The authors have no acknowledgments.

The study was approved by the ethics committee of our institution (reference 2020-277-1). Patients signed the CT scan informed consent.
1. Downloading the CT images
<ol>
	<li>Gain access to a picture archiving and communication system (PACS). 
	NOTE: Each software package has a different way of accessing a PACS, but all of them have a way to download a study in the DICOM format. If there is a question regarding how this is done, ask the system administrator of the cente...

<ol>
	<li>Teitge, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+lower+limb+torsion+matter.">Does lower limb torsion matter.</a> Techniques in Knee Surgery. 11 (3), 137-146 (2012).</li><li>Teitge, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+power+of+transverse+plane+limb+mal-alignment+in+the+genesis+of+anterior+knee+pain-Clinical+relevance.">The power of transverse plane limb mal-alignment in the genesis of anterior knee pain-Clinical relevance.</a> Annals of Joint. 3, 70 (2018).</li><li>Delgado, E. D., Schoenecker, P. L., Rich, M. M., Capelli, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+severe+torsional+malalignment+syndrome.">Treatment of severe torsional malalignment syndrome.</a> Journal of Pediatric Orthopedics. 16 (4), 484-488 (1996).</li><li>Bruce, W. D., Stevens, P. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+correction+of+miserable+malalignment+syndrome.">Surgical correction of miserable malalignment syndrome.</a> Journal of Pediatric Orthopedics. 24 (4), 392-396 (2004).</li><li>Teitge, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patellofemoral+syndrome+a+paradigm+for+current+surgical+strategies.">Patellofemoral syndrome a paradigm for current surgical strategies.</a> The Orthopedic Clinics of North America. 39 (3), 287-311 (2008).</li><li>Leonardi, F., Rivera, F., Zorzan, A., Ali, S. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+double+osteotomy+in+severe+torsional+malalignment+syndrome:+16+years+follow-up.">Bilateral double osteotomy in severe torsional malalignment syndrome: 16 years follow-up.</a> Journal of Orthopaedics and Traumatology. 15 (2), 131-136 (2014).</li><li>Stevens, P. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Success+of+torsional+correction+surgery+after+failed+surgeries+for+patellofemoral+pain+and+instability.">Success of torsional correction surgery after failed surgeries for patellofemoral pain and instability.</a> Strategies in Trauma and Limb Reconstruction. 9 (1), 5-12 (2014).</li><li>Dickschas, J., Harrer, J., Reuter, B., Schwitulla, J., Strecker, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Torsional+osteotomies+of+the+femur.">Torsional osteotomies of the femur.</a> Journal of Orthopaedic Research. 33 (3), 318-324 (2015).</li><li>Naqvi, G., Stohr, K., Rehm, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Proximal+femoral+derotation+osteotomy+for+idiopathic+excessive+femoral+anteversion+and+intoeing+gait.">Proximal femoral derotation osteotomy for idiopathic excessive femoral anteversion and intoeing gait.</a> SICOT-J. 3, (2017).</li><li>Iobst, C. A., Ansari, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Femoral+derotational+osteotomy+using+a+modified+intramedullary+nail+technique.">Femoral derotational osteotomy using a modified intramedullary nail technique.</a> Techniques in Orthopaedics. 33 (4), 267-270 (2018).</li><li>Stambough, J. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Knee+pain+and+activity+outcomes+after+femoral+derotation+osteotomy+for+excessive+femoral+anteversion.">Knee pain and activity outcomes after femoral derotation osteotomy for excessive femoral anteversion.</a> Journal of Pediatric Orthopedics. 38 (10), 503-509 (2018).</li><li>Murphy, S. B., Simon, S. R., Kijewski, P. K., Wilkinson, R. H., Griscom, N. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Femoral+anteversion.">Femoral anteversion.</a> Journal of Bone and Joint Surgery. American Volume. 69 (8), 1169-1176 (1987).</li><li>Gracia-Costa, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Análisis por elementos finitos de las presiones femoropatelares previas y posteriores a osteotomía desrrotadora. , (2019).</li><li>Ferr&#224;s-Tarrag&#243;, J., Sanchis-Alfonso, V., Ram&#237;rez-Fuentes, C., Rosell&#243;-A&#241;&#243;n, A., Baixauli-Garc&#237;a, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+3D-CT+Analysis+of+femoral+symmetry-Surgical+implications.">A 3D-CT Analysis of femoral symmetry-Surgical implications.</a> Journal of Clinical Medicine. 9 (11), 3546 (2020).</li><li>Chen, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+die-punch+fractures+with+3D+printing+technology.">Treatment of die-punch fractures with 3D printing technology.