3D Planning Research Articles

The Accuracy of Computed Tomography-Based, Three-Dimensional Implant Planning in Robotic-Assisted Total Knee Arthroplasty.

Advanced imaging used in robotic-assisted total knee arthroplasty (TKA), such as computed tomography (CT)-based three-dimensional (3D) planning, may provide an accurate means of implant sizing preoperatively. The purpose of this study was to examine preoperative CT-based implant planning accuracy for robotic-assisted TKA in patients who have (1) varus deformities, (2) valgus deformities, (3) neutral alignment, and (4) retained hardware. A total of 393 patients underwent a robotic-assisted TKA by a single surgeon received preoperative CT scans. The surgeon reviewed the CT-based model preoperatively and recorded the expected size of the components. The final implants used in each case were recorded and compared with the surgeon's preoperative plan. In all groups of patients, the surgeon's CT-based implant plan was within one size of the implant utilized 100% of the time for both the tibiae and femora. Overall, the surgeon was exactly matched in 319 (81%) and 315 (80%) cases for the femoral and tibial components, respectively. For the femoral component, the mean age for patients in whom the original plan was exactly matched was younger than those whose implants were upsized and older than patients those implants were downsized (p = 0.024). Other patient demographics and preoperative knee alignment were not associated with predictive accuracy for femoral or tibial components. Our results demonstrate how preoperative CT-based, 3D planning for robotic-assisted TKA is accurate to within one size of the components in every case (100%), and exactly matched in 80%. The results of this study are important because they demonstrate how CT-based preoperative implant planning for TKA is reliable and accurate across all native knee alignments and other patient-specific factors. In addition, they build on a previous study by the same single surgeon, demonstrating that predictive ability can improve over time. This may be important as we move toward more outpatient surgery with less ability for prostheses inventory at ambulatory sites.

3D Strata Visualization in Web Environment – Review

Nowadays, rapid population growth has caused a high demand of land and stratified property especially in urban areas (big city). In cadastral system, visualization is considered as a tool for reflecting the real world which is commonly drawn in 2-Dimensional (2D) based plan. However, it only works efficiently for land parcel but not in representing strata property (high rise building). The complexity and overlapping boundaries also need to be considered in portraying 3-Dimensional (3D) model which cannot be achieved using only 2D plan. On top of that, the need of providing a 3D visualization platform has been recognised by many researchers worldwide. There have been numbers of 3D Cadastral system prototype being developed for different country such as Australia, Russia and Indonesia. 3D visualization helps enhanced communication between users, improve decision making, and helps to manage and facilitate land information system. This paper therefore seeks to analyse the problems related to the visualisation for the application of strata and the current approach of 3D visualisation. It is carried out by investigating different techniques and methods used in visualising 3D objects. The outcome of this paper would be the solutions in finding suitable visualization tools to be developed via Web-based visualization applications which are common with end users and easily accessible due to advancements in technology.

Development of Learning Tools Using Remote IoT Labs with Blended Learning Method in The Department of Engineering Education

Learning is a process that involves educators, students, teaching materials, learning resources, learning media, and methods. The conventional method, whose main source of knowledge is only from educators, is considered to be less effective if it is the only source of knowledge transfer to students. The boring learning process, the media used in Digital Electronics courses is a simulator, the features presented in the simulator are less interesting. So it was appointed a research study on the development of the IoT Remote Lab learning tool with Blended Learning Digital Electronics Subjects in accordance with the Industrial Revolution era 4.0. This study aims to determine the stages and feasibility of developing the IoT Remote Lab learning tool with a valid, practical, and effective Blended Learning method in the Department of Electronics Education Faculty of Engineering Universitas Negeri Makassar (FT-UNM). The research method used by Research and Development (R&D) with the 4D development model (1), (2) planning, (3) development, and (4) distribution. The results of this study indicate that the Remote Lab IoT learning tool with the Blended Learning method has a very valid category to use. Got a response from students who said it was very practical in its use and the results of student test scores after implementation had increased. It was concluded that the data stated that the Remote Lab IoT learning device with the Blended Learning method that had been developed was declared valid/feasible to use as well as practical and efficient in its use.

