Metacarpal reconstruction with a medial femoral condyle flap based on a 3D-printed model: a case report.
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ABSTRACT:
SUBMITTER: Schmidt M
PROVIDER: S-EPMC8786248 | biostudies-literature | 2022
REPOSITORIES: biostudies-literature
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Metacarpal reconstruction with a medial femoral condyle flap based on a 3D-printed model: a case report.
Schmidt Manfred M Holzbauer Matthias M Froschauer Stefan M SM
Case reports in plastic surgery & hand surgery 20220121 1
Metacarpal bone reconstruction renders a surgical challenge. We describe a case using 3D printing assisted medial femoral condyle flap for extensive metacarpal reconstruction after wide resection of a large giant cell tumor recurrence. Thus, the length and stability of the entire third ray could be restored without any tumor recurrence. (50 w). ...[more]
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Project description:BackgroundComplex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial femoral condyle (MFC) flaps provide vascularized periosteum, skin, and corticocancellous bone.MethodsA retrospective, single-institution cohort study of consecutive MFC flaps performed for complicated hindfoot reconstruction between 2013 and 2019 was reviewed. Radiologic follow-up assessed osseous union and clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Thirty MFC flaps were performed in 28 patients for complex hindfoot pathology. Twenty-seven flaps had adequate clinical and radiographic follow-up (mean 15.8 months).ResultsThe majority presented with avascular necrosis (83%) and failed prior operations (67%, mean 3.1). Most hindfoot procedures involved arthrodesis (n = 24, 80%); tibiotalocalcaneal (n = 11) and talonavicular (n = 7) most frequently. Mean osseous flap volume was 10.3 cm3 (range 1.7-18.4 cm3); one flap required takeback for venous congestion but no total flap losses occurred. Primary osseous union was initially achieved in 20 patients (74%, mean 217 days). Six flaps developed interface nonunion; 5 underwent revision arthrodesis and ultimately achieved union in 24/27 flaps (89%, mean 271 days). Risk factors for nonunion were body mass index (BMI) >30 (P = .017) and prior arthrodesis (P = .042). Mean AOFAS hindfoot scores increased significantly from 52.3 preoperatively to 70.7 postoperatively (P < .001). Subscore analysis demonstrated significant improvement in postoperative pain scores from 14.2 to 27.3 out of 40 (P < .001).ConclusionThe MFC free flap provided vascularized bone for complicated foot and ankle reconstruction with relatively low donor site morbidity, promising osseous union results, and improved functional outcomes.Level of evidenceLevel IV, retrospective case series.
| S-EPMC8697073 | biostudies-literature
Project description:BackgroundRecalcitrant or persistent nonunions of the metatarsophalangeal (MTP) joint occur following failed MTP surgery for MTP fusion, failed MTP prosthesis, for hallux rigidus or due to infection and erosion. A deficient soft tissue envelope and compromised vascular supply of tissues in this region compound further attempts to salvage the great toe and preserve function. The medial femoral condyle (MFC) free flap provides vascularized corticocancellous bone and periosteum and has been successfully used for a variety of complex hindfoot and ankle pathologies. We present an additional indication with a small cohort study demonstrating its use in persistent nonunions of the first MTP joint.MethodsA retrospective review was completed of all MFC flaps used for revision of failed first MTP joint fusion from January 2019 to November 2022. Demographic information, comorbidities, as well as clinical and radiologic follow-up was obtained from the patient charts.ResultsThree patients were included with MTP nonunion and an average of 7.5 (range, 5-11) failed prior surgeries. Mean age at index surgery was 50 (range, 46-57) years. An osseous union was achieved in all patients after 82 (range, 75-88) days. Hardware removal was possible after 81 (range, 55-98) days. Mean follow-up was 17 (range, 5-31) months. We note a 100% flap success rate without returns to the operating room. The lengths of the bone flaps were 2 to 4 cm, the volumes were 8 to 12 cm3. Fixation was performed with 1 intramedullary K-wire. The recipient vessel in all patients was the dorsalis pedis artery or a tributary thereof. All arterial anastomoses were performed under the operating microscope.ConclusionThe MFC free flap is a reasonable option for salvage of complex recalcitrant or persistent nonunions of the first MTP joint. More prospective long-term studies with functional outcomes are necessary to confirm these findings.Level of evidenceLevel IV, retrospective case series.
