PurposeSurgical treatment of an acute Achilles tendon rupture can effectively reduce the risk of re-rupture, but it increases the probability of surgical complications. We postulated that a minimally invasive surgical treatment might reduce the number of complications related to open surgery and improve the functional results.MethodWe enrolled 47 patients with acute Achilles tendon ruptures in a prospective, randomised trial to compare clinical results and complications between a minimally invasive procedure with the Achillon® device and traditional open surgery with Krackow-type sutures. The average patient age was 46 years. The follow up time was 24 months.ResultsNo Achilles tendon re-rupture or nerve injury occurred in treated patients. There were two cases of wound infections in the open surgery group, and one superficial wound infection occurred in the minimally invasive group. The groups were not significantly different in the amount of pain, range of ankle movements, the single heel-rise test, calf circumference, or time to return to work and sports.ConclusionAfter a two year follow-up period, we found no significant differences in clinical outcomes between groups treated with traditional open surgery or minimally invasive surgery.
Background Three-dimensional (3D) printing is an emerging technology used in numerous medical fields. Reconstruction of large bone defects after tumor resections or complex revision surgeries is challenging especially in specific sites where modular prostheses are not available. The possibility to realize custom-made 3D-printed prostheses improves their application in surgical field despite the complication rate, gaining a lot of attention for potential benefits.Objectives We asked: (1) What are the emerging indications and designs of 3D-printed prostheses for complex bone reconstructions? (2) What complications occur with the use of custom implants considering site? Study design and methods We performed a retrospective analysis of every patient in whom a custom-made 3D-printed prosthesis was used to reconstruct a bone defect after resection for a bone tumour or challenging revision surgery from 2009 to 2018 in two referral centres. Forty-one patients (11 males [27%], 30 females [73%]) with a mean age of 41 years (range, 10-78 years) were included. Our general indications for using these implants were complex reconstructions of massive bone defects, in the absence of available modular prostheses. Seven were non-oncologic patients, whereas 24 patients were mainly treated for their malignant bone tumours. Custom-made 3D-printed prostheses were used in pelvis ( 29), forearm (6), scapula (2), distal tibia (2), calcaneus (1), and femoral diaphysis (1). The reconstruction included complete articular replacement in 24 cases (58%) whereas a combined spinopelvic implant has been used in two cases. Flaps were used in 25 cases (61%). Statistical analyses include Kaplan-Meier curves of survival.
ResultsThe mean follow-up was 20 months. In the oncologic group, overall survival was 89% at five year follow-up and only three patients died of disease. Only one patient required implant removal due to deep infection. Overall major and minor complication rate was 22% (14 complications in 9/41 patients), mainly wound-related problems. One patient reported a periprosthetic fracture, one had hip dislocation, and four (12% [4/34 cases]) had local recurrence. Mean MSTS functional outcome score at follow-up was 73% (range, 23-100%), with a full weight bearing at an average time of 73 days from surgery of lower limbs. Conclusions Custom-made 3D-printed prostheses represent at today a promising reconstructive technique, maintaining however the correct indications for their use in musculoskeletal oncology and challenging revision surgery. Complication rate is acceptable, with infection and wound healing problems relatively common after complex pelvic reconstructions. We will continue to follow our patients over the longer term to ascertain the role of these implants; however, larger studies will need to confirm indications and control for prognostic factors.
The aim of this study was to compare zinc, copper, lead, cadmium, and mercury concentrations in the bones of long-living mammals—humans (Homo sapiens) and Canidae (dogs Canis familiaris and foxes Vulpes vulpes) from northwestern Poland and to determine the usefulness of Canidae as bioindicators of environmental exposure to metals in humans. Zinc concentrations in cartilage with adjacent compact bone and in spongy bone were highest in foxes (∼120 mg/kg dry weight (dw)) and lowest in dogs (80 mg/kg dw). Copper concentrations in cartilage with adjacent compact bone were greatest in foxes (1.17 mg/kg dw) and smallest in humans (∼0.8 mg/kg dw), while in spongy bone they were greatest in dogs (0.76 mg/kg dw) and lowest in foxes (0.45 mg/kg dw). Lead concentrations in both analyzed materials were highest in dogs (>3 mg/kg dw) and lowest in humans (>0.6 mg/kg dw). Cadmium concentration, also in both the analyzed materials, were highest in foxes (>0.15 mg/kg dw) and lowest in humans (>0.04 mg/kg dw). Mercury concentration in bones was low and did not exceed 0.004 mg/kg dw in all the examined species. The concentrations of essential metals in the bones of the examined long-living mammals were similar. The different concentrations of toxic metals were due to environmental factors. As bone tissues are used in the assessment of the long-term effects of environmental exposure to heavy metals on the human body, ecotoxicological studies on the bones of domesticated and wild long-living mammals, including Canidae, may constitute a significant supplement to this research.
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