Integration of Safety Knowledge into Three-Dimensional Model Design and Construction Plan from the Perspective of Project Executors in Petrochemical Industry

In petrochemical industry, the execution of construction involves three main issues, namely, design planning, construction, and job safety. Three-dimensional (3D) models are increasingly applied to design and construction. However, the improper concept of 3D design has bred potential unsatisfactory behaviors and the lack of vigilance among workers. Besides, many employees are not fully aware of the safety in 3D design and construction planning. Therefore, our goal is to improve the safety and health of construction workers through design practices in the upstream of the construction phase, and verify the applicability of the combination of 3D models and safety knowledge. Specifically, a questionnaire survey was carried out among 124 employees in the construction-related fields of the petrochemical industry. The collected data were processed, and statically analyzed on SPSS. The results show that safety knowledge was acceptable in 3D model design from the perspective of project executors, and the integration of safety knowledge into the design helps to improve the safety environment of the construction site.

3D-printed saw guides for lower arm osteotomy, a comparison between a synthetic CT and CT-based workflow

BackgroundThree-dimensional (3D)-printed saw guides are frequently used to optimize osteotomy results and are usually designed based on computed tomography (CT), despite the radiation burden, as radiation-less alternatives like magnetic resonance imaging (MRI) have inferior bone visualization capabilities. This study investigated the usability of MR-based synthetic-CT (sCT), a novel radiation-less bone visualization technique for 3D planning and design of patient-specific saw guides.MethodsEight human cadaveric lower arms (mean age: 78y) received MRI and CT scans as well as high-resolution micro-CT. From the MRI scans, sCT were generated using a conditional generative adversarial network. Digital 3D bone surface models based on the sCT and general CT were compared to the surface model from the micro-CT that was used as ground truth for image resolution. From both the sCT and CT digital bone models saw guides were designed and 3D-printed in nylon for one proximal and one distal bone position for each radius and ulna. Six blinded observers placed these saw guides as accurately as possible on dissected bones. The position of each guide was assessed by optical 3D-scanning of each bone with positioned saw guide and compared to the preplanning. Eight placement errors were evaluated: three translational errors (along each axis), three rotational errors (around each axis), a total translation (∆T) and a total rotation error (∆R).ResultsSurface models derived from micro-CT were on average smaller than sCT and CT-based models with average differences of 0.27 ± 0.30 mm for sCT and 0.24 ± 0.12 mm for CT. No statistically significant positioning differences on the bones were found between sCT- and CT-based saw guides for any axis specific translational or rotational errors nor between the ∆T (p = .284) and ∆R (p = .216). On Bland-Altman plots, the ∆T and ∆R limits of agreement (LoA) were within the inter-observer variability LoA.ConclusionsThis research showed a similar error for sCT and CT digital surface models when comparing to ground truth micro-CT models. Additionally, the saw guide study showed equivalent CT- and sCT-based saw guide placement errors. Therefore, MRI-based synthetic CT is a promising radiation-less alternative to CT for the creation of patient-specific osteotomy surgical saw guides.

Orthognathic patient perception of 3D facial soft tissue prediction planning

The primary aim of this study was to explore patients’ perceptions regarding the impact of 3D prediction planning (3D PP) of facial soft tissue changes following orthognathic surgery.The study was carried out on 30 patients who were shown photorealistic 3D soft tissue prediction planning before undergoing orthognathic surgery to demonstrate the expected facial changes. Distraction osteogenesis and cleft deformities were excluded from the study before consenting to surgery. Following surgery, the included patients were asked to complete a standard questionnaire to explore their perceptions regarding the impact, accuracy, and value of 3D prediction planning.The majority of the 30 participants perceived 3D PP to be beneficial in reducing their presurgical anxiety, increasing their motivation to undergo surgery, improving the accuracy of their surgical expectations, and enhancing doctor–patient communication. Most of the patients perceived their surgical soft tissue changes to be better than the predictions. Significant positive correlations were detected between satisfaction with the delivered service and the facility of seeing 3D PP (rs = 0.4; p = 0.034). Similarly, 3D PP improved patients’ confidence in the surgical decision (rs = 0.4; p = 0.031), as well as increasing their motivation to undergo surgery (rs = 0.5; p = 0.010).3D PP was found to be effective in improving the quality of orthognathic surgical care.

