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Bruschi A, Donati DM, Di Bella C. What to choose in bone tumour resections? Patient specific instrumentation versus surgical navigation: a systematic review. J Bone Oncol 2023; 42:100503. [PMID: 37771750 PMCID: PMC10522906 DOI: 10.1016/j.jbo.2023.100503] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
Patient specific instrumentation (PSI) and intraoperative surgical navigation (SN) can significantly help in achieving wide oncological margins while sparing bone stock in bone tumour resections. This is a systematic review aimed to compare the two techniques on oncological and functional results, preoperative time for surgical planning, surgical intraoperative time, intraoperative technical complications and learning curve. The protocol was registered in PROSPERO database (CRD42023422065). 1613 papers were identified and 81 matched criteria for PRISMA inclusion and eligibility. PSI and SN showed similar results in margins (0-19% positive margins rate), bone cut accuracy (0.3-4 mm of error from the planned), local recurrence and functional reconstruction scores (MSTS 81-97%) for both long bones and pelvis, achieving better results compared to free hand resections. A planned bone margin from tumour of at least 5 mm was safe for bone resections, but soft tissue margin couldn't be planned when the tumour invaded soft tissues. Moreover, long osteotomies, homogenous bone topology and restricted working spaces reduced accuracy of both techniques, but SN can provide a second check. In urgent cases, SN is more indicated to avoid PSI planning and production time (2-4 weeks), while PSI has the advantage of less intraoperative using time (1-5 min vs 15-65 min). Finally, they deemed similar technical intraoperative complications rate and demanding learning curve. Overall, both techniques present advantages and drawbacks. They must be considered for the optimal choice based on the specific case. In the future, robotic-assisted resections and augmented reality might solve the downsides of PSI and SN becoming the main actors of bone tumour surgery.
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Affiliation(s)
- Alessandro Bruschi
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Davide Maria Donati
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| | - Claudia Di Bella
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- Department of Surgery, The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, VIC 3065, Australia
- VBJS, Victorian Bone and Joint Specialists, 7/55 Victoria Parade, Fitzroy, VIC 3065, Australia
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Shitova AD, Kovaleva ON, Olsufieva AV, Gadzhimuradova IA, Zubkov DD, Kniazev MO, Zharikova TS, Zharikov YO. Risk modeling of femoral neck fracture based on geometric parameters of the proximal epiphysis. World J Orthop 2022; 13:733-743. [PMID: 36159625 PMCID: PMC9453284 DOI: 10.5312/wjo.v13.i8.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/12/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fractures of the proximal femur epiphysis are problematic for state health care because they are associated with severe medical and social problems and high morbidity and mortality rates. AIM To model the potential risk of hip fracture via femur geometric parameters. METHODS Seventy educational cadaveric femurs from people aged 14 to 80 years, 10 X-ray images from the records of the Human Anatomy Department and 10 X-ray images from the Department of Traumatology, Orthopedics and Disaster Surgery of Sechenov University, were evaluated. The parameters of the fractured bone were measured using images captured with a Canon d60 camera. The projection values of the proximal epiphysis of the cadaveric femurs and geometric parameters of the bones shown in the X-ray images were measured with Autodesk software (AutoCAD 2018). Analysis of the video frames showing bone rotation reveal that the greater trochanter can be inscribed in a parallelepiped, where one of the faces is parallel to the plane of view in the frontal standard projection and is rectangular. The angle of bone rotation obtained by turning the cube corresponded to the angle measured with the second technique. This reliable method of calculating the rotation of the bone relative to the anterior projection was employed in subsequent calculations. The geometric parameters of the femur were measured using X-ray images according to the proposed method. RESULTS The geometric parameters of 70 femurs were analyzed, and correlation coefficients were calculated. Our measurement results were compared with those reported by other authors. The potential influence of femur geometry on force distribution in the proximal epiphysis of the femur was described, and a 2-dimensional model of the femur epiphysis associated with minimal neck fracture risk was provided. The assessment of the geometric parameters of the femoral epiphysis indicated the greatest risk of a varus fracture of the neck if the angle of the minimal resistance zone (AMRZ) index > 24° and the neck-shaft angle (NSA) < 127.5°. In contrast, the minimum risk was observed at AMRZ < 14° and NSA > 128.87°. CONCLUSION The proposed method provides the potential femur neck fracture risk based on geometric parameters.
