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Metastatic bone disease is a common sequela of malignancy and can lead to significant morbidity on patients. Systemic medical therapies and oncology surgery have greatly enhanced cancer survival rates over recent decades. Orthopaedic surgeons occupy a key position within the multidisciplinary team and coordinate surgical care for bone metastases where appropriate. This review describes the investigations for, and management of, patients with metastases to the appendicular skeleton. National guidelines exist to help orthopaedic clinicians and departments optimize patient care and outcomes. We outline and illustrate the freely available OPTIModel app from the Netherlands, which is an innovative, straightforward and useful tool for prognostic evaluation and suggestion of loco-regional treatment options for patients with symptomatic long bone metastases. [ABSTRACT FROM AUTHOR]

Purpose: Current clinical classifications do not distinguish between the severity of the MICrophthalmia/Anophthalmia (MICA) spectrum with regard to treatment urgency. We aim to provide parameters for distinguishing mild, moderate and severe MICA using clinical and biometrical characteristics. Methods: We performed a single‐centre, cross‐sectional analysis of prospective cohort of 58 MICA children from September 2013 to February 2018 seen at the Amsterdam University Medical Center, The Netherlands. All patients with a visible underdeveloped globe were included. We performed full ophthalmic evaluation including horizontal palpebral fissure length, axial length by ultrasound and/or MRI measurements, paediatric and genetic evaluation. Cases were subdivided based on clinical characteristics. Biometrical data were used to calculate the relative axial length (rAL) and the relative horizontal palpebral fissure length (rHPF) compared with the healthy contralateral eye for unilateral cases. Results: In previously untreated patients, a strong correlation exists between rAL and rHPF, distinguishing between severe, moderate and mild subjects using rAL of 0–45%, 45–75% and 75%–100%, respectively. Clinical subgroups were randomly dispersed throughout the scatterplot. Conclusion: Current classifications lack clinical implications for MICA patients. We suggest measuring eyelid length and axial length to classify the severity and determine treatment strategy. The 'severe' group has obvious asymmetry and abnormal socket configuration for which therapy should quickly be initiated; the 'moderately' affected group has normal socket anatomy with a microphthalmic eye with disturbing asymmetry for which treatment should be initiated within months of development; the 'mild' group has a slightly smaller axial length or less obvious eyelid asymmetry for which reconstructive correction is possible, but expansive conformer treatment is unnecessary. [ABSTRACT FROM AUTHOR]

Purpose: To assess the test-retest reliability of the Special Interest Group on Amputation Medicine Mobility Scale/Dutch Working Group on Amputations and Prosthetics, better known as SIGAM/WAP mobility scale, in persons with a lower-limb amputation. Method: Longitudinal study at the outpatient departments of a rehabilitation center and a university medical center. Persons with a lower-limb amputation, wearing a prosthesis, were assessed at the end of their multidisciplinary rehabilitation treatment twice, with a 3-week interval, by the same practitioner. Test-retest reliability was quantified using the intraclass correlation coefficient for agreement. Results: Eighty persons participated (mean age ± SD, 61 ± 15 years; 61% men; 76% vascular cause of amputation; 70% able to walk >50m). Fifty-one of them rated themselves to be stable with respect to their mobility and their intraclass correlation coefficient was 0.90 (95% confidence intervals 0.84-0.94). Conclusions: The Special Interest Group on Amputation Medicine Mobility Scale/Dutch Working Group on Amputations and Prosthetics had, at the outpatient departments of a rehabilitation center and a university medical center, excellent test-retest reliability in persons wearing a prosthesis after a lower-limb amputation.Implications for rehabilitationThe Special Interest Group on Amputation Medicine/Dutch Working Group on Amputations and Prosthetics Mobility Scale was developed to classify mobility after a lower-limb amputation and wearing a prosthesis.The Dutch translation of this mobility scale has excellent test-retest reliability.

