SWIFT Hilary, Brion BENNINGER, Craig GILLIS and Ravi BALASUBRAMANIAN, Medical Anatomy Center, Department of Medical Anatomical Sciences, Western University of Health Sciences, COMP–Northwest, Lebanon, OR 97355, USA. School... [ view full abstract ]
SWIFT Hilary, Brion BENNINGER, Craig GILLIS and Ravi BALASUBRAMANIAN, Medical Anatomy Center, Department of Medical Anatomical Sciences, Western University of Health Sciences, COMP–Northwest, Lebanon, OR 97355, USA. School of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis, OR 97331, USA. Department of Orthopaedic Surgery, Samaritan Health Services, Corvallis, OR 97355, USA.
INTRODUCTION. Upper-extremity injuries are the most common war injuries and highest rate of leading to long-term disability in military personnel. Of the 30,000 service members of the Afghanistan and Iraq wars, 82% reported an upper-extremity injury. Reconstructive tendon-transfer surgeries (TTS) have been extensively utilized in the military since World War II. Operational deployment reports indicate that 22% of hand surgeries performed in the military are TTS. The exemplar surgery used for this study, namely the TTS for median-ulnar nerve trauma, is one of the most common reconstructive TTS. The technology developed to advance this surgery will be available to military and civilian medicine. The objective of this study is to develop implantable passive mechanisms for advancing reconstructive orthopedic surgery for upper-extremity trauma and assess its surgical position using ultrasound. METHOD. Literature search was conducted on using US to assess implant returning function to the hand. Recently deceased unembalmed donors (N=6 sides) received conventional TTS including implant to Extensor Carpi Radialis Longus (ECRL) – Flexor Digitorum Profundus (FDP). Implants were designed, then implemented into a 3D printer which produced the implant made of a plastic material. Implant movement was assessed with ultrasound probes (5-12 & 18 MHz) and MRI scans in varied positions. Each implant was examined and compared with the tendons of ECRL and FDP for size variation. RESULTS. Literature search revealed no known studies. Surgical protocol was successful placing the implant. The implant moved unimpeded during tendon movements. DISCUSSION. Implants were successfully placed and modified with each surgery-image session to improve differential movement of the tendons distal to the implant. This research is developing “new technology” facilitating optimal restoration of physical reintegration post neuromuscular injury. The proposed technology is also applicable to other orthopedic surgeries in the area of regenerative medicine, where implants can be integrated with or constructed from tissue-engineered muscles and tendons. It promotes improved quality of life by an effective return to desired real-world functional activities. Fundamentally, it enables the re-engineering of the human body through surgery and improves patient quality of life when compared with state of the art techniques. Real time ultrasound of the tendon movement with the implant in situ could confirm intraoperative success and diminish post-morbidity and function. CONCLUSION. This multidiscipline study used an anatomy dissection lab to help design, assess with ultrasound, and develop an implant for median-ulnar nerve injuries to restore a more natural function of the hand “organ”.
Use of ultrasound in Undergraduate Medical Education , Technology , New Uses
