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3Dprintingistheprocess of manufacturing three-dimensional objects based on their computer models. Initially, this method was treated as a kind of rapid prototyping and used only in industry. Currently, it is one of the most dynamically developing areas not only in the context of industrial prototyping but also in the food or medical areas. All samples were printed from the same material—PLA Premium manufactured by Raise, on the same printer—Raise 3D Pro2, with the same print speeds and the same single-layer height. The only parameter changed was the orientation (V-vertical, H-horizontal). During the tests, the printing errors impact on the test results was minimised, as each of the systems was printed three times. PE which is currently used in orthopaedics served as a reference value. In order to check the stability of the mechanical properties, six PE samples were cut from various places of the tested board. The purpose of examining the samples was to conduct strength tests according to PN-EN ISO 14125. The results show that there is a significant difference between samples produced with different orientations of the material layers and that printed elements have a better strength to mass ratio, which is of great importance in the production of patient-specific orthopaedic supplies, as each gram less increases the comfort of the corset or orthosis worn by the patient.

Posterior dislocations of the hip are known to be associated with fractures of the femoral head, neck, shaft, or posterior acetabular wall. However, its association with ipsilateral intertrochanteric fracture has only been anecdotally described in the English literature. We report two such cases managed by open reduction (OR) of the hip and internal fixation (IF) of the intertrochanteric fracture. The first case was a 26-year-old male who was managed by OR of the hip with IF of the intertrochanteric fracture with a dynamic hip screw and had a good functional result at 1-year followup. The second case was a 36-year-old female who was also managed by OR of the hip with IF of the head fragments with Herbert screw and IF of the intertrochanteric fracture with a dynamic condylar screw. The patient had a fair, functional result at 1-year followup. With the increase in high energy trauma, these fracture patterns have become more common, and there is an urgent need to review the existing classifications so that these fractures are better categorized, and treatment guidelines defined.

An ankle-foot orthosis (AFO) is an externally applied assistive device that encompasses the lower leg, ankle, and foot of the human body. In the current one-piece passive-dynamic AFO design, the trimming process is performed from lateral and medial parts of the ankle to ensure desired rotational displacement (hereafter referred to as Design I). In most cases, stress concentrations occurring over the trimmed regions during walking can cause permanent damage to the AFO. In this study, to reduce the stress concentration and ensure a homogeneous stress distribution, a new trimming approach is presented, in which the trim zones were transferred from lateral and medial to dorsal (hereafter referred to as Design II). Finite element analyses of the Designs I and II models were carried out. Displacement and von Mises stress values for both models under the same loading and boundary conditions were obtained. Maximum displacement values were 8.51 mm and 9.05 mm for Design I and Design II, respectively. Maximum stress values were 15.19 MPa and 6.70 MPa for Design I and Design II, respectively. For the similar range of motion of ankle joint, the novel design produced less stress and more homogeneous stress distribution than the currently used design, thus indicating that Design II would be more resistant to plastic deformation than Design I.

Background/aims There are documented barriers to work experience in medicine for children from low socio-economic backgrounds. This can adversely affect their chances of successfully obtaining a medical school place Academic ability is not the only factor medical school applicants should demonstrate, but they should also understand what a career in medicine involves NHS Lanarkshire currently provides a three-day in-hospital work experience programme to local schoolchildren. In order to provide further opportunities to experience medical careers first hand, a widening access simulation initiative has been developed. The emphasis is on exposure to simulated surgical activities in hands-on theatre environment, as this is challenging to access during traditional work experience programmes due to safety concerns for both schoolchildren and patients resulting in a passive observational experience. This work describes the evolution of 9Fix the Fracture9, a simulated widening access orthopaedic theatre session. Project description Creating a simulated orthopaedic theatre that is both safe for schoolchildren to gain hand-on experience yet provides an authentic surgical experience is challenging. Due to health and safety concerns, real orthopaedic equipment could not be used due to the likelihood of injury. The same issues arose when considering what material to best use to simulate broken bones, as training sessions with postgraduates had previously used broken animal bones, but again this poses a health and safety issue to schoolchildren. Results We created an authentic theatre environment using basic surgical equipment and a simulation mannequin whose plastic legs had been replaced by legs filled with polyester and an open fracture created by inserting pre-broken plastic bones with pre-drilled holes. Moulage was used to create an open fracture skin effect. Surgical drapes were used to cover the leg for authenticity. The bones were repaired by the schoolchildren using a toy model construction system that consisted of reusable metal strips, plates and bolts. This minimised any risk of injury and providing the opportunity to 9repair9 a fracture in an authentic orthopaedic theatre environment. Conclusions and recommendations Using simulation in widening access is a novel approach to work experience supplementation, but is one where the only boundary is the imagination. This descriptive project has shown that there are low cost, reusable options to simulating theatre environments. This enables schoolchildren to get hands on theatre experience, augmenting their work experience and providing them with an inspirational and memorable experience to take forward to medical school applications and interviews. Reference . Nicholls, G.

