The method significantly lowers the incidence of cortex perforation and is therefore potentially applicable in clinical practice, especially in some selected cases. The applied method, however, carries a potential for errors during manufacturing and practical usage and therefore still requires further improvements.

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The application of a drill guide template for pedicle screw placement is not more effective in reducing pain and disability after midterm follow-up in comparison with the free-hand technique. However, it reduces the cortex perforation incidence. Concerning this evidence, a drill guide is still an additional tool that could in the future potentially compete with other screw placement techniques.

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Background Minimally invasive chevron Akin osteotomy (MICA) has become increasingly common and is compatible with the traditional open approaches for hallux valgus correction. However, it is impeded by concerns regarding the steep learning curve, increased radiation exposure and some specific complications. No standardized method for identifying a learning curve exists. We used a reproducible mathematical model to accurately define the learning curve of MICA with a focus on fluoroscopy time, procedure duration and complications rate. Methods We conducted a retrospective study of MICA procedure performed by a single surgeon during his initial experience with this procedure. The chronologic case number was plotted against variables of interest and learning was identified as the point at which instantaneous rate of change of a curve fit to the data set equalled the average rate of change of the data set. Results One hundred cases have been analysed. Learning plateau in operation time was achieved after 29 cases, with the first 29 cases requiring a median of 60 min compared to 40 min for the latter 71 cases. Proficiency in fluoroscopy application occurred in case 30. The median fluoroscopy time for the first 30 cases was 86 seconds compared to 70 seconds in another 70 cases. The complication rate plateau was reached after 42 cases, with 15 of 22 complications occurring in the group operated first. Conclusion Results demonstrate surgeon’s comfort with MICA to minimize operative time and radiation exposure after 30 cases. The plateau is achieved later for complications. Findings impose lag between surgeon feeling comfortable with procedure and a decrease in complications. Further research is reasonable to analyse several surgeons learning curve and to generate a potential reference learning curve that could serve as a normative. Trial registration UKC-MB-KME-33/19, retrospectively registered.

Using a combination of Computer-Assisted Design (CAD), expert surgical knowledge and Additive-Manufacturing (AM) technologies, it is nowadays possible to offer patients an individualized treatment that is better planned, more predictable and more reliable than traditional surgical procedures. Regardless of the specifics of different medical fields, planning is common to all of them when it comes to an invasive intervention into the human body. Surgical planning is always based on diagnostic data that need to be gathered, presented and evaluated in a way that best suits the final purpose. To understand the general needs of the surgical planning process, several surgical cases have been explored and analyzed in the Additive Manufacturing Laboratory (AML) at the Faculty of Mechanical Engineering, University of Maribor over the past 10 years. The common denominator in all cases is the reconstruction of diagnostic data into a 3D model that is later used for planning and is, after the confirmation of the planned therapeutic parameters, transformed into tangible surgical equipment by means of AM. The 3D planning process has a lot of benefits but requires some skills uncommon among the medical experts. The results of the presented research summarize the particularities of medical 3D planning and provide guidelines for the wider adoption of medical 3D planning and the use of additively manufactured patient-specific instruments. Keywords: additive manufacturing in medicine, 3D medical planning, surgical guides, patient-specific instruments and implants Uporaba ra~unalni{ko podprtega konstruiranja, specialisti~nih kirur{kih znanj in tehnologij dodajalne izdelave nudi pacientom individualno, bolje na~rtovano, predvidljivej{o in zanesljivej{o obravnavo kot tradicionalna kirurgija. Natan~no na~rtovanje operacij je skupno vsem medicinskim podro~jem, kadar gre za invaziven poseg v~lovekovo telo, ne glede na medicinsko specializacijo. Na~rtovanje kirur{kih posegov vedno temelji na diagnosti~nih podatkih, ki jih morajo zajeti, predstaviti in ovrednotiti na na~in, ki ustreza kon~nemu cilju. Da bi razumeli splo{ne potrebe na~rtovanja kirur{kih posegov, so v zadnjih 10 letih v Laboratoriju za dodajalno izdelavo Fakultete za strojni{tvo Univerze v Mariboru raziskali in analizirali precej kirur{kih primerov. Vsem primerom je skupna rekonstrukcija diagnosti~nih podatkov v trirazse`ne modele, ki jih kasneje uporabijo za na~rtovanje, po potrditvi na~rtovanih terapevtskih parametrov pa preoblikujejo v otipljiv kirur{ki pripomo~ek s pomo~jo dodajalne izdelave. Proces trirazse`nega na~rtovanja ima mnogo prednosti, zahteva pa nekaj znanj in spretnosti, ki med zdravniki niso obi~ajne. Rezultati prikazanih raziskav povzemajo posebnosti trirazse`nega na~rtovanja in podajajo smernice za bolj raz{irjeno uporabo pacientom prilagojenih medicinskih pripomo~kov, narejenih s tehnologijami dodajalne izdelave. Klju~ne besede: dodajalna izdelava v medicini, trirazse`no medicinsko na~rtovanje, kirur{ka vodila, pacientu prilagojeni instrumenti in vsadki

where he got subspecialized. His clinical work is based on foot and ankle surgery, pediatric orthopedics, and sports medicine. His research interests are mainly based on the application of rapid prototyping technology in orthopedics.