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Affiliation(s)
- Anna D Shitova
- International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
| | - Olga N Kovaleva
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Moscow, Russia
| | - Anna V Olsufieva
- Department of Biomedical Disciplines of the Faculty of Medicine, Nonstate Educational Private Institution of Higher Education "Moscow Financial and Industrial University “Synergy”, Moscow 125190, Moscow, Russia
| | - Inchekhanum A Gadzhimuradova
- International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
| | - Dmitry D Zubkov
- International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
| | - Mikhail O Kniazev
- Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Moscow, Russia
| | - Tatyana S Zharikova
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Moscow, Russia
| | - Yury O Zharikov
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Moscow, Russia
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Peng MJ, Cao X, Chen HY, Hu Y, Li X, Lao Y, Bai B. Intralesional curettage versus prosthetic replacement for bone tumors - a finite element analysis case of limb salvage simulation in biomechanics. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 198:105775. [PMID: 33130494 DOI: 10.1016/j.cmpb.2020.105775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES To compare mechanical properties of femoral tumor treatments so that better operative strategy for limb tumors surgery is optimized. METHODS Fourteen femoral CT images were randomly selected to rebuild 3D models by MIMICS. They were then executed by reverse engineering softwares for simulative modes. Mode #1: Intralesional curettage with cement filled plus fixator; Mode #2: Distal femur resection with tumorous prosthesis replaced. Finally, the mechanical aspects such as stress and displacement were compared by finite element analysis. RESULTS Analyzed by AnSys, the observation indexes were measured as follows: for displacement of femurs, d=1.4762 (< a=3.9042 < c=3.9845 < b=4.1159) in mm is the most staple of all models; for displacement of implants (fixators or prostheses), it's similar to the behavior of femurs and with no significant difference; for stresses of femurs, no significant difference was found among all models; the stresses of implants (fixations and prostheses) were observed as d=39.6334 (< a=58.6206 < c=61.8150 < b=62.6626) in MPa correspondently, which is the least; for stresses of the general system, the average of peak values for integrated devices of all models are: d=40.8072 (< a=58.6206 < c=61.7831< b=62.6626) in MPa, which is also the least. As a final result, both maximum values for displacement and stress of mode 2 are lower than those of mode 1. CONCLUSIONS Our finite element analysis of limb salvage simulation in biomechanics proved that, to treat distal femoral bone tumors, prosthetic replacement is more efficient than intralesional curettage.
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Affiliation(s)
| | - XiongWei Cao
- ENT Dept. Guanghai Central Hospital, Taishan, Guangdong, China
| | - Hai-Yan Chen
- Orthopedics Dept. HuiDong People's Hospital, HuiZhou, China
| | - Yong Hu
- Neural Electrophysiology Lab, University of HongKong, Hong Kong
| | - XinXu Li
- Traumatic Orthopedics Dept. SanShui People's Hospital, FoShan, China.
| | - YongQiang Lao
- Osteopathia Oncology Dept. FoShan Hospital of Traditional Chinese Medicine, China.
| | - Bo Bai
- Orthopedics Dept. of 1st Affiliated Hospital, GuangZhou Medical University, China.
