A Randomized Clinical Trialith an incidence of 1 to 3 cases and a prevalence of 50 cases per 1000 person-years, carpal tunnel syndrome is the most diagnosed entrapment neuropathy. 1,2 A course of nonsurgical treatment, is an option in carpal tunnel syndrome. When nonsurgical treatment fails to resolve the symptoms, surgery is considered a valid option. Carpal tunnel release can be considered as a first effective option if there is denervation or the patient elects surgery. 1,3-5 When comparing carpal tunnel release techniques with different incision lengths, smaller incisions show a faster return to work, better cosmetic results, 6,7 and lower pain rates. 4,[8][9][10][11][12] Incision sizes Jose Manuel Rojo-Manaute, MD, PhD, Alberto Capa-Grasa, MD, PhD, Francisco Chana-Rodríguez, MD, PhD, Ruben Perez-Mañanes, MD, PhD, Guillermo Rodriguez-Maruri, MD, Pablo Sanz-Ruiz, MD, PhD, Jorge Muñoz-Ledesma, MD, Mikel Aburto-Bernardo, MD, Luis Esparragoza-Cabrera, MD, Miguel del Cerro-Gutiérrez, MD, PhD, Javier Vaquero-Martín, MD, PhD Received July 2, 2015, ORIGINAL RESEARCHObjectives-The purpose of this study was to compare the outcomes of 1-mm ultraminimally invasive ultrasound-guided carpal tunnel release and 2-cm blind mini-open carpal tunnel release.Methods-We conducted a single-center individual parallel-group controlled-superiority randomized control trial in an ambulatory office-based setting at a third-level referral hospital. Eligible participants had clinical signs of primary carpal tunnel syndrome and positive electrodiagnostic test results and were followed for 12 months. Independent outcome assessors were blinded. Patients were randomized by concealed allocation (1:1) by an independent blocked computer-generated list. The postoperative score on the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire was the primary variable. Grip strength and time for discontinuation of oral analgesics, complete wrist flexion-extension, relief of paresthesia, and return to normal daily activities (including work) were assessed. Conclusions-Ultra-minimally invasive carpal tunnel release provides earlier functional return and less postoperative morbidity with the same neurologic recovery as mini-open carpal tunnel release for patients with symptomatic primary carpal tunnel syndrome.

Opening wedge osteotomy has recently gained popularity, thanks to the recent implementation of locking plates, which have shown equivalent stability with greater reproducibility, accuracy, and longevity than the closing wedge techniques and a lower prosthetic conversion rate. We present a new "do-it-yourself" cutting guides system for tibial opening osteotomy. Using a conventional computed tomography digital image, a positioning guide and wedge spacers were printed in three dimensions (3D) for implementing the osteotomy and obtaining the planned correction. The surgeon makes the whole process in a do-it-yourself style. This new technique was used in eight cases. Previous opening osteotomies with the standard technique were used as control (20 cases). Surgical time, fluoroscopic time, and accuracy of the axial correction were measured. The use of a custom positioning guide reduced the surgical (31 minutes less) and fluoroscopic times (6.9 times less) while achieving a high-axis correction accuracy compared with the standard technique. Digitally planned and executed osteotomies under 3D printed osteotomy positioning guides help the surgeon to minimize human error while reducing surgical time. The reproducibility of this technique is very robust, allowing a transfer of the steps planned in a virtual environment to the operating table.

Craniosynostosis must often be corrected using surgery, by which the affected bone tissue is remodeled. Nowadays, surgical reconstruction relies mostly on the subjective judgement of the surgeon to best restore normal skull shape, since remodeled bone is manually placed and fixed. Slight variations can compromise the cosmetic outcome. The objective of this study was to describe and evaluate a novel workflow for patient-specific correction of craniosynostosis based on intraoperative navigation and 3D printing. The workflow was followed in five patients with craniosynostosis. Virtual surgical planning was performed, and patient-specific cutting guides and templates were designed and manufactured. These guides and templates were used to control osteotomies and bone remodeling. An intraoperative navigation system based on optical tracking made it possible to follow preoperative virtual planning in the operating room through real-time positioning and 3D visualization. Navigation accuracy was estimated using intraoperative surface scanning as the gold-standard. An average error of 0.62 mm and 0.64 mm was obtained in the remodeled frontal region and supraorbital bar, respectively. Intraoperative navigation is an accurate and reproducible technique for correction of craniosynostosis that enables optimal translation of the preoperative plan to the operating room.

Augmented reality (AR) can be an interesting technology for clinical scenarios as an alternative to conventional surgical navigation. However, the registration between augmented data and real-world spaces is a limiting factor. In this study, the authors propose a method based on desktop three-dimensional (3D) printing to create patient-specific tools containing a visual pattern that enables automatic registration. This specific tool fits on the patient only in the location it was designed for, avoiding placement errors. This solution has been developed as a software application running on Microsoft HoloLens. The workflow was validated on a 3D printed phantom replicating the anatomy of a patient presenting an extraosseous Ewing's sarcoma, and then tested during the actual surgical intervention. The application allowed physicians to visualise the skin, bone and tumour location overlaid on the phantom and patient. This workflow could be extended to many clinical applications in the surgical field and also for training and simulation, in cases where hard body structures are involved. Although the authors have tested their workflow on AR head mounted display, they believe that a similar approach can be applied to other devices such as tablets or smartphones.