Wheelchair is perceived basic orthopaedic equipment, both for permanent and temporary use. Proper wheelchair fitting, and correct education of both medical staff, patients, and their families/caregivers may influence increased awareness of threats, limitations, and results of incorrect patient’s positioning in wheelchair. Basic knowledge and experience may significantly reduce consequences in aformentioned area, and influence to shorter and more effective therapeutic process. Aim of this paper is to discuss possible problems resulting from improper wheelchair fitting on the basis of presented case study, explore the relationship between improper wheelchair fitting and limitations of wheelchair users independence, mobility, and life quality based on own experience and propose solutiopna and direstions of further research.

IntroductionLow/middle-income countries (LMICs) have a growing need for trauma and orthopaedic (T&O) surgical interventions but lack surgical resources. Part of this is due to the high amount of road traffic accidents in LMICs. We aimed to develop recommendations for an essential list of equipment for three different levels of care providers.MethodsThe Delphi method was used to achieve consensus on essential and desirable T&O equipment for LMICs. Twenty experts with T&O experience from LMICs underwent two rounds of questionnaires. Feedback was given after each round of questionnaires. The first round of questionnaire consisted of 45 items graded on a Likert scale with the second round consisting of 50 items. We used an electronic questionnaire to collect our data for three different levels of care: non-operative-based provider, specialist provider with operative fracture care and tertiary provider with operative fracture care and orthopaedics.ResultsAfter two rounds of questionnaires, recommendations for each level of care in LMICs included 4 essential equipment items for non-operative-based providers; 27 essential equipment items for specialist providers with operative fracture care and 46 essential equipment items for tertiary providers with operative fracture care and orthopaedic care.ConclusionThese recommendations can facilitate in planning of appropriate equipment required in an institution which in turn has the potential to improve the capacity and quality of T&O care in LMICs. The essential equipment lists provided here can help direct where funding for equipment should be targeted. Our recommendations can help with planning and organising national T&O care in LMICs to achieve appropriate capacity at all relevant levels of care.

Background Orthopaedists make great use of eponymous equipment, however the origins of these tools are unknown to many users. This history enriches, enlightens, and enhances surgical education, and may inspire modern innovation. Questions/purposes We explored the origins of common and eponymous orthopaedic equipment. Methods We selected pieces of equipment named for their inventors and in the broadest use by modern orthopaedists. We do not describe specialized orthopaedic implants and instruments owing to the overwhelming number of these devices. Results The history of this equipment reflects the coevolution of orthopaedics and battlefield medicine. Additionally, these stories evidence the primacy of elegant design and suggest that innovation is often a process of revision and refinement rather than sudden inspiration. Their history exposes surgical innovators as brilliant, lucky, hardworking, and sometimes odd. These stories amuse, enlighten, and may inspire modern orthopaedists to develop creative solutions of their own. Conclusions The rich history of the field’s eponymous instruments informs an ongoing tradition of innovation in orthopaedics.