</a> Journal of Investigative Surgery. 31 (5), 385-392 (2017).</li><li>Wells, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Femoral+morphology+in+the+dysplastic+hip:+Three-dimensional+characterizations+with+CT.">Femoral morphology in the dysplastic hip: Three-dimensional characterizations with CT.</a> Clinical and Orthopaedics and Related Research. 475 (4), 1045-1054 (2016).</li><li>Liang, H., Ji, T., Zhang, Y., Wang, Y., Guo, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+with+3D-printed+pelvic+endoprostheses+after+resection+of+a+pelvic+tumour.">Reconstruction with 3D-printed pelvic endoprostheses after resection of a pelvic tumour.</a> The Bone and Joint Journal. 99-B (2), 267-275 (2017).</li><li>Wang, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-aided+designed,+three+dimensional-printed+hemipelvic+prosthesis+for+peri-acetabular+malignant+bone+tumour.">Computer-aided designed, three dimensional-printed hemipelvic prosthesis for peri-acetabular malignant bone tumour.</a> International Orthopaedics. 42 (3), 687-694 (2018).</li><li>Wong, K. C., Kumta, S., Geel, N. V., Demol, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One-step+reconstruction+with+a+3D-printed,+biomechanically+evaluated+custom+implant+after+complex+pelvic+tumor+resection.">One-step reconstruction with a 3D-printed, biomechanically evaluated custom implant after complex pelvic tumor resection.</a> Computed Aided Surgery. 20 (1), 14-23 (2015).</li><li>Fang, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+applications+of+three-dimensional+printing+in+the+pelvis+and+acetabulum:+From+models+and+tools+to+implants.">Surgical applications of three-dimensional printing in the pelvis and acetabulum: From models and tools to implants.</a> Der Unfallchirurg. 122 (4), 278-285 (2019).</li><li>Upex, P., Jouffroy, P., Riouallon, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+3D+printing+for+treating+fractures+of+both+columns+of+the+acetabulum:+Benefit+of+pre-contouring+plates+on+the+mirrored+healthy+pelvis.">Application of 3D printing for treating fractures of both columns of the acetabulum: Benefit of pre-contouring plates on the mirrored healthy pelvis.</a> Orthopaedics &amp; Traumatology, Surgery &amp; Research. 103 (3), 331-334 (2017).</li><li>Xie, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+printing+assisted+ORIF+versus+conventional+ORIF+for+tibial+plateau+fractures:+A+systematic+review+and+meta-analysis.">Three-dimensional printing assisted ORIF versus conventional ORIF for tibial plateau fractures: A systematic review and meta-analysis.</a> International Journal of Surgery. 57, 35-44 (2018).</li><li>Scorcelletti, M., Reeves, N. D., Rittweger, J., Ireland, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Femoral+anteversion:+Significance+and+measurement.">Femoral anteversion: Significance and measurement.</a> Journal of Anatomy. 237 (5), 811-826 (2020).</li><li>Seitlinger, G., Moroder, P., Scheurecker, G., Hofmann, S., Grelsamer, R. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+contribution+of+different+femur+segments+to+overall+femoral+torsion.">The contribution of different femur segments to overall femoral torsion.</a> The American Journal of Sports Medicine. 44 (7), 1796-1800 (2016).</li><li>Kaiser, P., Attal, R., Kammerer, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Significant+differences+in+femoral+torsion+values+depending+on+the+CT+measurement+technique.">Significant differences in femoral torsion values depending on the CT measurement technique.</a> Archives of Orthopaedic and Trauma Surgery. 136 (9), 1259-1264 (2016).</li><li>Schmaranzer, F., Lerch, T. D., Siebenrock, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differences+in+femoral+torsion+among+various+measurement+methods+increase+in+hips+with+excessive+femoral+torsion.">Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion.</a> Clinical Orthopaedics and Related Research. 477 (5), 1073-1083 (2019).</li><li>Sanchis-Alfonso, V., Domenech-Fernandez, J., Ferras-Tarrago, J., Rosello-A&#241;on, A., Teitge, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+incidence+of+complications+after+derotational+femoral+and/or+tibial+osteotomies+in+patellofemoral+disorders+in+adolescents+and+active+young+patients:+A+systematic+review+with+meta-analysis.">The incidence of complications after derotational femoral and/or tibial osteotomies in patellofemoral disorders in adolescents and active young patients: A systematic review with meta-analysis.</a> Knee Surgery, Sports Traumatology, Arthroscopy. 30 (10), 3515-3525 (2022).</li></ol>