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WITHDRAWN: Intralesional curettage versus prosthetic replacement, which approach is suitable for GCT?------ A finite element biomechanics analysis of limb-salvage simulation. Surg Oncol 2020. [DOI: 10.1016/j.suronc.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Three-Dimensional–Printed Individualized Guiding Templates for Surgical Correction of Severe Kyphoscoliosis Secondary to Ankylosing Spondylitis: Outcomes of 9 Cases. World Neurosurg 2019; 130:e961-e970. [DOI: 10.1016/j.wneu.2019.07.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/18/2022]
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Summers SH, Zachwieja EC, Butler AJ, Mohile NV, Pretell-Mazzini J. Proximal Tibial Reconstruction After Tumor Resection: A Systematic Review of the Literature. JBJS Rev 2019; 7:e1. [PMID: 31268862 DOI: 10.2106/jbjs.rvw.18.00146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The proximal part of the tibia is a common location for primary bone tumors, and many options for reconstruction exist following resection. This anatomic location has a notoriously high complication rate, and each available reconstruction method is associated with unique risks and benefits. The most commonly utilized implants are metallic endoprostheses, osteoarticular allografts, and allograft-prosthesis composites. There is a current lack of data comparing the outcomes of these reconstructive techniques in the literature. METHODS A systematic review of peer-reviewed observational studies evaluating outcomes after proximal tibial reconstruction was conducted, including both aggregate and pooled data sets and utilizing a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) review for quality assessment. Henderson complications, amputation rates, implant survival, and functional outcomes were evaluated. RESULTS A total of 1,643 patients were identified from 29 studies, including 1,402 patients who underwent reconstruction with metallic endoprostheses, 183 patients who underwent reconstruction with osteoarticular allografts, and 58 patients who underwent with reconstruction with allograft-prosthesis composites. The mean follow-up times were 83.5 months (range, 37.3 to 176 months) for the metallic endoprosthesis group, 109.4 months (range, 49 to 234 months) for the osteoarticular allograft group, and 88.8 months (range, 49 to 128 months) for the allograft-prosthesis composite reconstruction group. The mean patient age per study ranged from 13.5 to 50 years. Patients with metallic endoprostheses had the lowest rates of Henderson Type-1 complications (5.1%; p < 0.001), Type-3 complications (10.3%; p < 0.001), and Type-5 complications (5.8%; p < 0.001), whereas, on aggregate data analysis, patients with an osteoarticular allograft had the lowest rates of Type-2 complications (2.1%; p < 0.001) and patients with an allograft-prosthesis composite had the lowest rates of Type-4 complications (10.2%; p < 0.001). The Musculoskeletal Tumor Society (MSTS) scores were highest in patients with an osteoarticular allograft (26.8 points; p < 0.001). Pooled data analysis showed that patients with a metallic endoprosthesis had the lowest rates of sustaining any Henderson complication (23.1%; p = 0.009) and the highest implant survival rates (92.3%), and patients with an osteoarticular allograft had the lowest implant survival rates at 10 years (60.5%; p = 0.014). CONCLUSIONS Osteoarticular allograft appears to lead to higher rates of Henderson complications and amputation rates when compared with metallic endoprostheses. However, functional outcomes may be higher in patients with osteoarticular allograft. Further work is needed using higher-powered randomized controlled trials to definitively determine the superiority of one reconstructive option over another. In the absence of such high-powered evidence, we encourage individual surgeons to choose reconstructive options based on personal experience and expertise. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Spencer H Summers
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida
| | - Erik C Zachwieja
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida
| | - Alexander J Butler
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida
| | - Neil V Mohile
- Department of Education, The University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Juan Pretell-Mazzini
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida.,Musculoskeletal Oncology Division, Department of Orthopedics, University of Miami, Miami, Florida
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3D printed personalized titanium plates improve clinical outcome in microwave ablation of bone tumors around the knee. Sci Rep 2017; 7:7626. [PMID: 28790331 PMCID: PMC5548746 DOI: 10.1038/s41598-017-07243-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/22/2017] [Indexed: 12/14/2022] Open
Abstract
Microwave ablation has been widely accepted in treating bone tumor. However, its procedure is time-consuming and usually results in postoperative fractures. To solve this problem, we designed and fabricated titanium plates customized to the patients’ bone structures. The personalized titanium plates were then used for fixation after the removal of tumorous tissue. Specifically, 3D models of tumor-bearing bone segments were constructed by using computed tomography (CT) and magnetic resonance imaging (MRI). The 3D models were used to design the personalized titanium plates. The plate model was transferred into a numerical control machine for manufacturing the personalized titanium plates by 3D printing. The plates were then surgically implanted for reconstruction assistance following microwave-induced hyperthermia to remove the bone tumor. Implementation parameters and knee functions were then evaluated. No postoperative fractures, implant failures or loosening problems occurred; mean Musculoskeletal Tumor Society score was 27.17 from the latest follow-up. Mean maximum flexion of affected knees was 114.08°. The results of knee gait analysis were comparable with normal population data. Our work suggests that personalized titanium plates can significantly improve the clinical outcomes in the surgical removal of bone tumor. This study represents the first-time effort in using personalized titanium plates for such surgery.
