There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.

Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

I and i

Prosthetic Joint Infections

➤ Heterotopic ossification occurs most commonly after joint arthroplasty, spinal cord injury, traumatic brain injury, blast trauma, elbow and acetabular fractures, and thermal injury.➤ The conversion of progenitor cells to osteogenic precursor cells as a result of cell-mediated interactions with the local tissue environment is affected by oxygen tension, pH, availability of micronutrients, and mechanical stimuli, and leads to heterotopic ossification.➤ Radiation and certain nonsteroidal anti-inflammatory medications are important methods of prophylaxis against heterotopic ossification.➤ Well-planned surgical excision can improve patient outcomes regardless of the joint involved or the initial cause of injury.➤ Future therapeutic strategies are focused on targeted inhibition of local factors and signaling pathways that catalyze ectopic bone formation.

/pdf/heterotopic-ossification-basic-science-principles-and-1p2gsg0d85.pdf

Heterotopic Ossification: Basic-Science Principles and Clinical Correlates.

Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.

/pdf/radiological-society-of-north-america-rsna-3d-printing-5fxhdxmw3c.pdf

Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios

Bone tissue engineering: Scaffold preparation using chitosan and other biomaterials with different design and fabrication techniques

Arterial injuries following total hip arthroplasty (THA) are uncommon and are usually related to revision THA. Deep external pudendal artery injury and delayed bleeding due to percutaneous adductor tenotomy during THA has not been reported.A 62-year-old man with bilateral hip osteoarthritis and ankylosing spondylitis was treated with right cementless THA. Persistent severely limited hip abduction after prosthetic implantation required a percutaneous adductor tenotomy, which was performed bilaterally. No clinical signs of bleeding existed postoperatively. On postoperative day 3, the patient had a hypotensive attack, his right anteromedial thigh at the tenotomy site was distended, and the hemoglobin was 5.9 g/dL. Computed tomography angiography of the iliac and femoral vessels showed a right hematoma medial to the common femoral artery, with active contrast extravasation. Volumetric data reconstruction revealed active bleeding from the right external pudendal artery into an inguinal collection. Angiography was performed by the standard Seldinger technique via the contralateral femoral artery. A guiding catheter was placed as near to the lesion as possible. A microcatheter system and microguidewire were used for superselective catheterization, and 2 embolization coils were used to control the bleeding. The patient remained hemodynamically stable and was discharged 12 days later. Two-year follow-up was uneventful.The deep external pudendal artery may be injured during percutaneous adductor tenotomy, especially in patients with fragile arterial walls, and life-threatening complications may occur. Angiography and embolization are the best treatment options.

Deep external pudendal artery injury after percutaneous adductor tenotomy during THA in ankylosing spondylitis.

Surgical removal of a partial ossified sacrotuberous ligament for refractory pudendal nerve entrapment syndrome

We report a case of a 46-year-old male patient who sustained a fracture of the Burch–Schneider anti-protrusio cage (APC) that was implanted 13 years before. The fracture occurred in the transitional area to the proximal flange and was caused by direct and recurrent contact between the prosthetic metal head and the acetabular device. Late failure was related to increased wear of the polyethylene cup further aggravated by vertical orientation of the cage. Revision surgery included acetabular reconstruction using a new APC and cross-linked polyethylene cup, and replacement of the 36 mm diameter ball head. At 18 months follow-up the patient showed a complete functional recovery. When a reconstruction device is used, particularly in a young patient, special attention should be paid to the correct positioning of the cage in order to prevent accelerated polyethylene wear. Furthermore, cross-linked polyethylene cups that have become available in recent years must be used.

Late fracture of a Burch–Schneider acetabular cage: rare occurrence following polyethylene cup wear

Pipkin fractures are relative rare high-energy lesions characterized by an intra-articular fracture of the femoral head after posterior hip dislocation. Early anatomic reduction and stable fixation are the main goals of treatment. This case evaluates the outcome of managing Pipkin type 2 fracture with acute osteochondral defect of the femoral head using "rotational osteoplasty" and bioabsorbable polylactate pin fixation. 24-year-old male patient was involved in a motorcycle accident, suffering from a left hip fracture-dislocation, and pelvic Computed Tomography revealed a Pipkin type 2 lesion. An open urgent treatment was performed. After  anatomic reduction of the femoral head fragment a large osteochondral defect in the anterior-superior weight bearing surface was evident. The pattern of the fracture allowed us to perform a "rotational osteoplasty" including rotation of the femoral head fragment, to obtain an osteochondral cartilage congruence of the anterior-superior surface. Stable fixation was obtained by three bioabsorbable polylactate pins. At four-year follow up the patient had an excellent outcome and Magnetic Resonance Imaging (MRI) showed fracture healing, minimal signs of arthritis, excluding osteonecrosis of the femoral head. The reported case confirms that Pipkin fractures are very insidious surgical urgencies. In selected cases, "rotational osteoplasty" may be an alternative to osteochondral transplant for acute osteochondral defect of the femoral head. Bioabsorbable polylactate pin fixation allowed us to have a stable fixation evaluating the bone healing process and vitality of femoral head by MRI.

