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The purpose of this paper is to find the incidence and medical reasons for cancellations of elective orthopaedic cases following admission for an operation in a district general hospital. The paper also aims to determine the deficiencies in the local preoperative assessment protocol.

This is a retrospective study. The elective orthopaedic surgeries cancelled following their admission into the hospital due to medical reasons between January 2003 and December 2004, were identified. These cases were reviewed using the preoperative assessment charts and case notes. The NHS Modernisation Agency's guidelines, National Good Practice Guidance on Preoperative Assessment for Inpatient Surgery, are taken as the benchmark for comparison.

The paper finds that 44 elective orthopaedic cases were cancelled due to medical reasons. Of these patients, 64 per cent did not have a pre‐operative assessment prior to the admission for the planned surgery; 6 per cent had inadequate documentation of relevant past medical history; and 30 per cent (patients with significant medical problems) were not referred to the anaesthetist for advice although these problems were identified during the pre‐operative assessment.

It is possible to stimulate good medical practice through audit.

Cancellation of an elective operation is not uncommon in hospital practice. This paper aims to highlight the possible avoidable causes for such cancellations. The paper identifies such deficiencies in the local preoperative assessment protocol and suggests remedies to improve the quality of care. These improvements and close adherence to the guidelines are important as preoperative assessment by nurse‐led clinics are being increasingly practised through out the UK.

The paper fulfils its aims of identifying the medical causes for cancellation of an operation and also the existing deficiencies in the preoperative assessment practice. The paper values the importance of adherence to NHS Modernising Agency's guidelines in preoperative assessment. It is useful not only to the Orthopaedic department but also to the department managers.

This paper aims to describe computer‐aided design and rapid prototyping (RP) systems for the preoperative planning and fabrication of custom‐made implant.

A patient with mandible defect underwent reconstruction using custom‐made implant. 3D models of the patient's skull are generated based on computed tomography image data. After evaluation of the 3D reconstructed image, it was identified that some bone fragment was moved due to the missing segment. During the implant design process, the correct position of the bone fragment was defined and the geometry of the custom‐made implant was generated based on mirror image technique and is fabricated by a RP machine. Surgical approach such as preoperative planning and simulation of surgical procedures was performed using the fabricated skull models and custom‐made implant.

Results show that the stereolithography model provided an accurate tool for preoperative, surgical simulation.

The methods described above suffer from the expensive cost of RP technique.

This method allows accurate fabrication of the implant. The advantages of using this technique are that the physical model of the implant is fitted on the skull model so that the surgeon can plan and rehearse the surgery in advance and a less invasive surgical procedure and less time‐consuming reconstructive and an adequate esthetic can result.

The method improves the reconstructive surgery and reduces the risk of a second intervention, and the psychological stress of the patient will be eliminated.

This study aims to find the usefulness of the customized surgical osteotomy guide (CSOG) for accurate mandibular tumor resection for boosting the accuracy of prefabricated customized implant fixation in mandibular reconstructions.

In all, 30 diseased mandibular RP models (biomodels) were allocated for the study (for experimental group [n = 15] and for control group [n = 15]). To reconstruct the mandible with customized implant in the experimental group, CSOGs and in control group, no CSOG were used for accurate tumor resections. In control group, only preoperative virtual surgical planning (VSP) and reconstructed RP mandible model were used for the reference. Individually each patient’s preoperative mandibular reconstructions data of both the groups were superimposed to the preoperative VSP of respective patient by registering images with the non-surgical side of the mandible. In both the groups, 3D measurements were taken on the reconstructed side and compared the preoperative VSP and postoperative reconstructed mandible data. The sum of the differences between pre and postoperative data was considered as the total error. This procedure was followed for both the groups and compared the obtained error between the two groups using statistical analysis.

The use of CSOG for accurate tumor resection and exact implant fixation in mandibular reconstruction produced a smaller total error than without using CSOG.

The results showed that, benefits provided with the use of CSOG in mandibular reconstruction justified its use over the without using CSOG, even in free hand tumor resection using rotating burr.