The most important finding of this study is that 3D technology allows the planning of proximal external derotational femoral osteotomy. This technology can simulate the surgery that is to be performed on a specific patient on the computer. It is a simple, reproducible, and free technique that uses software adaptable to most computers. The only technical problem may be that the 3D builder software works only with the Windows operating system. The major limitation is the learning curve. This protocol is still in the prelim...

Anterior knee pain (AKP) is a common clinical issue among adolescents and young adults. There is a growing body of evidence that increased femoral anteversion (FAV) plays an important role in the genesis of AKP1,2,3,4,5,6,7,8,9,10,11. In addition, this same evidence suggests that a derotational femoral osteotomy is beneficial for these patients, as good clinical results have been reported1,2,3,4,5,6,7,8,9,10,11. However, this type of surgery is not widely used in daily clinical practice among orthopedic surgeons, especially in the cases of adolescents and young active patients with anterior knee pain27, because the many controversial aspects generate uncertainty. For example, it has been observed that sometimes the correction obtained after the osteotomy is not what was previously planned. That is, there is not always a 1:1 ratio between the amount of rotation planned when performing the osteotomy and the amount of FAV corrected. This finding has not been studied to date. Therefore, it is the subject of the present paper. To explain the discrepancy between the magnitude of the rotation performed with the osteotomy and the magnitude of the correction of FAV, it was hypothesized that the axis of rotation of the osteotomy and the axis of rotation of the femur may not coincide.
One of the main problems to be addressed is accurately locating the femoral axis of rotation and the axis of rotation of the osteotomy. The first femoral axis is the femoral axis measured on the CT scan at the time of the patient&#39;s diagnosis, while the second femoral axis is the femoral axis measured after performing the osteotomy. Over the last decade, 3D technology has become increasingly important in preoperative planning, especially in orthopedic surgery and traumatology, for simplifying and optimizing surgical techniques15,16. The development of 3D technology has supported the creation of anatomical biomodels based on 3D imaging tests such as CT, in which customized prosthetic implants can be adapted17,18,19 and osteosynthesis plates can be molded in the case of fractures20,21,22. Additionally, 3D planning has already been used in previous studies to analyze the origin of the deformity in unilateral torsional alterations of the femur14. Currently, there are several software programs that are completely free and adaptable to most computers and 3D printers on the market, making this technology easily accessible to most surgeons in the world. This 3D planning allows for the accurate calculation of the initial axis of rotation of the femur and the axis of rotation of the femur after the intertrochanteric osteotomy has been performed. The main purpose of this study is to demonstrate that the axis of rotation of the femoral intertrochanteric osteotomy and the axis of rotation of the femur do not coincide. This 3D technology makes it possible to visualize this discrepancy between the axes and correct it through an adjustment of the osteotomy. The ultimate goal is to stimulate greater interest from orthopedic surgeons in this type of surgery.
This protocol with a 3D methodology is conducted in four fundamental steps. First, CT images are downloaded, and the 3D biomodel is created from the DICOM (Digital Imaging and Communication in Medicine) files of the CT scan. Higher-quality CT scans allow for better biomodels but mean the patient receives more ionizing radiation. For surgical planning with biomodels, the quality of conventional CT is sufficient. The DICOM image of a CT scan consists of a folder with many different files, with one file for each CT cut made. Each of these files contains not only the CT cut&#39;s graphical information but also the metadata (data associated with the image). To open the image, it is essential to have a folder with all the files of the series (the CT). The biomodel is extracted from the totality of the files.
Second, to obtain the 3D biomodel, it is necessary to download the 3D Slicer computer program, an open-source program with many utilities. Furthermore, this is the most widely used computer software in international 3D laboratories and has the advantage of being completely free of cost and downloadable from its main page. As this software is an X-ray image viewer, the DICOM image must be imported into the program.
Third, the first biomodel obtained with 3D Slicer will not match with the definitive one, because there will be regions such as the CT table or bones and soft parts nearby that are of no interest. The biomodel is &#34;cleaned&#34; almost automatically with the 3D design software, MeshMixer, which can also be downloaded directly from its official website for free. Finally, femoral anteversion is calculated, and the osteotomy is simulated using another free software from the Windows Store, 3D Builder.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>3D Builder</td>
			<td>Microsoft Corporation, Washington, USA</td>
			<td></td>
			<td>open-source program; https://apps.microsoft.com/store/detail/3d-builder/9WZDNCRFJ3T6?hl=en-us&#38;gl=us</td>
		</tr>
		<tr>
			<td>3D Slicer</td>
			<td>3D Slicer Harvard Medical School, Massachusetts, USA</td>
			<td></td>
			<td>open-source program; https://download.slicer.org</td>
		</tr>
		<tr>
			<td>MeshMixer&#160;</td>
			<td>Autodesk Inc&#160;</td>
			<td></td>
			<td>open-source program; https://meshmixer.com/download.html</td>
		</tr>
	</tbody>
</table>

three-dimensional preoperative virtual planning in derotational proximal femoral osteotomy

Anterior knee pain (AKP) is a common pathology among adolescents and adults. Increased femoral anteversion (FAV) has many clinical manifestations, including AKP. There is growing evidence that increased FAV plays a major role in the genesis of AKP. Furthermore, this same evidence suggests that derotational femoral osteotomy is beneficial for these patients, as good clinical results have been reported. However, this type of surgery is not widely used among orthopedic surgeons.
The first step in attracting orthopedic surgeons to the field of rotational osteotomy is to give them a methodology that simplifies preoperative surgical planning and allows for the previsualization of the results of surgical interventions on computers. To that end, our working group uses 3D technology. The imaging dataset used for surgical planning is based on a CT scan of the patient. This 3D method is open access (OA), meaning it is accessible to any orthopedic surgeon at no economic cost. Furthermore, it not only allows for the quantification of femoral torsion but also for carrying out virtual surgical planning. Interestingly, this 3D technology shows that the magnitude of the intertrochanteric rotational femoral osteotomy does not present a 1:1 relationship with the correction of the deformity. Additionally, this technology allows for the adjustment of the osteotomy so that the relationship between the magnitude of the osteotomy and the correction of the deformity is 1:1. This paper outlines this 3D protocol.