| S-EPMC10467191 | biostudies-literature
Project description:The medial femoral condyle free flap serves as an attractive reconstructive option for small- to intermediate-sized bony defects. It is commonly applied in the extremities with limited reports in the head and neck.MethodsA systematic review of the literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsSeventeen articles met inclusion criteria, yielding 166 cases for analysis, with a majority of the cohort from a single study (n = 107; 64.4%). However, all included studies represented novel reconstructive sites and surgical indications. Flap components were described in 157 cases; periosteum was used only in four cases (2.5%), whereas all others are composed of cortical bone combined with periosteum, cancellous bone, and/or cartilage (97.5%). Additionally, a skin island was used in 43 cases (25.9%). Flap measurements were reported in 51 cases, averaging 4.5 ± 2.7 cm in length. Seven cases listed skin island dimensions, averaging 20.2 ± 12.8 cm2. The descending genicular artery was the primary pedicle employed (n = 162; 97.6%), while the superior medial genicular was used in the descending genicular artery's absence (n = 4; 2.4%). Descending genicular artery pedicle length from 15 reporting cases averaged 6.4 ± 1.2 cm. Successful reconstructions totaled 160 cases (96.4%). Recipient complications were seen in 16 cases (9.6%) with six constituting flap failures (3.6%). Donor site complications were minimal (n = 6; 3.6%); however, this included one major complication of femoral shaft fracture.ConclusionThe medial femoral condyle free flap is an effective reconstructive option for the head and neck due to its versatile nature, low complication profile at both recipient and donor site, ease of harvest, and two-team approach.
| S-EPMC10079347 | biostudies-literature
Project description:BackgroundReconstruction of the temporomandibular joint (TMJ) is a significant challenge in maxillofacial surgery. A vascularized medial femoral condyle (MFC) osteocartilaginous flap is a good choice for TMJ reconstruction. In this study, we evaluated the radiographic and histological changes of MFC after TMJ reconstruction.MethodsA ramus-condyle unit (RCU) defect was created unilaterally in five adult male Bama miniature pigs. The ipsilateral vascularized MFC osteocartilaginous flap was used to reconstruct the TMJ, and the non-operative sides served as controls. Multislice spiral computed tomography (CT) was performed preoperatively, immediately postoperatively, and at two weeks, three months, and six months postoperatively. Three animals were euthanized at 6 months postoperatively. Their reconstructed condyles, natural condyles and the MFCs on the opposite side were collected and subjected to µCT and histological evaluation.ResultsIn the miniature pigs, the vascularized MFC osteocartilaginous flap was fused to the mandible, thus restoring the structure and function of the RCU. The postoperative radiographic changes and histological results showed that the reconstructed condyle was remodeled toward the natural condyle, forming a similar structure, which was significantly different from the MFC.ConclusionsIn miniature pigs, the RCU can be successfully reconstructed by vascularized osteocartilaginous MFC flap. The reconstructed condyle had almost the same appearance and histological characteristics as the natural condyle.
| S-EPMC10474687 | biostudies-literature
Project description:Anterior cruciate ligament injury is one of the most common ligament injuries of the knee in sports medicine. The treatment of choice is anterior cruciate ligament reconstruction, which requires an experienced surgeon. Complications may occur at every step of the procedure. The surgeon should be especially careful when performing the step of femoral tunnel creation. Damage to the medial femoral condyle (MFC) could occur; thus, the full functional outcome of the knee might be affected. There are many surgical techniques to avoid MFC injury. We propose a surgical technique that could reduce the risk of MFC injury. This technique uses a Fast-Fix slotted cannula (Smith & Nephew) as a protector. Because such equipment is available in all meniscus instrument sets, this surgical technique is a feasible and easy method to use during the femoral tunnel creation step.
| S-EPMC5794712 | biostudies-literature
Project description:Accurate positioning of the femoral tunnel in the native femoral anterior cruciate ligament (ACL) footprint requires drilling through an accessory medial portal (AMP). The AMP is located far medial and at a low level. Despite the benefits of drilling through the AMP, it is possible that the drill bit head will injure the articular cartilage of the medial femoral condyle as it slides along the guide pin to the femoral insertion of the ACL. Because more surgeons are now performing anatomic ACL reconstructions and shifting from transtibial drilling toward transportal drilling, the risk of this injury might be increasing, especially during the beginning of their learning curve. To avoid such injury, a bio-interference screw sheath is used. It is inserted through the AMP over the guide pin until it reaches near the medial wall of the lateral femoral condyle. The drill bit is inserted over the guide pin and through the bio-interference screw sheath. Using the bio-interference screw sheath not only protects the articular cartilage of the medial femoral condyle but also protects the medial meniscus, posterior cruciate ligament, and skin of the AMP from injury because of the close proximity of the drill bit head to these structures during transportal drilling.