Rotational osteoplasty and bioabsorbable polylactate pin fixation in Pipkin type 2 fracture with acute osteochondral defect: a case report

Purpose. The aim of this study was to assess retrospectively the safety and efficacy of combined radiofrequency (RF) and kyphoplasty (KP) in managing painful osteolytic metastases to vertebral bodies resistant to conservative treatments. Materials and methods. Eleven patients (9 women and 2 men; mean age 68 years; age range 58–82) with painful osteolytic vertebral body metastases unresponsive to conservative treatments underwent RF combined with KP under general anaesthesia. Primary neoplasms were kidney carcinoma (n=1), breast carcinoma (n=1), thyroid carcinoma (n=2) and multiple myeloma (n=7). Lesion levels were cervical (n=1), thoracic (n=9) and lumbar (n=1). Combined RF and KP was well-tolerated by all patients. The procedures were performed using fluoroscopic guidance and intraoperative neurophysiology monitoring. Pain relief with the visual analogue scale (VAS) pain score and analgaesic consumption were evaluated before and after treatment. Results. No complication occurred. In one case, we observed an asymptomatic cement leakage. Pain significantly decreased after treatment: the mean VAS pain score before treatment was 8 (range 7–10) vs. 1.8 (range 0–3) and 1.9 (range 1–3), respectively, 72 h and 6 weeks after the treatment. Analgaesic reduction was achieved in all patients. Conclusions. RF combined with KP represents a potential alternative method for palliation of painful spinal Riassunto Obiettivo. Scopo di questo studio e stato valutare retrospettivamente la sicurezza e l’efficacia dell’utilizzo combinato di radiofrequenza (RF) e cifoplastica (CP) per il trattamento del dolore correlato a lesioni osteolitiche metastatiche del corpo vertebrale resistente ai trattamenti conservativi standard. Materiali e metodi. Undici pazienti (9 donne e 2 uomini), con eta media di 68 anni (range 58–82), affetti da metastasi osteolitiche del soma vertebrale associate a dolore resistente ai trattamenti conservativi standard, sono stati sottoposti all’utilizzo combinato di RF e CP in anestesia generale. Le neoplasie primitive erano di origine renale (n=1), mammaria (n=1), tiroidea (n=2), e mielomatosa (n=7). Il livello della lesione era cervicale (n=1), toracico (n=9) e lombare (n=1). La procedura combinata di RF e CP e stata ben tollerata da tutti i pazienti. Le procedure sono state eseguite con l’ausilio dell’amplificatore di brillanza e del monitoraggio neurofisiologico intraoperatorio. La riduzione del dolore, considerata secondo la scala analogica del dolore (VAS), e l’assunzione di farmaci analgesici, sono stati valutati prima del trattamento, dopo 72 ore e a 6 settimane dalla procedura. Risultati. Non si sono verificate complicazioni. Il dolore e significativamente diminuito dopo il trattamento: il valore medio era di 8 (range 7–10) prima del trattamento, passando a 1,8 (range 0–3) 72 ore dopo il trattamento e quindi a 1,9 (range 1–3) a 6 settimane dalla procedura. La MUSCULOSKELETAL RADIOLOGY RADIOLOGIA MUSCOLO-SCHELETRICA Radiol med (2010) 115:261–271 DOI 10.1007/s11547-009-0431-5 Combined radiofrequency and kyphoplasty in painful osteolytic metastases to vertebral bodies Il trattamento combinato con radiofrequenza e cifoplastica delle metastasi osteolitiche dolorose del corpo vertebrale A. Sandri • G. Carbognin • D. Regis • D. Gaspari • C. Calciolari • V. Girardi • G. Mansueto P. Bartolozzi Department of Orthopaedic Surgery, Department of Radiology, University of Verona, Policlinico G.B. Rossi, P.zza L.A. Scuro, 37134 Verona, Italy Correspondence to: G. Carbognin, Universita of Verona, Verona, Italy, Tel.: +39-045-8124657, Fax: +39-045-8277808, e-mail: giovanni.carbognin@azosp.vr.it Received: 22 January 2009 / Accepted: 2 March 2009 / Published online: 7 August 2009 © Springer-Verlag 2009 osteolytic metastases in selected patients. The procedures are safe and provide pain relief with bone augmentation and improvement in quality of life.

Combined radiofrequency and kyphoplasty in painful osteolytic metastases to vertebral bodies Il trattamento combinato con radiofrequenza e cifoplastica delle metastasi osteolitiche dolorose del corpo vertebrale

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