Femoral anteversion can be measured by different methods. Some of them focus on the femoral neck, using the line passing through the center of the neck and one passing through the femoral condyles as references. Others add a third reference point at the lesser trochanter23. Murphy&#39;s method, which is the most reliable in clinical practice because it has the best clinical-radiological relationship, is one such method using a third reference point25,<sup class="...

Watch this Scientific Journal Video about Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy at JoVE.com

Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy

This work presents a detailed surgical planning protocol using 3D technology with free open-source software. This protocol can be used to correctly quantify femoral anteversion and simulate derotational proximal femoral osteotomy for the treatment of anterior knee pain.

Anterior knee pain (AKP) is a common pathology among adolescents and adults. Increased femoral anteversion (FAV) has many clinical manifestations, ...

In this protocol, we demonstrate that the axis of rotation of the femoral osteotomy and the axis of rotation of the femur does not coincide. This protocol makes it possible to visualize and correct it. By using the free 3D software in this study, the surgeon can plan the surgery and increase the precision of the osteotomy.This technique is easily reproducible with simple step. We recommend practicing it many times to gain fluency. To begin, import the CT images in the DICOM format by clicking on the DCM icon on the top left corner of the screen, followed by clicking on Import DICOM Files on the left side of the screen.Next, click on Dummy Patient Name on the top right of the screen, and click on Load on the lower right margin. To create a 3D biomodel, in the dropdown menu, choose the Legacy and Editor options. Press OK on the message that appears and wait for a new menu to appear on the left side of the screen.Click on the Threshold Effect icon and move the bar in the lower box until only the bone is painted in the images on the right. This way, select the value of the Hounsfield units to be included in the model. Once the desired paint level is achieved, click on Apply.The selection is marked with the color green here. Select the option Make Model Effect from the side menu, and select Apply, which generates the 3D model in the upper right window. Click on the golden frame.Center the 3D view on the scene to center the image in the window. To save the created 3D biomodel, click on Save in the upper left margin. In the box that appears, uncheck other files, and only select the file Tissue.In the second column in the dropdown menu, select STL. Import the STL image by selecting the Import option in the center of the screen. Look for the Select option in the menu on the left side.Select the thickness of the brush using the Select tool, and double-click on the femur. Use the Select tool to select the part of interest. Look for the options, Modify and Invert in the side menu, and then press the delete button on the keyboard.Then navigate to Edit, Generate Face Groups, and move the bar of Angle Threshold until the different structures have a different color. Next, using the Select tool, double-click on the femur, modify, invert, and press the Delete button on the keyboard. to make a solid model, navigate to Edit, Make Solid, Solid Type, and Accurate.Then maximize the solid accuracy and mesh density values. Select the Export option from the side menu, and select the STL format and the folder to which the biomodel is exported. In the 3D builder software, click on the Insert icon at the top of the screen.Then click on Add to import the biomodel to the scene. Click on Object, then Settle to fix the object to the work plane. To perform the femoral osteotomy, click on Edit and Split from the top menu.When a rectangular cut plane appears, select Keep Both. Use the Move mode button on the bar in the lower margin of the screen to move the cutting plane horizontally and vertically. Use the Rotate mode button on the bar in the lower margin of the screen to rotate the plane around the femur.Put the cutting plane parallel to the x-axis and perpendicular to the Y-axis. Click on Split. To calculate the femoral anteversion, insert the guides by clicking on Insert, Add, and choose the 3MF file.Select only the proximal part of the femur on the right side of the screen, and press Control+X on the keyboard to cut the selection. The femoral diaphysis appears like this. Select the red circular guide and the purple circular guide together, on the right side of the screen.Use the commands in the bottom margin panel to move the guides and put them in the center of the femoral diaphysis. Then use the inferior margin panel commands to adjust the size and ensure that all the edges touch the cortex of the bone. Press Control+V on the keyboard to paste the proximal femur again.Select only the sphere on the right side of the screen and adjust the size, including all the edges touching the bone cortex. Select the proximal femur on the right side and cut it by pressing Control+X on the keyboard. Select only the red plane on the right side of the screen and place it to pass through the center of the sphere and the center of the circular guides.Press Control+V on the keyboard to paste the proximal femur again. To perform the rotational osteotomy of the proximal femur, select the proximal femur, the red circumference, and the sphere on the right side. Make an internal derotational proximal femoral osteotomy of 20 degrees by adding 20 to the pitch using the commands on the panel of the lower margin.To measure the new femoral anteversion, select the proximal femur and the red circumference, and press Control+X on the keyboard to cut these two elements. Select only the red plane and place it to pass through the center of the sphere and the center of the purple circular guide. Paste the proximal femur and the red circumference.To perform the adjustment of the rotational osteotomy, select the femoral diaphysis and the red plane, and press Control+X on the keyboard to cut. Select the proximal femur, the sphere, and the red circumference, and move these three elements en bloc so that the center of the red circumference matches the center of the purple circumference. Recalculate the new femoral anteversion with the adjustment made.The data here detail the values of the femoral anteversion obtained in two groups for the three magnitudes of the rotational osteotomy, 10, 20, and 30 degrees. When the adjustment was made so that the femur's rotation axis and the osteotomy's rotation axis coincided, the relationship between the planned correction and the final correction was a one-to-one ratio in the three correction magnitudes, but the same did not occur in group 1. The most important thing to remember is accuracy in performing the procedure, especially when creating the bone model, selecting only the bone of interest, and performing the osteotomy measurement before and after the adjustment.In the field of rotational deformities of the femur, this technique opens the way to study the region of these deformities and the consequences they have on potential femoral pressure and anterior knee pain.