Clinical and radiographic results of eccentric glenoid reaming in anatomical total shoulder arthroplasty using 3D planning and PSI

BackgroundTreatment of deformed type B glenoids with anatomical total shoulder arthroplasty (TSA) can be challenging when using standard imaging and instrumentation. 3D planning and PSI-guided (patient-specific instrumentation) eccentric reaming may substantially aid in both the glenoid correction and implantation of anatomical components in difficult cases. We hypothesized that the implementation of preoperative planning and a PSI-guided anatomical component protocol would result in accurate correction of the glenoid deformity and precise glenoid implant positioning. MethodsTwenty-two consecutive patients with primary glenohumeral osteoarthritis, intact rotator cuff and modified-Walch type B glenoids were treated with anatomical total shoulder arthroplasty. Preoperative 3D planning and PSI were used to guide eccentric reaming and correct glenoid deformity. Postoperative clinical and radiographic outcomes were assessed in all patients with a minimum follow-up of 2 years (mean of 26 months). Postoperative corrections of glenoid version and inclination were measured and the variation between preoperative planning and postoperative implant position was evaluated on CT 3D reconstructions. Similarly, both humeral subluxation in the axial scapular plane and glenoid joint line medialization were compared between preoperative and postoperative computed tomographic imaging. ResultsThe mean age was 57 years (range, 54-68). Significant improvements in pain and functional outcome measurements were seen in all 22 subjects. Mean native glenoid version and inclination were −15° ± 5° and 3° ± 5°, respectively. Postoperatively, version was corrected to −7° ± 6° and inclination to 1° ± 2°. Cortical central peg perforation was noted in 1 case and cement perforation in 3 cases. The mean deviation from the preoperative plan was 3° ± 3° for version and 2° ± 2° for inclination. Humeral head subluxation improved from 68% ± 6% to 37% ± 6% and re-centering on the glenoid implant was achieved in all cases. The mean executed medialization of the glenoid joint line was 6 ± 3 mm and proved accurate to within 1 ± 1 mm of the planned medialization. A strong linear correlation was found between the degree of correction of retroversion and the amount of medialization (R = 0.82; P< .001). Conclusion3D preoperative planning and PSI guided correction of deformed modified-type B glenoids resulted in accurate postoperative correction of the glenoid deformity, correct glenoid component implantation with low deviation from the planned position and excellent short-term functional and radiographic results. Level of Evidence: Level IV; Case Series; Treatment Study.

The accuracy of computer-aided design and manufacturing surgical-guide for infrazygomatic crest miniscrew placement

Objectives: Infrazygomatic crest (IZC) surgical guides have been employed to prevent any avoidable complications during miniscrew insertion. The purpose of this study was to evaluate the accuracy of IZC miniscrew placement when using a surgical-guide developed by computer-aided design and manufacturing (CAD/CAM) techniques. Materials and Methods: Ten patients were scanned with cone-beam computed tomography for three-dimensional (3D) planning of IZC miniscrew placements. The upper arches were scanned separately, and virtual miniscrews were placed in the position planned by 3D software. The CAD/CAM surgical guides were designed and fabricated individually to enable accurate miniscrew placement. Subsequently, 20 self-drilling miniscrews were inserted at the right and left IZC areas using 5 CAD/CAM surgical guides (CS group, n = 10) and direct insertion (DI group, n = 10), respectively. Pre- and post-operative digital model images were compared, actual and planned miniscrew positions were superimposed and measured for 3D angular and distance deviations in the two groups. Comparisons between groups were made using the Kruskal–Wallis test. Results: In the CS group, the median coronal and sagittal angular deviations were 2.95 degrees (range 0.34–5.26 degrees) and 2.05 degrees (range 0.38–4.08 degrees), respectively, while the median coronal and apical deviations were 0.39 mm (range 0.24–0.51 mm) and 0.50 mm (range 0.16–0.66 mm). These deviations differed significantly from those of the DI group. Conclusion: The IZC CAD/CAM surgical guide has made it possible to control miniscrew placement with high precision.

