After a severe trauma, a 16-year-old female patient sustained multiple injuries, including a distal radius fracture of the left arm. This distal radius fracture eventually developed into a malunion. In this case, we demonstrate our preoperative low-cost workup for three-dimensional (3D) planned and assisted corrective osteotomy of a malunited distal radius fracture using an in-hospital 3D printer.

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Treatment with psychotropic drugs is frequently associated with obesity, dislipidemia, hyperglycaemia and hypertension, resulting in the development of the metabolic syndrome which in turn is an important risk factor for cardiovascular disease and type 2 diabetes mellitus. The atypical antipsychotics clozapine and olanzapine have the most pronounced effect on metabolic .parameters. Over the past years, several studies using the definitions of the so called Third Adult Treatment Panel (ATP-III) of the National Cholesterol Education Program, demonstrated a high prevalence of metabolic syndrome in schizophrenic patients treated with atypical antipsychotics. The present study includes a total of 96 clozapine-treated inpatients. A total of 34 patients had to be excluded because of refusal tot participate (n=23) or not meeting the DSM-IV criteria for psychotic disorders (n=11). Finally, 62 patients (male: 46; female: 16; mean age: 49 ± 14.2 years; mean duration of clozapine treatment: 9.2 years; current dose: 331.5mg daily) were evaluated according to ATP-III criteria. Other parameters that were collected comprised co-medication, smoking status and alcohol use. Metabolic syndrome was found in 60% of the patients and was associated with female gender. No association was found between metabolic syndrome and duration of clozapine treatment. Frequencies of the individual components were 92% for dyslipidemia, 43% for obesity, 36% for hypertension, 18% for impaired fasting glucose and 18% for diabetes mellitus type 2. Metabolic syndrome is highly prevalent among patients with psychotic disorders who are treated with clozapine. Additional factors like unhealthy life stile, inactivity and co-medication, emerge as major treatment targets.

IntroductionCardiovascular disease is the most common cause of death in patients with severe mental illness (SMI). Patients are more likely to be overweight and to have hypertension, dyslipidemia, hyperglycemia and diabetes mellitus. Antipsychotic medication can induce or worsen these cardiovascular risk factors.ObjectivesAccessibility to healthcare and adequate somatic treatment is limited in patients with SMI.AimsPrevalence of inadequate treatment for metabolic cardiovascular risk factors in patients treated with antipsychotic medication.MethodsA health monitor was introduced as a screening instrument in a schizophrenia treatment and recovery program (so called F-ACT) at the outpatient departments. Assesment included physical and laboratory examination, demographics, DSM-IV diagnoses, remission-criteria, social functioning, use of medication and drugs.ResultsOver a period of 18 months (2009–2010), 520 of the 600 patients included in the F-ACT were evaluated. Preliminary analysis shows that 452 patients met DSM-IV criteria of schizophrenia and other psychotic disorders. All patients were treated with at least one antipsychotic agent. Metabolic syndrome according to ATP-III was present in 50% of patients (60% abdominal obesity, 58% hypertension, 24% hyperglycemia, 52% high triglycerides, 49% low HDL-cholesterol). Rates of non-treatment ranged from 78% for hypertension, 85% for dyslipidemia and 48% for diabetes mellitus. Rates of inadequate treatment ranged from 69% for hypertension and 83% for dyslipidemia.Conclusions1.Metabolic cardiovascular risk factors are highly prevalent in patients treated with antipsychotics2.Inadequate treatment of metabolic cardiovascular risk factors is common3.There is a need to improve the cooperation between psychiatrists and general practitioners

Introduction: Patients with severe mental illnesses (SMI) are at increased risk for cardiovascular disease. Treatment with antipsychotics can induce and worsen cardiometabolic risk factors, like obesity, hypertension, dyslipidemia and hyperglycemia. Rates of somatic treatment for cardiometabolic risk factors are limited in these patients. In clinical practice the decision to start somatic treatment depends on the risk for cardiovascular mortality according to risk charts based on the general population. Objectives: To investigate wether currently used cardiovascular risk scoring systems can be used in patients with SMI. Aims: Assessement of cardiovascular risk in patients treated with antipsychotics. Methods: Frequencies of cardiometabolic risk factors were assessed in 570 patients treated with antipsychotics. The estimated risk for cardiovascular mortality was determined according to the SCORE Absolute and Relative Risk Charts. Results: Preliminary analyses show that frequencies of cardiometabolic risk factors ranged from 10% for diabetes to 90% for dyslipidemia. The mean absolute risk of cardiovascular mortality was 1,9% whereas the mean relative risk was 2,5%. The absolute risk was moderate to high (≥5%) in 29 and high (≥10%) in 5 patients. The relative risk was moderate to high (≥5) in 33 and high (≥10) in 1 patient. Conclusions: A discrepancy seems to be present between the high frequencies of cardiometabolic risk factors and the low absolute and relative risks according to the SCORE risk charts. It is advocated to develop a cardiovascular risk scoring system that is appropiate for use in patients with SMI so that somatic treatment can be started when nessesary.