The aims of this study were to identify the location of the A1 pulley combining palpation technique with superficial palm landmarks and to determine the efficacy and safety of A1 pulley percutaneous release with a 19-gauge needle. Fourteen fresh frozen cadaveric specimens were used: 56 fingers and 14 thumbs. The location of the A1 pulley was based on anatomical landmarks and was identified in all digits. Complete release of the A1 pulley occurred in 60 of the 70 digits (85.7%). The length of the A1 pulley in thumbs was 5.7 mm and in other fingers 4.5 mm. There were no signs of neurovascular bundle injuries. The mean distance between needle pathway and neurovascular bundle was 4.3 mm in the thumbs and 6.5 mm in the other fingers. There were no total flexor tendon injuries. The location of the A1 pulley can be predicted with success. Percutaneous release of the A1 pulley with a 19-gauge needle shows acceptable results in both safety and efficacy.
Objective: This study aimed to compare inter- and intra-observer agreement between radiographs with 2-dimensional and 3-dimensional computed tomography scans with and without 3-dimensional printed models in the evaluation of the distal radius fracture of Association for Osteosynthesis/Orthopaedic Trauma Association type C classification. Methods: Fifteen consecutive cases with X-Rays, 2-dimensional and 3-dimensional computed tomography reconstructions views, and 3-dimensional printed models were selected. Three-dimensional printed models of the distal radius fractures were created using 2-dimensional computed tomography scan files in Digital Imaging and Communication in Medicine format, processed with the 3-dimensional Slicer software, and segmented, creating a 3-dimensional printed model in Standard Triangle Language format. Three-dimensional models were printed using fused deposition modeling (FDM) type 3D printer Zortrax M200Plus using polylactic acid material on a scale of 1 : 1. Twenty observers were invited into the study. Results: Intra- and inter-observer reliability was analyzed using Fleiss’ kappa statistics. Overall kappa values for both groups in inter-observer agreement range from 0.113 to 0.283 and in intra-observer agreement from 0.25 to 0.545. Generally, inter-observer agreement increased with additional 3-dimensional printed models from slight to fair, and intra-observer agreement increased from fair to moderate. Surgeons’ opinions about 3-dimensional printed models with Likert scale-type questions show positive overall results ranging from 8.3± 2.1 to 8.6 ± 1.4. Conclusion: This study has shown that the inter- and intra-observer agreement with the addition of a 3-dimensional printed model for the evaluation of the distal radius fractures of Association For Osteosynthesis/Orthopedic Trauma Association C type for classification, fractures morphology, and preoperative planning tends to increase; however, improvements for an inter-observer agreement remain fair. Level of Evidence: Level III Diagnostic Study
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