The purpose of the study was to investigate the influence of 3D printing parameters on fit and internal gap of 3D printed resin dental prosthesis. The dental model was simulated and fabricated for three-unit prostheses with two implants. One hundred prostheses were 3D printed with two-layer thicknesses for five build orientations using a resin (NextDent C&B; 3D systems, Soesterberg, The Netherlands) and ten prostheses were manufactured with a milling resin as control. The prostheses were seated and scanned with micro-CT (computerized tomography). Internal gap volume (IGV) was calculated from 3D reconstructed micro-CT data. IGV, marginal fit, and lengths of internal gaps were measured, and the values were analyzed statistically. For the 3D printed prostheses, IGV was smaller at 45°, 60°, and 90° compared to other build orientations. The marginal fit evaluated by absolute marginal discrepancy was smaller than other build orientations at 45° and 60°. IGV was smaller at 50 µm layer thickness than at 100 µm layer thickness, but the marginal fit was smaller at 100 µm layer thickness than at 50 µm layer thickness. The 3D printed prosthesis had smaller internal gap than the milled prosthesis. The marginal fit of the 3D printed resin prosthesis was clinically acceptable, and build orientation of 45° and 60° would be recommended when considering fit and internal gap. [ABSTRACT FROM AUTHOR]

Purpose: Not long after the introduction of osseointegrated implants outside the oral cavity, auricular prostheses are retrained on osseointegrated implants. New insights have been gained with the next-generation percutaneous osseointegrated titanium implants for bone conduction hearing since its introduction in 2010. As a result, the same technology was introduced in the Vistafix ® system (VXI implant) to retain auricular prostheses. The aim of this study is to evaluate the surgical procedure, clinical outcome, and satisfaction of the patient of osseointegration-retained auricular prosthesis using VXI implants., Materials and Methods: 11 patients who received an auricular prosthesis using VXI implants between December 2012 and November 2017 were evaluated retrospectively. The patient's medical files were reviewed to assess clinical complications and the necessity for revision surgery. The subjective outcome was measured using the Glasgow benefit inventory (GBI)., Results: In total, 31 implants were placed in 11 patients. None of these implants were lost nor revision surgery needed. An adverse skin reaction was observed in 13.0% of the implants and in 27.2% of the patients, adequately treated with an antibiotic ointment. The average follow-up time was 2 years and 7 months. The GBI displayed a positive score in every patient., Conclusions: The VXI implants used are a safe and reliable treatment option for retaining auricular prostheses in patients with an absent auricle. Patients were satisfied with their auricular prosthesis and showed benefit in quality of life. Studies with larger numbers and preferably a prospective character are needed to draw statistically significant conclusions.

Background: A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis fitting and the use of replacement parts., Objectives: To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 2 focuses on rehabilitation process and prosthetics., Study Design: Systematic literature design., Methods: Literature search in five databases and quality assessment on the basis of evidence-based guideline development., Results: An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity., Conclusion: The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for treatment and reintegration of patients undergoing amputation of a lower extremity and can be used to provide patient information., Clinical Relevance: This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice., (© The International Society for Prosthetics and Orthotics 2014.)

The VoiceMaster indwelling voice prosthesis was designed and developed for use in laryngectomized patients. The VoiceMaster pre-production model (0-series), tested during 1997 and 1998, proved to be a safe and valid concept. After the refining of a few technical details the currently available VoiceMaster device was introduced in June 1998. The preliminary results obtained with the device were encouraging and led to a multicentre study. The average device life span varies between the participating clinics, ranging up to 4.8 months. As there still are devices in situ, the average life span is still increasing. Factors such as stoma size and fistula position influence the insertion of the device and should be considered before VoiceMaster insertion. The general experience with the VoiceMaster prosthesis has proven it to be a worthwhile new device in prosthetic voice rehabilitation in laryngectomized patients. [ABSTRACT FROM AUTHOR]