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Background 3D printing technology in hospitals facilitates production models such as point-of-care manufacturing. Orthopedic Surgery and Traumatology is the specialty that can most benefit from the advantages of these tools. The purpose of this study is to present the results of the integration of 3D printing technology in a Department of Orthopedic Surgery and Traumatology and to identify the productive model of the point-of-care manufacturing as a paradigm of personalized medicine. Methods Observational, descriptive, retrospective and monocentric study of a total of 623 additive manufacturing processes carried out in a Department of Orthopedic Surgery and Traumatology from November 2015 to March 2020. Variables such as product type, utility, time or materials for manufacture were analyzed. Results The areas of expertise that have performed more processes are Traumatology, Reconstructive and Orthopedic Oncology. Pre-operative planning is their primary use. Working and 3D printing hours, as well as the amount of 3D printing material used, vary according to the type of product or material delivered to perform the process. The most commonly used 3D printing material for manufacturing is polylactic acid, although biocompatible resin has been used to produce surgical guides. In addition, the hospital has worked on the co-design of customized implants with manufacturing companies. Conclusions The integration of 3D printing in a Department of Orthopedic Surgery and Traumatology allows identifying the conceptual evolution from “Do-It-Yourself” to “POC manufacturing”.

Background Intraoperative electron-beam radiation therapy (IOERT) during limb-sparing surgery has the advantage of delivering a single high boost dose to sarcoma residues and surgical bed area near to radiosensitive structures with limited toxicity. Retrospective studies have suggested that IOERT may improve local control compared to standard radiotherapy and we aimed to demonstrate this theory. Therefore, we performed an observational prospective study to determine (1) if it is possible to achieve high local control by adding IOERT to external-beam radiation therapy (EBRT) in extremity soft-tissue sarcomas (STS), (2) if it is possible to improve long-term survival rates, and (3) if toxicity could be reduced with IOERT Materials and methods From 1995−2003, 39 patients with extremity STS were treated with IOERT and postoperative radiotherapy. The median follow-up time was 13.2 years (0.7–19). Complications, locoregional control and survival rates were collected. Results Actuarial local control was attained in 32 of 39 patients (82%). Control was achieved in 88% of patients with primary disease and in 50% of those with recurrent tumors (p = 0.01). Local control was shown in 93% of patients with negative margins and in 50% of those with positive margins (p = 0.002). Limb-sparing was achieved in 32 patients (82%). The overall survival rate was 64%. 13% of patients had grade ≥3 acute toxicity, and 12% developed grade ≥3 chronic toxicity. Conclusion IOERT used as a boost to EBRT provides high local control and limb-sparing rates in patients with STS of the extremities, with less toxicity than EBRT alone.

Introduction Acetabular revision surgery poses a challenge due to the increased frequency of severe defects and poor quality of the remaining bone. We compare the clinical and radiological outcomes, complications, and survival of two systems commonly used in complex acetabular revisions (AAOS types II, III, and IV): trabecular metal system (TM) and Burch-Schneider antiprotrusion cages (BS). Methods Eighty-four patients underwent acetabular revision surgery with TM or BS in our centre between 2008 and 2014. Comparison was made of demographic and clinical characteristics, satisfaction, radiographic parameters, complications, and survival of the implants. A BS was implanted in 30.9% of the patients, while 69.1% received a TM implant. The mean follow-up was 4.77 years. Results The BS group required a significantly greater number of constrained implants ( p  = 0.001) and more walking aids ( p  = 0.04). The mean satisfaction ( p  = 0.02) and HHS scores at the end of the follow-up were higher in the TM group ( p  = 0.003). No differences were observed in the incidence of complications, though the only two cases of implant rupture corresponded to the BS group. The overall survival rate was 88.1% after 7.5 years. Conclusion TM implants afforded better clinical outcomes and greater patient satisfaction than antiprotrusion cages in the treatment of severe acetabular defects.

Objective: To examine the influence of age, sex and height on the symphysis–ischial spine distance (SID) measured on pelvic Computed tomography (CT)images in subjects of reproductive age, and to determine the interobserver reproducibility. This measurement (SID) is of great importance because the use of intrapartum ultrasound is based on the assumption of a specific value (30 mm) of such a measurement. Methods: This was a cross-sectional descriptive study in which SID was measured in subjects aged 20 to 44 years who had been scheduled for pelvic CT at our centre from January 2018 to May 2021 for different reasons. Radiographic measurements of the pelvis were obtained through the multiplanar reconstruction of the CT image. The images obtained from all of the participants were independently assessed by three senior radiologists, and the SID measurements made by each one were blinded from those of the remaining observers. Correlations between the SID and patient age, height and sex were analyzed by univariate and multivariate linear regression. Results: The mean SID for 87 of the enrolled participants (45 women, 42 men) was 28.2 ± 6.25 mm. Among the observers, the mean difference in this distance was 1 to 2 mm, and was scarcely related to measurement size, with agreement being greater than 70%. The mean SID was significantly related to sex and height (SID = −24.9 − 6.51 × sex (0 or 1) + 0.34 × height (cm); p = 0.01; sex equals 1 for a man and 0 for a woman), such that it was a mean of 2.5 mm greater in women than men (29.50 mm vs. 26.99 mm). Conclusion: Measurements of SID on CT images show good interobserver reproducibility, and are related to sex and height.

