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Background: Percutaneous guide wire insertion for scaphoid screw fixation can be challenging and often requires multiple attempts with significant radiation exposure to the surgical team. A 3-dimensional (3D) printed targeting device has the potential to reduce procedure time and intraoperative radiation exposure. Methods: Our targeting device protocol included a preprocedure computed tomography (CT) scan of a casted cadaver wrist, followed by 3D printing of a customized targeting guide. In a comparison trial, seven orthopedic surgery residents performed percutaneous scaphoid guide wire insertion on different cadaver specimens by both freehand technique and using our targeting device. Radiation exposure and procedure times were compared. All specimens underwent postprocedure CT to assess Kirschner wire (K-wire) accuracy, determined by central third placement. Pre- and postprocedure CT scans from the targeting device group were co-registered to compare planned and actual K-wire trajectories. Results: Using the freehand technique, mean fluoroscopy time was 120 seconds (standard deviation: ±53 seconds) generating 2.45 milligray of radiation. Average procedure time was 21 minutes with a mean of 6.4 (range: 3-9) insertion attempts. A single insertion attempt was made using the targeting device with an average procedure time of 30 seconds and no fluoroscopy exposure. Four K-wires were placed within the central scaphoid in both groups. Using the targeting device, average linear deviation from the planned trajectory was 2.1 mm, while the maximum linear deviation was 3.75 mm. Conclusion: When compared to freehand scaphoid guide wire insertion, our targeting device provides similar accuracy while significantly reducing intraoperative radiation exposure and procedure time.

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CASE: A 31-year-old male sustained acute compartment syndrome to his left leg after a low-energy fall and required a 4-compartment fasciotomy release. His immediate postoperative course was complicated by acute tubular necrosis (ATN) with creatinine elevated to 4.89 mg/dL from rhabdomyolysis. ATN was managed with aggressive hydration, sodium bicarbonate, and alkaline diuresis, and his creatinine levels improved. CONCLUSIONS: ATN from rhabdomyolysis is a rare complication of compartment syndrome that requires high suspicion and timely treatment to prevent further nephrotoxicity and the resultant increases in mortality. It is imperative for orthopedic surgeons to be aware of this potential complication.

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INTRODUCTION: Orthopedic oncologists often encounter patients with minor bony lesions that are difficult to access surgically and therefore require large exposures out of proportion to the severity of disease that confer significant patient morbidity. Minimally invasive surgical techniques offer the advantage of smaller incisions, shorter operative times, decreased tissue damage, and decreased costs. A variety of surgical procedures have emerged using minimally invasive technologies, particularly in the field of spine surgery. Areas covered: In this article, we describe the Minimal Exposure Tubular Retractor (METRxTM) System which is a minimally invasive surgical device that utilizes a series of dilators to permit access to a surgical site of interest. This system was developed for use in treatment of disc herniation, spinal stenosis, posterior lumbar interbody fusion, transforaminal lumbar interbody fusion and spinal cord stimulation implantation. We also describe novel uses of this system for minimally invasive biopsy and treatment of benign and metastatic bone lesions at our institution. Expert commentary: Minimally invasive surgical techniques will continue to expand into the field of orthopedic oncology. With a greater number of studies proving the safety and effectiveness of this technique, the demand for minimally invasive treatments will grow.

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CASE: An eighty-one-year-old man had begun taking ciprofloxacin one week prior to the sudden inability to extend the metacarpophalangeal joint of the ring finger of the dominant right hand. He presented to us three months after he initially noticed this finding. CONCLUSION: Ciprofloxacin-induced tendon rupture appears to be possible in the extensor digitorum communis tendons of the hand. Our patient was managed operatively and had a good functional outcome.