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Peng X, Wang F, Su J. The value of computer-assisted navigation for bone reconstruction after tumor resection. Oncol Lett 2017; 14:2771-2774. [PMID: 28928818 PMCID: PMC5588145 DOI: 10.3892/ol.2017.6523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/28/2017] [Indexed: 12/13/2022] Open
Abstract
This study was designed to evaluate the use of computer-assisted navigation with computed tomography (CT) images for bone reconstruction after resection in malignant bone tumor treatment. Forty-five patients with malignant bone tumors were recruited for this study. CT scan images in a computer-assisted navigation system were used to assist during the osteotomy, the pairing with allografts, and the monitoring of the allograft and joint lines to perform joint reconstruction. Our results show that osteotomy and allograft pairing were successful in all patients. The average duration of the osteotomy procedures was 46.8±12.3 min; and the average pairing time was 32.5±9.8 min. The anatomical registration points and the three-dimensional virtual CT images were successfully matched. The average error of registration was 0.36±0.09 mm. Also, the range of tumor resection and allograft osteotomy were successfully paired, with an average error of 0.11±0.03 mm. No complications such as unequal limbs length or joint deformities occurred after reconstruction. The average follow-up time was 11.6±3.9 months. The tumor recurrence rate was 11.1% (5/45) and the survival rate 95.6% (43/45). The average healing time for the allograft and host bone was 5.5±1.2 months and no unexpected internal fixations, fractures or joint collapses occurred. The average knee joint functionality MSTS score was 25.5±6.6 points. No significant differences were found in the length of tumor resection, rate of negative incision margin, duration of osteotomy or of pairing, registration error or allogeneic bone and defect matching error averages between those patients with tumor recurrence and those without it (p>0.05). Based on our results, the computer-assisted navigation system for bone reconstruction after malignant tumor resection allows for high precision during osteotomy, delivers a high success rate of pairing, results in great limb function and low complication rates, and is thus a highly successful and safe approach benefiting bone cancer patients.
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Affiliation(s)
- Xuejun Peng
- Department of Traumatology, Linyi People's Hospital, Linyi, Shandong 276000, P.R. China
| | - Fengping Wang
- Department of Ultrasound, Linyi People's Hospital, Linyi, Shandong 276000, P.R. China
| | - Jing Su
- Community Health Center of Yinque Mountain, Linyi, Shandong 276003, P.R. China
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Mediouni M, Schlatterer DR. Orthopaedic tumors: What problems are we solving, and are universities and major medical centers doing enough? J Orthop 2017; 14:319-321. [PMID: 28507421 DOI: 10.1016/j.jor.2017.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Indexed: 11/19/2022] Open
Abstract
Little has been published about the complexity of orthopaedic tumors compared to others tumors. The current study in the literature treated this problem in terms of classification, surgical intervention and impact on the patient. In this article, factors risks of tumors will be we identified. A strategy based on three dimensional simulations will be explained in order to improve the clinical trials.