3D planning and patient-specific surgical guides in forearm osteotomy in children: Radiographic accuracy and clinical morbidity

IntroductionThree-dimensional (3D) planning and patient-specific surgical guides are increasingly used in the treatment of skeletal deformities. The present study hypothesis was that they are reliable in forearm osteotomy in children, with low morbidity. Material and methodsTwenty-there children with one or several osteotomies to correct forearm deformities were retrospectively included: 9 (20 osteotomies) with surgical guide (G+), and 14 (28 osteotomies) without (G-). Etiologies comprised 8 cases of Madelung disease (3G+, 5G−) and 15 of post-traumatic malunion (6G+, 9G−). Mean age at surgery was 14.8±1.9 years. The patient-specific 3D-printed polyamide guides were produced from 3D virtual models based on 3D CT reconstruction. Mean follow-up was 22.1±13.6 months. ResultsMean correction error was 5.3°±4.1 and 4.2°±4.1 in the frontal and sagittal planes respectively in G+ (p=0.6). Surgery time was significantly shorter in G+, by a mean 42min (p=0.02). Mean total radiation dose (preoperative CT+intraoperative fluoroscopy) was significantly higher in G+ (p<0.0001). Complications rates were similar between groups. Improvement in PRWE score was significantly greater in G+. ConclusionThe present preliminary results were encouraging. 3D planning and patient-specific surgical guides can be used in the treatment of forearm deformity in children. Level of evidenceIII; retrospective cohort study.

Three-dimensional preoperative planning in the weight-bearing state: validation and clinical evaluation

Objectives3D preoperative planning of lower limb osteotomies has become increasingly important in light of modern surgical technologies. However, 3D models are usually reconstructed from Computed Tomography data acquired in a non-weight-bearing posture and thus neglecting the positional variations introduced by weight-bearing. We developed a registration and planning pipeline that allows for 3D preoperative planning and subsequent 3D assessment of anatomical deformities in weight-bearing conditions.MethodsAn intensity-based algorithm was used to register CT scans with long-leg standing radiographs and subsequently transform patient-specific 3D models into a weight-bearing state. 3D measurement methods for the mechanical axis as well as the joint line convergence angle were developed. The pipeline was validated using a leg phantom. Furthermore, we evaluated our methods clinically by applying it to the radiological data from 59 patients.ResultsThe registration accuracy was evaluated in 3D and showed a maximum translational and rotational error of 1.1 mm (mediolateral direction) and 1.2° (superior-inferior axis). Clinical evaluation proved feasibility on real patient data and resulted in significant differences for 3D measurements when the effects of weight-bearing were considered. Mean differences were 2.1 ± 1.7° and 2.0 ± 1.6° for the mechanical axis and the joint line convergence angle, respectively. 37.3 and 40.7% of the patients had differences of 2° or more in the mechanical axis or joint line convergence angle between weight-bearing and non-weight-bearing states.ConclusionsOur presented approach provides a clinically feasible approach to preoperatively fuse 2D weight-bearing and 3D non-weight-bearing data in order to optimize the surgical correction.

Research on 3D global path planning technology for UUV based on fusion algorithm

Aiming at the global path planning problem of unmanned underwater vehicle (UUV) in three-dimensional environment, a fusion algorithm named PACO based on particle swarm optimization (PSO) and ant colony optimization (ACO) is proposed. In order to meet the needs of three-dimensional path planning, the grid method is used to model the actual marine environmental data. Besides, PSO and ACO are optimized respectively. Taking the path length as the measurement index, the simulation is realized by using MATLAB. The simulation results show that the initial path search ability of the fusion algorithm is significantly improved, and the effectiveness of the algorithm is verified.