It is estimated that electric drills (ED) have been used in orthopaedic surgeries for bone drilling for more than 50 years in Brazilian hospitals. It is an electric, thermosensitive equipment, not indicated for surgical use, which has not been previously evaluated regarding the sterilization efficacy, being suspect of infection risk. This study evaluated the efficacy of sterilization by ethylene oxide (EtO) of new drills that were intentionally contaminated with Bacillus atrophaeus spores. An experimental, laboratory, randomized applied research was developed, where 16 electric drills were analyzed, in addition to positive and negative controls. All the previously cleaned and sterilized equipment were submitted to contamination by spores. The experimental group was submitted to cleaning and sterilization by EtO and test of sterility by filtration through a 0.45 µm membrane. The membranes were cultivated and Gram and Wirtz-Conklin staining were carried out in positive results for spore visualization. An efficacy of 99.99999881% of the process of sterilization by EtO was confirmed, with a probability of survival of 1.19 x 10-8. Under the development conditions of the experiment, the efficacy of the sterilization of ED by EtO was confirmed.Estima-se que há mais de 50 anos, as furadeiras elétricas têm sido empregadas em cirurgias ortopédicas nos hospitais brasileiros para a perfuração óssea. Trata-se de equipamento elétrico, termossensível, não indicado para uso cirúrgico, não avaliado anteriormente quanto à eficácia da esterilização, suspeitando-se de risco para infecções. Esse estudo avaliou a eficácia da esterilização por óxido de etileno (ETO) de furadeiras novas intencionalmente contaminadas com esporos de Bacillus atrophaeus. Foi desenvolvida pesquisa experimental, laboratorial, randomizada e aplicada onde foram analisadas 16 furadeiras elétricas, além de controle positivo e negativo. Todos os equipamentos previamente limpos e esterilizados foram submetidos à contaminação com esporos. O grupo experimental foi submetido à limpeza e esterilização por ETO e teste de esterilidade por filtração por membrana de 0,45 µm. As membranas foram cultivadas e para resultados positivos foram realizadas coloração de Gram e Wirtz-Conklin para visualização dos esporos. Foi comprovada a eficiência de 99,99999881% do processo de esterilização por ETO, com a probabilidade de sobrevivência de 1,19 x 10-8. Nas condições do desenvolvimento do experimento, a eficácia da esterilização das FE por ETO foi comprovada.

en The norms elaborated by national and international bodies contain essential information concerning various authorisation processes relevant to the marketing of orthopaedic equipment. Primarily, they guarantee the quality of the use and/or construction of equipment. Concerning authorisation specific to the marketing of hip prostheses (homologation), the AFNOR norms represent the globally validated criteria. Concerning authorisation of products marketed in Europe (EC marking), it is essential for safety purposes that the norms prescribed by the directives be strictly followed, and that equipment conforms to these norms. These norms, at the various stages in which they exist, result from a consensus between the different concerned parties. They have therefore been established a posteriori, and do not apply to innovative equipment. In these cases, the manufacturer must prove the product in a specific fashion. These norms results from open discussions, and the entire industry is in agreement to follow them. Finally, they are open to revision, and it is one of the fundamental roles of equipment vigilance to periodically challenge the accepted rules.

Total hip replacement (THR) still is a rare intervention in many African countries. In Burkina Faso it is not performed on a regular basis. A visiting programme for THR was started in a district hospital with no previous relevant experience. In this paper we present an analysis of the surgical technical problems and peri-operative complications of 152 THRs in 136 patients and three bipolar hemiarthroplasties in three patients undertaken in this new programme with limited orthopaedic equipment. There were 86 male and 53 female patients with a mean age of 49 years (21 to 78). We identified 77 intra-operative technical problems in 51 operations. There were 24 peri-operative complications in 21 patients, 17 of which were bony in nature. So far, ten revision THRs have been performed in nine patients. Regular analysis of the technical problems and complications was used to improve quality, and we identified patient selection adapted to the local circumstances as important to avoid complications. Our reflections on the problems encountered in initiating such a programme may be of help to other teams planning similar projects. Cite this article: Bone Joint J 2014;96-B:177–80.