three-dimensional-preoperative-virtual-planning-derotational-proximal

Research

JoVE Journal

Medicine

828 Aufrufe.  Hospital Arnau de Vilanova. In diesem Protokoll zeigen wir, dass die Rotationsachse der Femurosteotomie und die Rotationsachse des Femurs nicht übereinstimmen. Dieses Protokoll ermöglicht es, es zu visualisieren und zu korrigieren. Durch den Einsatz der kostenlosen 3D-Software in dieser Studie kann der Chirurg die Operation planen und die Präzision der Osteotomie erhöhen.Diese Technik ist mit einfachen Schritten leicht reproduzierbar. Wir empfehlen, es viele Male zu üben, um fließend zu werden. Importieren ...

Serie: Three-Dimensional Preoperative Virtual Planning in Derotational Proximal Femoral Osteotomy

This work presents a detailed surgical planning protocol using 3D technology with free open-source software. This protocol can be used to correctly quantify femoral anteversion and simulate derotational proximal femoral osteotomy for the treatment of anterior knee...

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phospholipid mediator induced transformation in three-dimensional cultures

Phospholipid Mediator Induced Transformation in Three-Dimensional Cultures

The present protocol describes the setting up of 3D 'on top' cultures of a non-transformed breast epithelial cell line, MCF10A, that has been modified to study Platelet Activating Factor (PAF) induced transformation. Immuno-fluorescence has been used to assess the transformation and is discussed in...

a neural implant design toolbox for nonhuman primates

Author Spotlight: Streamlined Brain and Skull Modeling for Enhanced Neurosurgical Planning in NHP Research

This paper outlines automated processes for nonhuman primate neurosurgical planning based on magnetic resonance imaging (MRI) scans. These techniques use procedural steps in programming and design platforms to support customized implant design for NHPs. The validity of each component can then be confirmed using three-dimensional (3D) printed life-size anatomical...

Automated 3D Brain and Skull Modeling from MRI for NHP Neurosurgical Planning

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human fear conditioning conducted in full immersion 3-dimensional virtual reality

Human Fear Conditioning Conducted in Full Immersion 3-Dimensional Virtual Reality

Classical fear conditioning paradigm was adapted for human participants in a fully immersive virtual reality setting. Using a discrimination paradigm, conditioned fear, cue and context memory retention, and extinction was measured with skin conductance response to dynamic virtual snakes and spiders (the conditioned stimuli) in two distinct virtual contexts.

surgical fixation of sternal fractures: preoperative planning and a safe surgical technique using locked titanium plates and depth limited drilling

Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

Here we present a method to stabilize sternal fractures by using locked titanium plates in a low profile design. Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates provides a safe surgical...

three-dimensional imaging of aortic tissues in atherosclerosis

Author Spotlight: Advanced Imaging Techniques for Investigating Nervous System Interactions in Atherosclerosis Progression

Here, we present optimized tissue-clearing protocols to image the murine aorta in three dimensions (3D). We delineate state-of-the-art procedures for immunostaining, optical clearing, and imaging with the intent to define the anatomical proximity of the peripheral nervous system with atherosclerotic plaques and the adventitia in...

Three-Dimensional Imaging of Aortic Tissues in Atherosclerosis

protocol for producing three-dimensional infrared video of freezing in plants

Protocol for Producing Three-Dimensional Infrared Video of Freezing in Plants

Here, we present a protocol to image a strawberry plant freezing in 3 dimensions. Two infrared cameras positioned at slightly different angles are used to produce a red-blue anaglyph video to observe the freezing of the plant in 3...

culturing mammalian cells in three-dimensional peptide scaffolds

Culturing Mammalian Cells in Three-dimensional Peptide Scaffolds

Here, we present a protocol to obtain 3D-culture systems in self-assembling peptide scaffolds to promote the differentiation of dedifferentiated human articular chondrocytes into cartilage-like...

left hind limb osteotomy in ambystoma mexicanum

Left Hind Limb Osteotomy in Ambystoma mexicanum

computer-aided three-dimensional visualization in the treatment of locally advanced thyroid cancer

Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer

In diagnosing and treating locally advanced thyroid cancer, the application of computer-aided three-dimensional reconstruction can provide additional information regarding the tumor scope and anatomic characteristics, thereby assisting in risk assessment and surgical...

three-dimensional printing guide template assisted percutaneous vertebroplasty (pvp)

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

Herein, we present a three-dimensional printing guide template for percutaneous vertebraplasty. A patient with a T11 vertebral compression fracture was selected as a case...

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

three-dimensional (3d) tumor spheroid invasion assay

Three-Dimensional 3D Tumor Spheroid Invasion Assay

Invasion of surrounding normal tissues is a defining characteristic of malignant tumors. We provide here a simple, semi-automated micro-plate assay of invasion into a natural 3D biomatrix that has been exemplified with a number of models of advanced human...

