Objective: To evaluate the precision of a three-dimensional (3D)-printed percutaneous pinning guide (PPG) for Kirschner wire placement in the treatment of femoral fractures using canine cadavers. Methods: The PPG was designed using 3D computer-aided design software and fabricated using medical-grade resin. In part 1, Kirschner wires were inserted into the intact femurs.In part 2, simulated femoral neck fractures were created using a 3D-printed osteotomy guide.Three wires were inserted into each femur under fluoroscopic guidance. The number of insertion attempts, fluoroscopic images, procedure times, and ease of use were recorded.Post-procedural computed tomography was used to assess angular deviation from ideal trajectories and pin engagement in the proximal femur. Results: The PPG group required fewer insertion attempts (p < 0.01), fewer fluoroscopic images (p < 0.001), and had higher ease-of-use scores (p < 0.047) than the freehand pinning technique (FHPT) group; angular deviation was significantly smaller in the proximodistal (2.9 ± 6.5° vs. 10.7 ± 5.9°; p = 0.022) and craniocaudal (4.8 ± 3.0° vs. 12.3 ± 8.8°; p < 0.001) directions. In part 2, the PPG group showed lower angular variance and greater proximal pin engagement than the FHPT group (p = 0.011). Conclusions and Relevance: The PPG showed better pinning precision and procedural efficiency than the FHPT under intact and simulated fracture conditions. The PPG may enhance safety and consistency in the percutaneous pinning of canine femoral fractures.

Streptococcus pneumoniae (pneumococcus) has been known to cause pneumonia, sinusitus, otitis media, meningitis, endocardiditis, myelitis and arthritis. Spinal epidural abscess by S. pneumoniae has been diagnosed rarely among the patients with spinal trauma, intravenous drug abuse, alcoholism, diabetes mellitus, long term steroid use, chronic renal failure, and acquired immune deficiency syndrome. We experienced a case of pneumococcal spinal epidural abscess occurred in 75-year-old female with L1 compression fracture since 4 years ago. Her spine magnetic resonance imaging revealed epidural abscess at the level from L3 to S1. S. pneumonia was identified on blood which was susceptible to penicillin. She was immediately treated with antibiotics and surgical exploration. The pneumococcal spinal epidural abscess is very unusual. Therefore, we report here this case with a brief review of the literature.
Acquired Immunodeficiency Syndrome ; Aged ; Alcoholism ; Anti-Bacterial Agents ; Arthritis ; Bacteremia ; Diabetes Mellitus ; Epidural Abscess ; Female ; Fractures, Compression ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Meningitis ; Myelitis ; Otitis Media ; Penicillins ; Pneumonia ; Spine ; Streptococcus pneumoniae ; Substance Abuse, Intravenous