Role of Navigation in Oral and Maxillofacial Surgery: A Surgeon's Perspectives.

Surgeries related to the maxillofacial area deal with an intricate network of anatomical structures. With the complexity of the vital structures, it necessitates a surgical team to respect each anatomical boundary. In the past, there was an exceptionally high number of cases with surgical errors. These errors were not because of flaws in the surgeon’s skills or techniques but owing to lack of resources. Visualisation is one of the key factors that determines the precision of any surgical outcome. Advances in surgical planning have led to the introduction of a “Navigation” system that helps surgeons to see more, know more and ultimately do more for their patients. The usefulness of the navigation system in oral surgeries has been indicated by its surgical applications in craniomaxillofacial trauma, orthognathic surgeries, head and neck pathological resections, complex skull base surgeries and surgery involving temporomandibular joint. A vast majority of research literature has suggested remarkable improvement in surgical outcomes under the guidance of 3d planning and navigation. However, with such an inordinate advancement, financial expenses and a gradual learning curve are always a constraining factor in surgical navigation. This article overviews indication of navigation in craniofacial surgeries with a focus on applied aspect, planning and solution to the future problem.

Comparisons of orthodontic residents' performance and attitudes using 2D, 3D, and virtual reality surgical simulation methods.

Advances in virtual reality technology for surgical simulation methods may improve diagnosis and treatment planning of complex orthognathic surgery cases. The objectives were to assess orthodontic residents' performance and attitudes when treatment planning orthognathic surgery cases using two-dimensional (2D) digital, three-dimensional (3D) digital, and virtual reality (VR) surgical simulations. The study had a mixed methods study design involving 20 graduate orthodontic residents. Their previous experiences, confidence, and competence with orthodontic diagnosis and surgical treatment planning were assessed with a baseline survey. Each resident completed 2D, 3D, and VR treatment planning and simulation tasks in a randomized order and recorded their diagnosis, objectives, treatment plan, and special surgical concerns for each case using a treatment planning worksheet. The worksheets were scored and quantitative data were analyzed. Attitudinal responses to the simulation experience were captured with a post-survey and interview. The number of total prescribed surgical movements was greater for 3D and VR simulation methods (p=0.001). There were no differences in the overall total written treatment plan analysis score among the three surgical simulation tasks. Participants took longer to complete the VR and 3D tasks (p<0.001) and asked more questions regarding manipulation (p<0.001) and software features (p<0.002) for higher fidelity tools. Analysis of qualitative feedback showed positive attitudes toward higher fidelity tools with regard to visualization, manipulation, and enjoyment of the task. The results demonstrate that simulation methods of increased fidelity (3D and VR) are appropriate alternatives to 2D conventional orthognathic surgical simulation methods when combined with traditional records. Qualitative feedback confirms residents' readiness to adopt VR simulation. However, comprehensive training is needed to increase familiarity and comfort with using the new technology.

Dosimetry comparison and evaluation of 3D and IMRT for left breast cancer radiotherapy techniques treated at ain wazein medical village hospital in Lebanon