The use of physical 3D models has been used in the industry for a while, fulfilling the function of prototypes in the majority of cases where the designers, engineers and manufacturers optimize their designs before taking them into production. In recent years, there has been an increasing number of reports on the use of 3D models in medicine for preoperative planning. In some highly complex surgeries, the possibility of using printed models to previously perform operations can be determining in the success of the surgery. With the aim of providing new functionalities to an anatomical 3D-printed models, in this paper, a cost-effective manufacturing process has been developed. A set of tradition of traditional techniques have been combined with 3D printing to provide a maximum geometrical freedom to the process. By the use of an electroluminescent set of functional paints, the tumours and vessels of the anatomical printed model have been highlighted, providing to this models the possibility to increase its interaction with the surgeon. These set of techniques has been used to increase the value added to the reproduced element and reducing the costs of the printed model, thus making it more accessible.

Successfully case in where the use of a low-cost 3D-printed anatomical model was used as a tool for preoperative planning for a complex oncological surgery. The said model of a 70-year-old female patient with hepatic metastases was functionalized with the aim of increasing the interaction with the surgeons. The analysis of the construction process of the anatomical model based on the 3D printing as a tool for their use in the medical field has been made, as well as its cost.

The use of 3D printing in the construction of anatomical models as preoperative tools is relatively new; however, the functionalization of these tools by using conductive and electroluminescent materials with the aim of increasing the interaction with it by the surgeons is a novelty. And, based on the DIY principles, it offers a geographical limitlessness, reducing its cost without losing the added value.

The process based on 3D printing presented in this paper allows to reproduce low-cost anatomical models by following a simple sequence of steps. It can be done by people with low qualification anywhere with only access to the internet and with the local costs. The interaction of these models with the surgeon based on touch and sight is much higher, adding a very significant value it, without increasing its cost.

To develop a computer‐assisted prefabricated implant design and manufacturing system to improve the esthetic outcome in chin surgery.

Design methods for medical rapid prototyping (RP) of custom‐fabricated chin augmentation implant are presented in this paper. After a careful preoperative planning based on cephalometric tracing for esthetic assessment, helical computed tomography data were used to create a three‐dimensional model of the deficient mandible. Based on these data, the inner surface of the prosthesis was designed to fit the bone surface exactly. The outer geometry was generated from a dried human mandible to create anatomically correct shape prosthesis. The inner and outer surfaces were then connected, and a solid model resulted. A RP system was used for production of the physical models. The surgical planning was performed using the implants and skull models. The resulting SLA implant is used for the production of a mold, which is used to cast the titanium part. Three patients with a congenital small chin or a small and asymmetric mandible underwent reconstruction with individual prefabricated implant. Mean follow‐up period was 1.5 years.

This approach showed significant results in chin augmentation. Compared with traditional methods, the intra‐operative fit was excellent. The operating time was reduced. Postoperatively, the patients experienced the restoration of a natural chin contour, so the esthetic outcome was pleasing. Over the mean follow‐up period of 1.5 years, there were no complications and no implant had to be removed. Long‐term excellent esthetic outcomes by using this new technique have recently been reported.

The methods described above suffer from certain limitations. The registration of the mandible template to create the augmentation image requires high skills of the designer. In addition, the use of RP model in preoperative preparation is expensive.

This method not only demonstrates the significant progress in the reconstruction of chin defects using CAD/CAM RP and RT, compared with the conventional methods of chin augmentation surgery, but also provides natural geometrical prosthesis contour design and accurate fabrication and precise fitting of the prosthesis. The advantages of using this technique are that the physical model of the implant is fitted on the skull model so that the surgeon can plan and rehearse the surgery in advance and a less invasive surgical procedure and less time‐consuming reconstructive and an adequate esthetic can result.

This clinical case demonstrated the potential value of CAD/CAM and RP‐based custom fitted and anatomically correct shape prosthesis fabrication and presurgical planning in craniofacial surgery.