Three-Dimensional (3D) Tumor Spheroid Invasion Assay

analysis of craniomaxillofacial malformations in mice using three-dimensional microcomputed tomography

Here, we describe in depth a method, which is based on microcomputed tomography, to segment and measure 3D models of craniomaxillofacial bones in mice, for better assessment of craniomaxillofacial bone development in mice than what is possible with current...

Analysis of Craniomaxillofacial Malformations in Mice Using Three-dimensional Microcomputed Tomography

whole-kidney three-dimensional staining with cubic

Whole-Kidney Three-Dimensional Staining with CUBIC

The present protocol describes a tissue clearing method and whole-mount immunofluorescent staining for three-dimensional (3D) kidney imaging. This technique can offer macroscopic perspectives in kidney pathology, leading to new biological...

three-dimensional printing of a complex aortic anomaly

Three-Dimensional Printing of a Complex Aortic Anomaly

Here, we present a protocol to use three dimensional printed models for pre-operative planning and intra-operative reorganization of complicated vascular locations when handling a congenital aortic...

Three-dimensional Imaging of Nociceptive Intraepidermal Nerve Fibers in Human Skin Biopsies

A punch biopsy of the skin is commonly used to quantify intraepidermal nerve fiber densities (IENFD) for the diagnosis of peripheral polyneuropathy 1,2. At present, it is common practice to collect 3 mm skin biopsies from the distal leg (DL) and the proximal thigh (PT) for the evaluation of length-dependent polyneuropathies 3. However, due to the multidirectional nature of IENFs, it is challenging to examine overlapping nerve structures through the analysis of two-dimensional (2D) imaging. Alternatively, three-dimensional (3D) imaging could provide a better solution for this dilemma.
In the current report, we present methods for applying 3D imaging to study painful neuropathy (PN). In order to identify IENFs, skin samples are processed for immunofluorescent analysis of protein gene product 9.5 (PGP), a pan neuronal marker. At present, it is standard practice to diagnose small fiber neuropathies using IENFD determined by PGP immunohistochemistry using brightfield microscopy 4. In the current study, we applied double immunofluorescent analysis to identify total IENFD, using PGP, and nociceptive IENF, through the use of antibodies that recognize tropomyosin-receptor-kinase A (Trk A), the high affinity receptor for nerve growth factor 5. The advantages of co-staining IENF with PGP and Trk A antibodies benefits the study of PN by clearly staining PGP-positive, nociceptive fibers. These fluorescent signals can be quantified to determine nociceptive IENFD and morphological changes of IENF associated with PN. The fluorescent images are acquired by confocal microscopy and processed for 3D analysis. 3D-imaging provides rotational abilities to further analyze morphological changes associated with PN. Taken together, fluorescent co-staining, confocal imaging, and 3D analysis clearly benefit the study of PN.

In order to study the changes of nociceptive intraepidermal nerve fibers (IENFs) in painful neuropathies (PN), we developed protocols that could directly examine three-dimensional morphological changes observed in nociceptive IENFs. Three-dimensional analysis of IENFs has the potential to evaluate the morphological changes of IENF in PN.

A punch biopsy of the skin is commonly used to quantify intraepidermal nerve fiber densities (IENFD) for the diagnosis of peripheral polyneuropathy 1,2. ...

Femoral Bone Marrow Aspiration in Live Mice

Serial sampling of the cellular composition of bone marrow (BM) is a routine procedure critical to clinical hematology. This protocol describes a detailed step-by-step technical procedure for an analogous procedure in live mice which allows for serial characterization of cells present in the BM. This procedure facilitates studies aimed to detect the presence of exogenously administered cells within the BM of mice as would be done in xenograft studies for instance. Moreover, this procedure allows for the retrieval and characterization of cells enriched in the BM such as hematopoietic stem and progenitor cells (HSPCs) without sacrifice of mice. Given that the cellular composition of peripheral blood is not necessarily reflective of proportions and types of stem and progenitor cells present in the marrow, procedures which provide access to this compartment without requiring termination of the mice are very helpful. The use of femoral bone marrow aspiration is illustrated here for cytological analysis of marrow cells, flow cytometric characterization of the hematopoietic stem/progenitor compartment, and culture of sorted HSPCs obtained by femoral BM aspiration compared with conventional marrow harvest.

This protocol describes a procedure for serial sampling of femoral bone marrow (BM) without requiring the sacrifice of mice. This procedure facilitates longitudinal studies of the BM composition of mice over time and provides serial access to cells within the BM for ex vivo and transplantation studies.

Serial sampling of the cellular composition of bone marrow (BM) is a routine procedure critical to clinical hematology. This protocol describes a detailed ...

Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the anterior chest wall or the flexion-compression injury of the trunk, there is a need to retain each sternal fragment in the correct position while neutralizing shearing forces to the sternum. Anterior sternal plating provides the best stability and is therefore increasingly used in most cases. However, many surgeons are reluctant to perform sternal osteosynthesis due to possible complications such as difficulties in preoperative planning, severe injuries to mediastinal organs, or failure of the performed method.
This manuscript describes one possible safe way to stabilize different types of sternal fractures in a step by step guidance for anterior sternal plating using low profile locking titanium plates. Before surgical treatment, a detailed survey of the patient and a three dimensional reconstructed computed tomography is taken out to get detailed information of the fracture&#8217;s morphology. The surgical approach is usually a midline incision. Its position can be described by measuring the distance from upper sternal edge to the fracture and its length can be approximated by the summation of 60 mm for the basis incision, the thickness of presternal soft tissue and the greatest distance between the fragments in case of multiple fractures.
Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates prevents injuries to mediastinal organs and vessels.
Transverse fractures and oblique fractures at the corpus sterni are plated longitudinally, whereas oblique fractures of manubrium, sternocostal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Usually the high convenience of a patient is seen during follow up as well as a precise reconstruction of the sternal morphology.

Here we present a method to stabilize sternal fractures by using locked titanium plates in a low profile design. Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates provides a safe surgical way.

Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the ...

Three-dimensional Co-culture Model for Tumor-stromal Interaction

Cancer progression (initiation, growth, invasion and metastasis) occurs through interactions between malignant cells and the surrounding tumor stromal cells. The tumor microenvironment is comprised of a variety of cell types, such as fibroblasts, immune cells, vascular endothelial cells, pericytes and bone-marrow-derived cells, embedded in the extracellular matrix (ECM). Cancer-associated fibroblasts (CAFs) have a pro-tumorigenic role through the secretion of soluble factors, angiogenesis and ECM remodeling. The experimental models for cancer cell survival, proliferation, migration, and invasion have mostly relied on two-dimensional monocellular and monolayer tissue cultures or Boyden chamber assays. However, these experiments do not precisely reflect the physiological or pathological conditions in a diseased organ. To gain a better understanding of tumor stromal or tumor matrix interactions, multicellular and three-dimensional cultures provide more powerful tools for investigating intercellular communication and ECM-dependent modulation of cancer cell behavior. As a platform for this type of study, we present an experimental model in which cancer cells are cultured on collagen gels embedded with primary cultures of CAFs.

Here we present a protocol to co-culture in three-dimensions, which is useful for investigating multicellular interactions and extracellular matrix-dependent modulation of cancer cell behavior. In this experimental model, cancer cells are cultured on collagen gels embedded with human cancer-associated fibroblasts.

Cancer progression (initiation, growth, invasion and metastasis) occurs through interactions between malignant cells and the surrounding tumor stromal ...

Invasion of surrounding normal tissues is generally considered to be a key hallmark of malignant (as opposed to benign) tumors. For some cancers in particular (e.g., brain tumors such as glioblastoma multiforme and squamous cell carcinoma of the head and neck &#8211; SCCHN) it is a cause of severe morbidity and can be life-threatening even in the absence of distant metastases. In addition, cancers which have relapsed following treatment unfortunately often present with a more aggressive phenotype. Therefore, there is an opportunity to target the process of invasion to provide novel therapies that could be complementary to standard anti-proliferative agents. Until now, this strategy has been hampered by the lack of robust, reproducible assays suitable for a detailed analysis of invasion and for drug screening. Here we provide a simple micro-plate method (based on uniform, self-assembling 3D tumor spheroids) which has great potential for such studies. We exemplify the assay platform using a human glioblastoma cell line and also an SCCHN model where the development of resistance against targeted epidermal growth factor receptor (EGFR) inhibitors is associated with enhanced matrix-invasive potential. We also provide two alternative methods of semi-automated quantification: one using an imaging cytometer and a second which simply requires standard microscopy and image capture with digital image analysis.

Invasion of surrounding normal tissues is a defining characteristic of malignant tumors. We provide here a simple, semi-automated micro-plate assay of invasion into a natural 3D biomatrix that has been exemplified with a number of models of advanced human cancers.

Invasion of surrounding normal tissues is generally considered to be a key hallmark of malignant (as opposed to benign) tumors. For some cancers in ...

Three-dimensional Alginate-bead Culture of Human Pituitary Adenoma Cells

A three-dimensional culture method is described in which primary pituitary adenoma cells are grown in alginate beads. Alginate is a polymer derived from brown sea algae. Briefly, the tumor tissue is cut into small pieces and submitted to an enzymatic digestion with collagenase and trypsin. Next, a cell suspension is obtained. The tumor cell suspension is mixed with 1.2% sodium alginate and dropped into a CaCl2 solution, and the alginate/cell suspension is gelled on contact with the CaCl2 to form spherical beads. The cells embedded in the alginate beads are supplied with nutrients provided by the culture media enriched with 20% FBS. Three-dimensional culture in alginate beads maintains the viability of adenoma cells for long periods of time, up to four months. Moreover, the cells can be liberated from the alginate by washing the beads with sodium citrate and seeded on glass coverslips for further immunocytochemical analyses. The use of a cell culture model allows for the fixation and visualization of the actin cytoskeleton with minimal disorganization. In summary, alginate beads provide a reliable culture system for the maintenance of pituitary adenoma cells.