Abstract Background and aims Spontaneous Intracerebral haemorrhage (ICH) has high morbidity and mortality. We aimed to identify prognostic factors in clinical practice and to assess whether an intensive management care bundle protocol (CBP) improves outcomes. Methods Retrospective observational study included patients admitted with ICH between 2022-2025. Clinical and radiological variables and ICHMAX score were analysed. Outcomes were mortality and modified Rankin Scale (mRS) at 90 days. Results were compared before and after CBP implementation in 2024. Results 321 patients (201 before, 120 after CBP), mean age 69.45 years, 56.4% male. Median baseline stroke severity was: NIHSS 10, ICHMAX score 3, pre-ICH mRS 1. No baseline differences between periods. Women had higher mortality (22.9% vs 13.3%; p=0.02) and worse functional outcome (p=0.02). Hypertension, diabetes and admission hyperglycaemia were associated with poor functional outcome (p<0.05). Radiological markers (spot, blend, black hole and island signs) and hematoma size were strongly associated with higher mortality and poor outcome (p<0.001). A linear association existed between ICHMAX and both mortality and 90-day mRS (p<0.001). Following CBP implementation, a trend towards improved blood pressure control (p=0.08) and better glycaemic control (p=0.046) was observed. Overall outcome and mortality showed limited improvement (14.2% vs 19.5%; p=0.28), but mortality decreased in ICHs with radiological poor-prognosis signs (23.3% vs 37.8%; p=0.075) and ICHMAX size-positive haemorrhages (21.4% vs 45.3%; p=0.016) Conclusions Our protocol appears to benefit patients with worse prognosis. Initial severity, ICHMAX and radiological poor-prognosis features are strong determinants of outcome. Future prognostic improvement will likely require complementary strategies, including brain injury biomarkers and novel therapeutic approaches. Conflict of interest Nothing to disclose

Abstract Background and aims The coexistence of atrial fibrillation (AF) and the need for carotid intervention is uncommon, limiting the available evidence on optimal antithrombotic management. Based on this premise, we aimed to evaluate the safety and efficacy of two antithrombotic strategies at one month and one year following carotid artery stenting (CAS) in patients with AF receiving direct oral anticoagulants (DOACs). Methods Single-center retrospective cohort study including patients undergoing CAS between May 2018 and May 2025. Patients with non-valvular AF on DOAC therapy were included. Two groups were compared: dual therapy (DOAC + clopidogrel) and triple therapy (DOAC + clopidogrel + aspirin). Baseline characteristics, bleeding events, stent thrombosis/restenosis, and stroke recurrence were assessed at one month and one year post-procedure. Results Of 535 patients treated with CAS, 41 had AF, and 29 met the inclusion criteria (mean age 75.4 years; 31% women). There were no significant differences in baseline characteristics or complication rates between groups. No adverse events were recorded within the first month. During the first year, one stroke occurred in each group, one asymptomatic major bleeding event was reported, and four stent restenoses were observed—three in the dual therapy group and one in the triple therapy group. Conclusions In our cohort, no statistically significant differences in complications were observed between dual and triple antithrombotic therapy at one month or one year post-CAS. Larger studies are needed to establish evidence-based clinical recommendations. Conflict of interest Ignacio Ruiz Salcedo: nothing to disclose. Figure 1 - belongs to Results

Abstract Background and aims Current studies support infarct size–guided anticoagulation after cardioembolic stroke, although no widely accepted guidelines define an optimal timing. In 2023, the ELAN trial classified ischemic strokes according to infarct size and defined “early” and “late” anticoagulation strategies (minor: <2 and 3-4 days; moderate: <2 and 6-7 days; major: 6-7 and 12-14 days), showing no significant differences in complications. We aimed to evaluate these strategies in real-world experience. Methods Restrospective study of atrial fibrillation-related cardioembolic strokes admitted to our tertiary-care centre between 2023-2024. Patients meeting ELAN trial criteria for “early” or “late” strategies were included. Baseline and discharge characteristics and complications during follow-up were analysed. Results Among 168 patients with cardioembolic stroke, 96 met ELAN trial criteria for \"early\" (58.3%) or \"late\" (41.7%) anticoagulation strategies. Baseline demographic and clinical characteristics, NIHSS and modified Rankin Scale (mRS), were similar between groups. At discharge, “early” group showed significantly better outcomes, with lower median NIHSS (2 vs 5, p=0.009) and mRS (2 vs 3, p=0.035). After anticoagulation, no recurrent ischemic strokes were observed, with no significant differences in intracranial haemorrhage (p=0.305) or all-cause mortality at 1 (p=0.569) or 6 months (p=0.691). Conclusions In our real-world experience, early anticoagulation was significantly associated with better functional outcomes, differing from the ELAN trial. By contrast, no statistically significant differences were observed in haemorrhagic complications or mortality, consistent with the ELAN trial. These findings support infarct size–guided anticoagulation after cardioembolic stroke. However, differences in sample size and baseline characteristics highlight the need for larger studies to confirm these results. Conflict of interest All authors have nothing to disclose