The OR Times

Week of 1/12/2020

During shoulder arthroscopy, it’s extremely common to find some form of a bone spur on the acromion that is impinging the rotator cuff, typically supraspinatus, that is causing pain on patients. This pathology can appear when using radiology pre-op, and make it easier to find rotator cuff tears when in the sub-acromial space. However, occasionally an x-ray that shows a bone spur can be very misleading.

I was with a surgeon that was operating on a 46 year old male suffering from textbook acromioclavicular joint impingement symptoms, as well as a possible rotator cuff tear. Interestingly enough, the pre-op radiology report saw a slightly odd bone spur on medial side of the acromion, so the surgeon thought that it was going to be a simple distal clavicle excision and SAD. What we found through the microscope was a previous acromial fracture from when the patient was a child that had healed, but had also calcified over, so it was impinging on the shoulder in a major way and the main source of his pain.

Common Sub-Acromial Decompression with a bone spur.

This discovery did not necessarily affect the surgery in any way, outside of taking longer than expected, but left the surgeon upset because he had sent the students observing him for the day home. Acromial fractures are uncommon, personally I have seen thousands of shoulder cases and this was the first fracture of its kind I have seen in my career, so the teaching moment was lost. The simple solution that Med Dimensions could have assisted with is a pre-op model of the surrounding osteology of the glenohumeral joint, so this surgeon could have seen this odd x-ray in 3D and been prepared to teach his students in the moment, rather than just having to tell them about the unique case he had just completed.

Please leave a comment if you have any questions, and reach out to me at [email protected] if there is anything you’d like me to cover!

-Fred

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The OR Times

Week of 1/5/20

In early December, I was in a case on a human 32 year old patient with anterior labrum of the hip and femeroacetabular defect pathologies. Going into the operation the surgeon noticed one large defect on the femoral head from the original x-ray, and we had at least some kind of game plan going into the case. We were going to use dried bone chips with a native PRP and Bone Marrow injection to fill in this defect and the surrounding tissues, as well as several suture anchors to repair the labrum. It all seemed to be working until we got into the joint and started cleaning up the joint space.

Figure depicting simple hip joint

What we originally thought was one large defect turned out to be several smaller defects and one gigantic defect in the femoral head, roughly the size of a quarter, not to mention 2 cysts on the acetabulum. Our original plan would work for the labrum, but left our femoral defect issues up in the air. We used a biocartilage scaffold that we had in the surgery center for the cysts on the acetabulum, and used the cancellous bone chips/PRP/Bone Marrow mix for the smaller defects. However, the large defect was only cleaned out because we were not prepared for the size of the hole in this patient’s femur and did not have the necessary tools or implants available to fix this issue.

If we had sent for a pre-op model with a CT-Scan, there is no question that we would have been more prepared for this case and it would have given us a much better chance of fixing this patient’s pathology and allow us to be more efficient while in the joint space.

Please leave a comment if you have any questions, and reach out to me at [email protected] if there is anything you’d like me to cover!

Happy New Year from Med Dimensions!

-Fred

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The OR Times

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Week of 12/15/2019

Welcome to the OR Times! This forum will discuss several hot topics in surgery, and how we may be able to assist with all kinds of growing problems. I’m a professional technical consultant for a plethora of medical devices, and can provide real OR insight as to how pre-op products can totally change the trajectory of success of surgery. I will be writing a post weekly, however there may be an occasional relevant article or story provided by a different author.

For my first article I want to address incomplete fractures and osteochondral deformities of weight bearing bones/joints on canine patients. One of the many complications that can arise during these surgeries is blood loss- specifically in trauma cases; the more time during surgery, the more chances there are for blood loss and likelihood of a blood transfusion. These issues only put more stress on the surgeons, increased OR time, higher infection rate, and increased cost for the owners of the animals.

What can be done to prevent this is either:

  1. new and expensive instrumentation/video
  2. detail oriented pre-op models

There is obviously plenty of evidence of the benefit of new instrumentation and technology, but it can be very expensive. Where pre-op models can prove their worth is in their cost-effective nature and practicality. For example, a specific canine case in 2017.

Pictured above is a distal femur osteochondral defect on a canine patient. In the surgeons hand is the model used for reference.

The above model was used for making practice cuts pre-surgery, and later used as a visual aid during the difficult surgery. The young dog had a distal femoral deformation which lead to patellar subluxation. The surgeon provided CT scans of the dog, Med Dimensions isolated and converted the femur into a 3D printable STL file. Once the femur model was printed, it was provided to the surgeon, who used the model in pre-op strategy and as a reference point during the surgery. The use of this model lead to a solution for all of the problems I mentioned in the second paragraph for this specific case.

This is just one example of how I’ve seen these models be beneficial before, during, and after surgery. I’m looking forward to sharing more of these seemingly endless success stories with you! Please leave a comment if you have any questions, and reach out to me at [email protected] if there is anything you’d like me to cover!

-Fred

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