The purpose of the paper was to present a specific case study of how 3D printing was introduced in the chest wall construction process of a specific patient with unique medical condition. A life-size 3D model of the patient’s chest wall was 3D printed for pre-surgical planning. The intent was to eliminate the need for operative exposure to map the pathological area. The model was used for preoperative visualization and formation of a 1-mm thick titanium plate implant, which was placed in the patient during chest wall reconstructive surgery. The purpose of the surgery was to relive debilitating chronic pain due to right scapular entrapment.

The patient was born with a twisted spine. Over time, it progressed to severe and debilitating scoliosis, which required the use of a thoracic brace. Computerized tomography (CT) data were converted to a 3D printed model. The model was used to size and form a 1-mm thick titanium plate implant. It was also used to determine the ideal location for placement of the plate during thoracotomy preoperatively.

The surgery, aided by the model, was successful and resulted in a significantly smaller incision. The techniques reduced invasiveness and enabled the doctors to conduct the procedure efficiently and decreased surgery time. The patient experienced relief of the chronic debilitating pain and no longer need the thoracic brace.

The 3D model facilitated pre-operative planning and modeling of the implant. It also enabled accurate incision locations of the thoracotomy site and placement of the implant. Although chest wall reconstruction surgeries have been undertaken, this paper documents a specific case study of chest wall construction fora specific patient with unique pathological conditions.

Although proximal row carpectomy, wrist arthrodesis and even total wrist arthroplasty were developed to treat wrist disease using bone and cartilage of the wrist, severe and complicated bone defects caused by ferocious trauma and bone tumors remain a stubborn problem for surgeons. Development and application of the three-dimensional (3D) printing technology may provide possible solutions.

Computed tomography (CT) data of three cases with severe bone defects caused by either trauma or bone tumor were collected and converted into three-dimensional models. Prostheses were designed individually according to the residual anatomical structure of the wrist based on the models. Both the models and prostheses were produced using 3D printing technology. A preoperative design was prepared according to the models and prostheses. Then arthroplasty was performed after preoperative simulation with printed models and prostheses.

The diameter of the stem and radial medullary cavity, the direction and location of the prosthesis, and other components were checked during the preoperative design and simulation process phases. The three cases with 3D printed wrist all regained reconstruction of normal anatomy and part of the function after surgery. The average increasing Cooney score rate of Cases 2 and 3 was 133.34 ± 23.57 per cent, and that of Case 1 reached 85 per cent. The average declining rate of the Gartland and Werley Score in Cases 2 and 3 was 65.21 ± 18.89 per cent, and that of Case 1 dropped to 5 per cent in the last follow-up. The scores indicated that patients experienced pain relief and function regain. In addition, the degree of patient satisfaction improved.

3D printed wrist arthroplasty may provide an effective method for severe and complicated cases without sacrificing other bones. Personal customization can offer better anatomy and function than arthrodesis or other traditional surgical techniques.

This report describes Rapid Prototyping (RP) ‐aided assessment and preoperative planning for treatment of bilateral multifocal pelvic limb deformities in a 1 year old German Shepherd dog. Computed tomography (CT) scans were acquired on a General Electric CT scanner and converted to solid models using Mimics software from Materialise. Stereolithography patterns were prototyped using QuickCast build style on a SLA ‐190. Room temperature vulcanized silicone molds were constructed and three sets of polyurethane patterns were cast for pre‐surgical planning and rehearsal. The paper compares traditional osteotomy planning procedures using only radiographs and 2D CT images to planning with full‐scale physical biomodels. The biomodels had a clearly beneficial impact on the accuracy of surgery and positively influenced the clinical outcome.

This study aims to provide an overview of rapid prototyping (RP) and shows the potential of this technology in the field of medicine as reported in various journals and proceedings. This review article also reports three case studies from open literature where RP and associated technology have been successfully implemented in the medical field.

Key publications from the past two decades have been reviewed.

This study concludes that use of RP-built medical model facilitates the three-dimensional visualization of anatomical part, improves the quality of preoperative planning and assists in the selection of optimal surgical approach and prosthetic implants. Additionally, this technology makes the previously manual operations much faster, accurate and cheaper. The outcome based on literature review and three case studies strongly suggests that RP technology might become part of a standard protocol in the medical sector in the near future.

The article is beneficial to study the influence of RP and associated technology in the field of medicine.