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Affiliation(s)
| | - Daniel R Schlatterer
- Orthopaedic Trauma Division, Wellstar at Atlanta Medical Center, 303 Parkway Drive NE, Atlanta, GA 30312, USA
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Miao Q, Ding H, Huang M, Shen J, Tu Q, Huang M. [Preliminary application of three dimensional printing personalized navigation template in assisting total elbow replacement for patients with elbow tumor]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:385-391. [PMID: 29798600 PMCID: PMC8498180 DOI: 10.7507/1002-1892.201611091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/14/2017] [Indexed: 11/03/2022]
Abstract
Objective To explore the clinical methods of resection of elbow tumor and total elbow replacement with custom personalized prosthesis based on three dimensional (3-D) printing navigation template. Methods In August 2016, a 63-year-old male patient with left elbow joint tumor was treated, with the discovery of the left distal humerus huge mass over 3 months, with elbow pain, activity limitation of admission. Computer-assisted reduction technique combined with 3-D printing was used to simulate preoperative tumor resection, a customized personal prosthesis was developed; tumor was accurately excised during operation, and the clinical result was evaluated after operation. Results The time was 46 minutes for tumor resection, and was 95 minutes for personalized implant and allograft bone without fluoroscopy. X-ray and CT examination at 1 week after operation showed good position of artificial elbow joint; the anteversion of ulna prosthesis was 30° and the elbow carrying angle was 15°, which were consistent with the simulated results before surgery. The finger flexion was normal at 1 month after operation; the range of motion was 0-130° for elbow flexion and extension, 80° for forearm pronation, and 80° for forearm supination. The elbow function was able to meet the needs of daily life at 7 months after operation, and no recurrence and metastasis of tumor were observed. Conclusion For limb salvage of elbow joint, computer aided design can make preoperative surgical simulation; the navigation template can improve surgical precision; and the function of elbow joint can be reconstructed with customized and personlized prosthesis for total elbow replacement.
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Affiliation(s)
- Qiuju Miao
- Department of Bone and Joint Disease, Guangzhou General Hospital of Guangzhou Military, Guangzhou Guangdong, 510010, P.R.China;Graduate College, Traditional Chinese Medicine University of Guangzhou, Guangzhou Guangdong, 510010, P.R.China
| | - Huanwen Ding
- Department of Bone and Joint Disease, Guangzhou General Hospital of Guangzhou Military, Guangzhou Guangdong, 510010,
| | - Minqiang Huang
- Department of Bone and Joint Disease, Guangzhou General Hospital of Guangzhou Military, Guangzhou Guangdong, 510010, P.R.China;Graduate College, Traditional Chinese Medicine University of Guangzhou, Guangzhou Guangdong, 510010, P.R.China
| | - Jianjian Shen
- Department of Bone and Joint Disease, Guangzhou General Hospital of Guangzhou Military, Guangzhou Guangdong, 510010, P.R.China
| | - Qiang Tu
- Department of Bone and Joint Disease, Guangzhou General Hospital of Guangzhou Military, Guangzhou Guangdong, 510010, P.R.China
| | - Miaojun Huang
- Guangdong University of Technology, Guangzhou Guangdong, 510006, P.R.China
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Mediouni M, Volosnikov A. The trends and challenges in orthopaedic simulation. J Orthop 2015; 12:253-9. [PMID: 26566328 PMCID: PMC4601998 DOI: 10.1016/j.jor.2015.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/24/2015] [Indexed: 11/19/2022] Open
Abstract
Generally, in some universities of medicine, orthopaedic training procedures represent a difficult task due to the inadequacies of the systems, the resources, and the use of technologies. This article explains the challenges and the needs for more research in the issue of orthopaedic simulation around the world.
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Affiliation(s)
| | - Alexander Volosnikov
- Federal State Budgetary Institution, Russian Ilizarov Scientific Center, Restorative Traumatology and Orthopaedics of Ministry of Healthcare, Russian Federation
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