fnac-static.comtanta maldade, fez um inflamado sermão dominical contra os «malha- dos» (nome pejorativo dado aos liberais pelos miguelistas), acusando-os dc scrcm piorcs quc o diabo,
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APRIL 2014 | Volume 37 • Number 4 237 n tips & techniques Tactile Surgical Navigation System for Complex Acetabular Fracture Surgery Takahiro Niikura, MD; Maki Sugimoto, MD; Sang Yang Lee, MD; Yoshitada Sakai, MD; Kotaro Nishida, MD; Ryosuke Kuroda, MD; Masahiro Kurosaka, MD A n acetabular fracture is an intra-articular frac- ture of the hip joint, which is generally treated by open re- duction and internal fixation if displaced. 1-5 Anatomical reduction and stable fixation are important for good func- tional recovery. 1-3,6 However, the anatomical complexity of acetabular fractures makes them particularly challenging and technically demanding to treat surgically. 7 Precise understanding of fracture pat- terns is difficult because of the complex 3-dimensional (3D) anatomy of the pelvis and ac- etabulum, and assessment and classification of acetabular fractures can be difficult even for experienced surgeons. Improved understanding of the anatomy and fracture pat- terns should improve surgical outcomes. Tools that could assist in the assessment of complicated fracture patterns would be useful. Traditional radiological assessment of acetabular fractures involves plain radiography (Figure 1) and computed tomography (CT). However, these modali- ties provide only 2-dimension- al (2D) images of the complex 3D anatomy. The 3D digital images reconstructed from CT data (Figure 2) can be rotated and viewed from any angle, but are still viewed as 2D im- ages on a flat screen. The design and manufac- turing industries now use com- puter-aided design and rapid prototyping to manufacture 3D prototypes. Using this technol- ogy and specialized software, CT scans can be converted into 3D data, which can then be used to manufacture life-size 3D models of the bony pelvis using a 3D printer. Application of such computer-aided design and rapid prototyping to the field of orthopedics has been reported in trauma, compli- cated fractures, hand surgery, and osteotomies to correct de- formities. 8-16 Some previous reports have described using rapid prototyping to manufacture 3D models of the bony pelvis prior to surgery for acetabular fractures. 8,17-20 However, these models were for preoperative use only. It is difficult for less experienced surgeons, and even experienced surgeons, to achieve precise intraoperative understanding of acetabular fracture patterns. Surgical teams do not always consist of experienced surgeons, and sharing information and com- municating effectively are important to achieving good surgical results and educating surgeons. The authors report the pre- operative and intraoperative The authors are from the Department of Orthopaedic Surgery (TN, SYL, YS, KN, RK, MK) and the Department of Gastroenterology (MS), Kobe Uni- versity Graduate School of Medicine, Kobe, Japan. The authors have no relevant financial relationships to disclose. Correspondence should be addressed to: Takahiro Niikura, MD, Depart- ment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan ([email protected]u.ac.jp). Received: January 17, 2013; Accepted: September 5, 2013; Posted: April 15, 2014. doi: 10.3928/01477447-20140401-05 Abstract: The authors describe a tactile surgical navigation system using custom 3-dimensional (3D) models of the bony pelvis for complex acetabular fracture surgery. The bone area of interest was extracted from the Digital Imaging and Communications in Medicine (DICOM) data of computed tomography scans. A standard triangulated language file was used to create 3D models of the bony pelvis by layered manu- facturing using a 3D printer and non-cytotoxic, sterilizable, acrylic-based photopolymers. No infections and no toxic or other adverse events were observed. The models were useful for preoperative assessment, planning, and simulation; intra- operative assessment; obtaining informed consent; and edu- cation. [Orthopedics. 2014; 37(4):237-242.]