Breast cancer patients undergoing radiation therapy can be treated using the 3D conformal or VMAT techniques. For both plans, the doses received by the target and the organs at risk are determined and compared with protocols recommended for the safety of the patients. CT simulations of 10 women with left breast cancer were used for a 3D conformal and VMAT treatment plans in the radiotherapy department of Ain Wazein Medical Village Hospital (AWMV) utilizing Monaco Treatment Planning system using Collapsed-cone and Monte Carlo algorithms respectively. The total prescribed dose to the PTV was 50 Gy in 25 fractions each 2 Gy. The dosimetric parameters obtained were mean, D95%, and homogeneity index for PTV; mean dose and max doses for the heart; the V20% for the left and the right lungs. All values of this retrospective study were analysed and compared to the normal tissue maximum dose tolerance. VMAT plans resulted in significantly better coverage for the target volume concepts as compared with 3D-CRT (D95: 97% vs. 82%, p-value = 0.002; Dmean 4953 cGy in 3D-CRT vs. 5093 cGy in VMAT, p-value = 0.01). The left lung (V20:28.44% with 3D-CRT vs. 21.93 with VMAT, p-value = 0.02). For the heart (Dmax = 4919 cGy in 3D-CRT vs. 4617 cGy in VMAT, p-value = 0.07). For the right lung (V20 was 0.12% in 3D-CRT vs. 0.52% in VMAT with p-value = 0.008). Even though the p-value was significant for the 3D conformal technique, the dose for both techniques was very low and non-significant to have a risk in the organ. The VMAT technique with correct target volume delineation allowed a significant dose escalation and an increase in Tumor Control Probability (TCP). VMAT resulted in an improved sparing of OARs as compared with 3D-CRT at equivalent dose levels.

Clinical and functional results after implantation of the bonebridge, a semi-implantable, active transcutaneous bone conduction device, in children and adults

PurposeAim of the study was to evaluate the surgical, clinical and audiological outcome of 32 implantations of the Bonebridge, a semi-implantable transcutaneous active bone conduction implant.MethodsIn a retrospective cohort study, we analyzed data for 32 implantations in 31 patients (one bilateral case; seven age < 16 years) with conductive or mixed hearing loss, malformations, after multiple ear surgery, or with single-sided deafness as contralateral routing of signal (CROS).ResultsFour implantations were done as CROS. Five cases were simultaneously planned with ear prosthesis anchors, and 23 implantations (72%) were planned through three-dimensional (3D) “virtual surgery.” In all 3D-planned cases, the implant could be placed as expected. For implant-related complications, rates were 12.5% for minor and 3.1% for major complications. Implantation significantly improved mean sound field thresholds from a preoperative 60 dB HL (SD 12) to 33 dB HL (SD 6) at 3 postoperative months and 34 dB HL (SD 6) at > 11 postoperative months (p < 0.0001). Word recognition score in quiet at 65 dB SPL improved from 11% (SD 20) preoperatively to 74% (SD 19) at 3 months and 83% (SD 15) at > 11 months (p < 0.0001). The speech reception threshold in noise improved from − 1.01 dB unaided to − 2.69 dB best-aided (p = 0.0018).ConclusionWe found a clinically relevant audiological benefit with Bonebridge. To overcome anatomical challenges, we recommend preoperative 3D planning in small and hypoplastic mastoids, children, ear malformation, and simultaneous implantation of ear prosthesis anchors and after multiple ear surgery.

Physcomitrium patens: A Single Model to Study Oriented Cell Divisions in 1D to 3D Patterning.

Development in multicellular organisms relies on cell proliferation and specialization. In plants, both these processes critically depend on the spatial organization of cells within a tissue. Owing to an absence of significant cellular migration, the relative position of plant cells is virtually made permanent at the moment of division. Therefore, in numerous plant developmental contexts, the (divergent) developmental trajectories of daughter cells are dependent on division plane positioning in the parental cell. Prior to and throughout division, specific cellular processes inform, establish and execute division plane control. For studying these facets of division plane control, the moss Physcomitrium (Physcomitrella) patens has emerged as a suitable model system. Developmental progression in this organism starts out simple and transitions towards a body plan with a three-dimensional structure. The transition is accompanied by a series of divisions where cell fate transitions and division plane positioning go hand in hand. These divisions are experimentally highly tractable and accessible. In this review, we will highlight recently uncovered mechanisms, including polarity protein complexes and cytoskeletal structures, and transcriptional regulators, that are required for 1D to 3D body plan formation.

Planning tools and indications for "virtual surgery" for the Bonebridge bone conduction system.