| S-EPMC3678619 | biostudies-literature
Project description:Summary Objective The juvenile equine medial femoral condyle (MFC) is frequently affected with radiographic changes (sclerosis and subchondral lucencies) that arise at a similar site to juvenile osteochondritis dissecans (JOCD) in children. There is little information on maturation of the MFC. To describe the normal development of the equine MFC osteochondral unit from birth to 2 years. Methods Micro CT, histology and immunohistochemistry were performed on healthy equine MFCs (n = 29) at sites where lesions occur. Parameters assessed included: cartilage thickness; the epiphyseal growth plate cartilage organization; the osteochondral junction and progression of endochondral ossification. Results From 0 to 6 months, chondrocytes near the articular surface are small and flat and have a characteristic hypertrophic appearance near the osteochondral junction but are not arranged in columns like physeal growth plates. The osteochondral junction is also crossed by cartilage canals containing vessels giving a porous appearance on 3D μCT images. At 7 months of age, a subchondral bone plate compact structure emerged histologically coincident with the end of endochondral ossification (absence of type X collagen immunostain and chondrocyte hypertrophy). Conclusion New information is provided on MFC osteochondral unit maturation that will improve our understanding of the development of juvenile equine orthopaedic disease. Equine MFC endochondral ossification is complete at 6 months of age. The immature osteochondral junction may be structurally fragile because of its microarchitecture and susceptible to focal traumatic events that induce developmental lesions.
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Project description:Background: The restoration and reconstruction of patello-femoral large osteochondral defects caused by bone tumours are challenging because of the local recurrence rate and the joint’s mechanical complexity. Although three-dimensional (3D)-printed prostheses are commonly adopted for tumour-induced bone defect reconstruction, patello-femoral osteochondral reconstruction with 3D-printed prostheses is rarely reported. Case presentation: A 44-year-old female patient with progressive swelling and pain in the left knee for 6 months was diagnosed with Campanacci Grade II giant cell tumour (GCT). She underwent intralesional curettage combined with autografting and internal fixation, after which complications of deep infection arose. The patient then underwent internal fixation removal and cement packing. Afterwards, the pain of the affected knee persisted for 11 months, and bone cement removal plus 3D-printed modular prosthesis reconstruction was performed. At the last follow-up 27 months after surgery, she was pain free, the Musculoskeletal Tumour Society (MSTS) score improved from 15/30 to 29/30, the Visual Analogue Scale (VAS) score decreased from 7 to 0, and knee flexion increased from 50° to 130°. X-ray images 22 months after surgery showed that the prosthesis and screws were in a stable position, and callus formation was found at the prosthesis-bone interface. Conclusions: A 3D-printed modular prosthesis may be a useful treatment option for the surgical reconstruction of GCT-induced patello-femoral large osteochondral defects. The firm fixation, osseointegration, and favourable congruency of the 3D-printed prosthesis with the adjacent articular surface can achieve long-term knee function and stability.
| S-EPMC9532597 | biostudies-literature
Project description:Contemporary anterior cruciate ligament reconstruction attempts to replicate the anatomical insertion sites on both the femoral and tibial sides to restore knee stability. Creation of the femoral tunnel by independently reaming through an anteromedial portal may allow surgeons to more reproducibly place the tunnel within the anatomic femoral footprint relative to a transtibial approach. However, inherent to the technique is the risk of iatrogenic injury to the articular cartilage of the medial femoral condyle as the reamers are passed adjacent to the condyle. This is particularly an issue with the use of standard nonflexible guide pins and reamers, which are placed with the knee in hyperflexion. We describe a relatively straightforward technique that can be used with standard equipment and that can be quite useful in avoiding this pitfall of the transportal approach.
| S-EPMC5368344 | biostudies-literature
Project description:BackgroundFemoral malrotation errors are prevalent after intramedullary (IM) nailing for femur fractures. Supposing fracture consolidation has occurred, only a derotation osteotomy can offer a solution to this complication, despite in situ nail interference. The authors present a novel case-based surgical technique using 3D technology to obtain an accurate derotation correction and desired clinical outcome while facilitating surgery technics.Case descriptionA 32-year-old woman was referred to our clinic with ongoing right anterior groin pain. Three months earlier, she sustained a high energy fall resulting in a subtrochanteric femur fracture. This was treated with a long IM femoral nail (PFNA™, Synthes, Solothurn, Switzerland) elsewhere. Postoperatively, she developed a limping gait pattern with 'toeing-in' and persistent hip pain during walking. In supine position, a notable axial malalignment towards endo-rotation was visible as compared to the contralateral side. CT-scan showed a side to side difference of 36° anteversion. It was decided to perform a subtrochanteric femoral derotation osteotomy. Outcomes concerning restoration of painless gait and bony healing were successfully obtained at 4 months.ConclusionsThe application of a 3D guide with uni-cortical K-wire placement for derotation osteotomies provides additional correction control during surgery and accurate outcome, while facilitating the flow of this technically demanding procedure.
| S-EPMC10113089 | biostudies-literature