As furadeiras elétricas domésticas tem sido empregadas em cirurgias ortopédicas nos Hospitais Brasileiros, para a perfuração óssea. Entretanto, trata-se de um equipamento elétrico, termossensível, não específico para uso cirúrgico, não avaliado quanto à eficácia da esterilização e não investigada a ocorrência de infecções cirúrgicas relacionadas ao seu uso. O objetivo dessa revisão foi descrever o estado da arte do uso das furadeiras domésticas em cirurgias ortopédicas, tendo em vista as dificuldades de limpeza e esterilização do equipamento. As bases de dados LILACS e MEDLINE foram consultadas usando vocabulários controlados, livres e a combinação deles, sem restrição de tempo. Foram localizados dois artigos que abordavam o uso de furadeiras elétricas domésticas em cirurgias ortopédicas. No primeiro, o autor sugere o descarte do equipamento quando percebida a contaminação interna por sangue, considerando as dificuldades da limpeza e esterilização. O segundo artigo descreve a adaptação de uma furadeira para o uso em cirurgias, cujo método de esterilização é pastilha de formalina em condições ambientais. Estudos são necessários para avaliar a prática atual e recomendar condições seguras de uso ou o seu abandono. Domestic ordinary drilling machines have been used in orthopedic surgeries in Brazilian hospitals, for bone drilling. However, it is an electric thermo-sensitive appliance, non-specific for surgical use, not assessed in terms of sterilization efficiency, as well as on potential surgical infections associated to its use. The objective of this review was to describe the state-of-the-art use of domestic drills in orthopaedic surgeries, considering the difficulties of cleaning and sterilization. The LILACS and MEDLINE databases were consulted using MeSH and free medical terms, without time restraints. Two specific articles were found about the use of domestic electric drills in orthopaedic surgeries. In the first article, the author suggests the disposal of the equipment in cases of any noticeable blood contamination that could result in difficulties to clean it. The second article describes how to adapt a domestic drilling machine for orthopaedic surgery, but the sterilization process is performed by using formalin tablets at room conditions. Further studies are required for evaluating the current practice and to recommend safe conditions for its use or towards giving it up.

Editor—I agree with H V Hogerzeil and colleagues about the problems that may be caused by drug donations.1 Sadly, such problems also extend to donations of orthopaedic equipment and appliances. Most orthopaedic departments in the developing world rely on donated orthopaedic implants and equipment. This, however, entails considerable transport costs because of the weight involved. …

Primary prosthetic replacement in elderly patients with displaced intracapsular fracture of the femoral neck has been used during the last few years with encouraging early results. The prosthetic device preferred has been Christiansen's endoprosthesis. During the past year a new type with separable plastic head and metallic cap has been used. This modification has resulted in the occurrence of a previously unknown complication, a separation of these two parts, necessitating reoperation and insertion of a new head piece. The possible mechanisms causing this separation are discussed.

nursing program and an adjunct faculty member at Johnston-Willis Hospital, Richmond, Va. She and Dr. Deyerle coauthored Your Total Hip Replacement, a pamphlet published by the Orthopaedic Equipment Company of America. "New" developments in the field of orthopedics are often the reinforcement of past knowledge or the restoration of a forgotten technique(1). This is certainly true of ambulation and weight bearing as a treatment for fractures of the femur.

— A checklist is given of equipment required for orthopaedic surgery in small animals. The items are listed under instruments and implants, including care and selection of size of implants (screws, plates and medullary pins). Resume— Une Iiste est fournie du materiel necessaire en chirurgie orthopedique chez l'animal de petite taille. Les articles sont classes sous les rubriques instruments et pieces d'implantation, com-prenant des indications quant au maintien et au choix de ces dernieres (vis, plaques et clous medul-laires). Zusammenfassung— Es wird eine Prufliste der fur die Orthopadie kleiner Tiere notwendigen Gerate gegeben. Die Einzelgegenstande werden unter den Sammelbegriffen Instrumente und Implanate aufgezahlt. Letztere Gruppe umfasst auch die sorgfaltige Auswahl der Grosse der Im-planate (Schrauben, Platten und Medullarstifte).