management were extracted including arthritis, heterotopic ossification (HO), avascular necrosis (AVN), and functional scores (Thompson Epstein, Merle' d Augine and Postel Score). We performed a meta-analysis with the available data. Results: Eight studies (7 case series and 1 RCT) were included in this study. In a pooled analysis, the overall rate of arthritis was 37% (95% CI, 2-79%), HO was 20% (95% CI, 2-45%), and AVN was 3% (95% CI, 0-16%). In comparison of management types, the excision group reached the best functional outcomes including Thompson Epstein Score (poor to worse, 9%; 95% CI, 0-27%) and Merle d' Aubigne and Postel Score (poor to worse, 18%; 95% CI, 3-38%); ORIF group had the highest AVN rate (11%; 95% CI, 0-92%); conservative treatment had the highest arthritis rate (67%; 95% CI: 0-100%) and lowest HO rate (2%; 95% CI, 0-28%). Discussion: This meta-analysis demonstrates that different procedures lead to various clinical outcomes: fragment excision may achieve better function, conservative treatment may result in a higher arthritis rate, while ORIFs may have a higher AVN rate. These findings may assist surgeons in tailoring their decision-making to specific patient profiles. Future RCTs with multicenter efforts are needed to validate associations found in this study. Level of Evidence: II, systematic review and meta-analysis.

Project description:BackgroundDespite several surgical options, there remains no consensus regarding the optimal approach for osteonecrosis of the femoral head (ONFH), a prevalent and refractory disease. To determine the most suitable treatment modality, we compared randomized controlled trials (RCTs) that evaluated multiple surgical treatments for ONFH using a Bayesian network meta-analysis (NMA).MethodsThe outcomes of 11 different surgical treatments were assessed using NMA comparisons of the rate of progression of femoral head necrosis, the rate of conversion to total hip arthroplasty, and improvement of the Harris hip score (HHS). A random effects model was used to analyze the odds ratio (OR) or mean difference, and risk of bias was assessed using the Cochrane risk of bias assessment tool for randomized trials. The confidence of the results was assessed using the confidence in network meta-analysis tool.ResultsA total of 18 RCTs were included in the meta-analysis. Compared with core decompression (CD), the forest plot showed that autologous bone grafting (ABG), free fibula grafting (FFG), vascularized bone grafting (VBG), autologous bone grafting combined with bone marrow aspirate concentrate (ABG + BMAC), and biomaterial grafting combined with vascularized bone grafting (BMG + VBG) delayed ONFH progression. Among them, ABG + BMAC showed the most promising results (OR 0.019; 95% confidence interval [CI] 0.0012-0.25). However, upon comparing CD with different surgical modalities, no significant differences were found in preventing total hip arthroplasty. Furthermore, we cannot draw conclusions regarding the HHS due to attribution and high heterogeneity across the studies.ConclusionOverall, ABG, VBG, FFG, ABG + BMAC, and BMG + VBG showed significant results in preventing ONFH progression compared with that shown by CD. Based on the surface under the cumulative ranking, ABG + BMAC was the most effective. Moreover, all treatments involving bone grafting were found to be effective, possibly indicating the necessity of its use in the treatment of ONFH.

Dataset Information

A 3D-CT Analysis of Femoral Symmetry-Surgical Implications.

Publications

A 3D-CT Analysis of Femoral Symmetry-Surgical Implications.

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