Implantation of the Bonebridge (MED-EL, Innsbruck, Austria), an active semi-implantable transcutaneous bone conduction hearing system, involves the risk of impression or alesion in intracranial structures, such as the dura or sigmoid sinus. Therefore, determining the optimal implant position requires careful preoperative radiological planning. The aim of this study was to provide an overview of the possibilities for preoperative radiological planning for the Bonebridge implantation and to evaluate their indications and feasibility. Asystematic literature search was conducted in the PubMed/MEDLINE database for all studies with preoperative planning or implant placement as the primary endpoint or that secondarily mention preoperative planning. Of 558studies, 49fulfilled the inclusion criteria. In 18studies, preoperative planning and floating mass transducer (FMT) placement were the primary endpoints, whereas in 31studies, preoperative planning was described secondarily. There are both freely available and commercial tools involving different time commitments for preoperative three-dimensional (3D) planning and intraoperative transfer. Preoperative 3D planning can increase the safety of Bonebridge implantation.

Novel In-House Design for Fibula Cutting Guide With Detachable Connecting Arm for Head and Neck Reconstruction

The use of in-house 3D planning and manufacture has become more common in high-volume head and neck reconstructive centers worldwide. Various fibula cutting guides have been designed to allow for accurate and predictable head and neck reconstruction. In this paper, we describe the design, manufacture, and operative technique for use of a novel fibula cutting guide with detachable connecting arms. This straightforward design produces a guide that is less bulky, provides better access for safe osteotomies, and is versatile and adjustable to minimize bone removal between segments.

An update on reverse total shoulder arthroplasty: current indications, new designs, same old problems.

Reverse total shoulder arthroplasty (RTSA) was originally developed because of unsatisfactory results with anatomic shoulder arthroplasty options for the majority of degenerative shoulder conditions and fractures.After initial concerns about RTSA longevity, indications were extended to primary osteoarthritis with glenoid deficiency, massive cuff tears in younger patients, fracture, tumour and failed anatomic total shoulder replacement.Traditional RTSA by Grammont has undergone a number of iterations such as glenoid lateralization, reduced neck-shaft angle, modular, stemless components and onlay systems.The incidence of complications such as dislocation, notching and acromial fractures has also evolved.Computer navigation, 3D planning and patient-specific implantation have been in use for several years and mixed-reality guided implantation is currently being trialled.Controversies in RTSA include lateralization, stemless humeral components, subscapularis repair and treatment of acromial fractures.Cite this article: EFORT Open Rev 2021;6:189-201. DOI: 10.1302/2058-5241.6.200085

Inter-rater variability of three-dimensional fracture reduction planning according to the educational background

BackgroundComputer-assisted three-dimensional (3D) planning is increasingly delegated to biomedical engineers. So far, the described fracture reduction approaches rely strongly on the performance of the users. The goal of our study was to analyze the influence of the two different professional backgrounds (technical and medical) and skill levels regarding the reliability of the proposed planning method. Finally, a new fragment displacement measurement method was introduced due to the lack of consistent methods in the literature.Methods3D bone models of 20 distal radius fractures were presented to nine raters with different educational backgrounds (medical and technical) and various levels of experience in 3D operation planning (0 to 10 years) and clinical experience (1.5 to 24 years). Each rater was asked to perform the fracture reduction on 3D planning software.ResultsNo difference was demonstrated in reduction accuracy regarding rotational (p = 1.000) and translational (p = 0.263) misalignment of the fragments between biomedical engineers and senior orthopedic residents. However, a significantly more accurate planning was performed in these two groups compared with junior orthopedic residents with less clinical experience and no 3D planning experience (p < 0.05).ConclusionExperience in 3D operation planning and clinical experience are relevant factors to plan an intra-articular fragment reduction of the distal radius. However, no difference was observed regarding the educational background (medical vs. technical) between biomedical engineers and senior orthopedic residents. Therefore, our results support the further development of computer-assisted surgery planning by biomedical engineers. Additionally, the introduced fragment displacement measure proves to be a feasible and reliable method.Level of EvidenceDiagnostic Level II