Three-dimensional culture in alginate beads, due to its simplicity and reproducibility, was chosen to maintain the pituitary adenoma cells. The procedures included an initial enzymatic digestion and mechanical dissociation of the tumor tissue, and the subsequent cell suspension was encapsulated in alginate beads.

A three-dimensional culture method is described in which primary pituitary adenoma cells are grown in alginate beads. Alginate is a polymer derived from ...

Complex congenital aortic anomalies include diverse types of malformations that may be clinically asymptomatic or present with respiratory or esophageal symptoms. These anomalies may be associated with other congenital heart diseases. It is hard to identify the accurate anatomic vessel location from two-dimensional imaging data, such as computed tomography. As an additive manufacturing method, three-dimensional (3-D) printing can covert the acquired imaging data into 3-D physical models. This protocol describes the procedure for modeling the volumetric DICOM imaging into 3-D data and printing it as an anatomically realistic 3-D model. Using this model, surgeons can identify the vessel location of complex aortic anomalies, which is helpful for pre-operative planning and intra-operative guidance.

Here, we present a protocol to use three dimensional printed models for pre-operative planning and intra-operative reorganization of complicated vascular locations when handling a congenital aortic anomaly.

Complex congenital aortic anomalies include diverse types of malformations that may be clinically asymptomatic or present with respiratory or esophageal ...

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The accuracy of PVP mainly depends on the surgeons&#39; experience and multiple fluoroscopes during a traditional procedure. Puncture related complications were reported all over the world. To make the surgical procedure more precise and decrease the rate of puncture-related complications, our team applied a three-dimensional printing guide template to PVP to modify the traditional procedure. This protocol introduces how to model target vertebrae DICOM imaging data into three-dimensions in the software, how to simulate operation in this 3-D model, and how to use all of the surgical data to reconstruct a patient specific template for application. Using this template, surgeons can identify suitable puncture points accurately to improve the accuracy of the operation. The whole protocol includes: 1) diagnosis of the osteoporotic vertebral compression fracture; 2) acquisition of CT imaging of the target vertebra; 3) simulation of the operation in the software; 4) design and fabrication of the 3-D printing guide template; and 5) application of the template into an operation procedure.

Herein, we present a three-dimensional printing guide template for percutaneous vertebraplasty. A patient with a T11 vertebral compression fracture was selected as a case study.

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

Virtual, hybrid three-dimensional (3D) model acquisition is presented in this article, utilizing the sequence of radiographic image segmentation, spatial registration, and free-form surface modeling. Firstly cone-beam computed tomography datasets were reconstructed with a semi-automatic segmentation method. Alveolar bone and teeth are separated into different segments, allowing 3D morphology, and localization of periodontal intrabony defects to be assessed. The severity, extent, and morphology of acute and chronic alveolar ridge defects are validated concerning adjacent teeth. On virtual complex tissue models, positions of dental implants can be planned in 3D. Utilizing spatial registration of IOS and CBCT data and subsequent free-form surface modeling, realistic 3D hybrid models can be acquired, visualizing alveolar bone, teeth, and soft tissues. With the superimposition of IOS and CBCT soft tissue, thickness above the edentulous ridge can be assessed about the underlying bone dimensions; therefore, flap design and surgical flap management can be determined, and occasional complications may be avoided.

A workflow for creating three-dimensional (3D) virtual hybrid models has been designed based on cone-beam computed tomography dataset and intraoral optical scans utilizing radiographic image segmentation methods and free-form surface modeling. Digital models are used for the virtual planning of reconstructive dentoalveolar surgical procedures.

Virtual, hybrid three-dimensional (3D) model acquisition is presented in this article, utilizing the sequence of radiographic image segmentation, spatial ...

Pulp canal obliterations (PCO) are often a consequence of dental trauma, such as luxation injuries. Even though dentin apposition is a sign of vital pulp, pulpitis or apical periodontitis may develop in the long term. Root canal treatment of teeth with severe PCO and pulpal or periapical pathosis is challenging for general practitioners and even for well-equipped endodontic specialists. To ensure detection of the calcified root canal and avoid excessive loss of tooth structure or root perforation, static navigation using templates ("Guided Endodontics") was introduced a few years ago. The general workflow includes three-dimensional imaging using cone-beam computed tomography (CBCT), a digital surface scan, and superimposition of both in a planning software. This is followed by virtual planning of the access cavity and the design of a template that will guide the drill to the desired target point. To do this, a true-to-scale virtual image of the drill must be placed in a way that the tip of the drill reaches the orifice of the calcified root canal. Once the template has been fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM) or a 3D printer, guided preparation of the access cavity can be performed clinically. For research purposes, a postoperative CBCT image can be used to quantify the accuracy of the access cavity performed. This work aims to present the technique of static guided endodontics from imaging to clinical implementation.

Guided endodontics describes a template-aided approach for access cavity preparation. The procedure requires cone-beam computed tomography and a surface scan to produce a template. An incorporated sleeve guides the drill to the target point. This allows the preparation of minimally invasive endodontic access cavities in calcified teeth.

Pulp canal obliterations (PCO) are often a consequence of dental trauma, such as luxation injuries. Even though dentin apposition is a sign of vital pulp, ...