Assessment of two 3-D fluoroscopic systems for articular fracture reduction: a cadaver study

Weil, Yoram A.; Liebergall, Meir; Mosheiff, Rami; Singer, Syndie B.; Joskowicz, Leo; Khoury, Amal

doi:10.1007/s11548-011-0548-6

Cited by 15 publications

(6 citation statements)

References 20 publications

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“…41 Intraoperative imaging may reduce the need to return to the operating room to address articular malreductions and/or intra-articular hardware penetration missed on standard intraoperative fluoroscopy and later discovered on postoperative CT. Intraoperative imaging technology has progressed with the use of intraoperative CT, particularly for guided placement of pedicle screws in spine fusions; however, this is not standard practice for reduction of articular fractures.…”

Section: Assessment Of Articular Reductionmentioning

confidence: 99%

Pathogenesis and Prevention of Posttraumatic Osteoarthritis After Intra-articular Fracture

Schenker

Mauck

Ahn

et al. 2014

Journal of the American Academy of Orthopaedic Surgeons

115

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Posttraumatic osteoarthritis (PTOA) occurs after traumatic injury to the joint. It is most common following injuries that disrupt the articular surface or lead to joint instability. The reported risk of PTOA following significant joint trauma is as high as 75%; articular fractures can increase the risk more than 20-fold. Despite recent advances in surgical management, the incidence of PTOA following intra-articular fractures has remained relatively unchanged over the last few decades. Pathogenesis of PTOA after intra-articular fracture is likely multifactorial and may be associated with acute cartilage injury as well as chronic joint overload secondary to instability, incongruity, and malalignment. Additional studies are needed to better elucidate how these factors contribute to the development of PTOA and to develop advanced treatment algorithms that consist of both acute biologic interventions targeted to decrease inflammation and cellular death in response to injury and improved surgical methods to restore stability, congruity, and alignment.

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Section: Assessment Of Articular Reductionmentioning

confidence: 99%

Pathogenesis and Prevention of Posttraumatic Osteoarthritis After Intra-articular Fracture

Schenker

Mauck

Ahn

et al. 2014

Journal of the American Academy of Orthopaedic Surgeons

115

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“…Since its first application at the start of the 21st century, intraoperative 3D imaging has become increasingly important in the treatment of displaced intra-articular fractures [ 5 ]. Several cadaveric and clinical studies have verified that diagnostic accuracy, fracture reduction and implant position can be improved by using intraoperative 3D imaging in different anatomical regions [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

et al. 2016

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BackgroundThree-dimensional (3D) imaging with a mobile C-arm has proven to be a valuable intraoperative tool in trauma surgery. However, little data is available concerning its use in the treatment of elbow fractures. The aim of the current study was to determine the intraoperative findings and consequences of 3D imaging in the treatment of elbow fractures.MethodsBetween 2001 and 2015, prospectively collected data of 36 patients who underwent intraoperative 3D imaging during elbow surgery were recorded. The findings and consequences of the intraoperative 3D scans were analyzed in a retrospective chart review. For clinical evaluation the analysis included the patients’ medical history, the injury pattern of the affected elbow and concomitant injuries. Intraoperative and postoperative complications and revision surgeries were evaluated as well.ResultsIn 6 patients (16.7 %) analysis of the intraoperative 3D scan led to an immediate revision due to the detection of intra-articular screw placement (n = 3, 8.3 %) and remaining intra-articular step of >2 mm (n = 3, 8.3 %). In all of these patients, correct implant positioning and anatomical reduction could be achieved after immediate intraoperative revision, which was verified by a repeated intraoperative 3D scan. None of the 36 patients needed surgical revision based on postoperative radiological examinations due to secondary dislocation, wrong implant placement or remaining steps in the articular surface.ConclusionsIntraoperative 3D imaging offers additional information about fracture reduction and implant positioning in the treatment of elbow fractures compared to conventional intraoperative 2D imaging. It may therefore reduce the need for revision surgery. The value of intraoperative 3D imaging for clinical outcomes still needs to be assessed.

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confidence: 99%

“…The diagnostic accuracy of 3D fluoroscopy appears to be higher than 2D fluoroscopy and similar to computed tomography (CT) for the evaluation of both reduction and implant position. 5,13,22,36 Three-dimensional fluoroscopy has proven to be a valuable addition to conventional intraoperative fluoroscopy in calcaneal fracture surgery. 16 Previous studies of 3D fluoroscopy in calcaneal fracture surgery have reported an intraoperative correction rate of up to 47% for indications that were not recognized on conventional 2D fluoroscopy.…”

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confidence: 99%

Intraoperative Effect of 2D vs 3D Fluoroscopy on Quality of Reduction and Patient-Related Outcome in Calcaneal Fracture Surgery

et al. 2020

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Background: Three-dimensional (3D) fluoroscopy is thought to be advantageous in the open reduction and internal fixation (ORIF) of calcaneal fractures. The goal of this multicenter randomized controlled trial was to investigate the clinical effect of additional intraoperative 3D fluoroscopy on postoperative quality of reduction and fixation and patient-reported outcome as compared to conventional 2-dimensional (2D) fluoroscopy in patients with intra-articular fractures of the calcaneus. Methods: Patients were randomized to 3D or conventional 2D fluoroscopy during operative treatment of calcaneal fractures. Primary outcome was the difference in quality of fracture reduction and implant position on postoperative computed tomography (CT). Secondary endpoints included intraoperative corrections (prior to wound closure), complications, and revision surgery (after wound closure). Function and patient-reported outcome were evaluated after surgery and included range of motion, Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Short-Form 36 (SF-36) questionnaires, and Kellgren-Lawrence posttraumatic osteoarthritis classification. A total of 102 calcaneal fractures were included in the study in 100 patients. Fifty fractures were randomized to the 3D group and 52 to the 2D group. Results: There was a statistically significant difference in duration of surgery between the groups (2D 125 min vs 3D 147 min; P < .001). After 3D fluoroscopy, a total of 57 intraoperative corrections were performed in 28 patients (56%). The postoperative CT scan revealed an indication for additional revision of reduction or implant position in 69% of the 3D group vs 60% in the 2D fluoroscopy group. At 2 years, there was no difference in number of revision surgery, complications, FAOS, AOFAS score, SF-36 score, or posttraumatic osteoarthritis. Conclusion: The use of intraoperative 3D fluoroscopy in the treatment of intra-articular calcaneal fractures prolongs the operative procedures without improving the quality of reduction and fixation. There was no benefit of intraoperative 3D fluoroscopy with regard to postoperative complications, quality of life, functional outcome, or posttraumatic osteoarthritis. Level of Evidence: Level I, prospective randomized controlled study.

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Assessment of two 3-D fluoroscopic systems for articular fracture reduction: a cadaver study

Abstract: Intraoperative 3D fluoroscopes can detect clinically significant intra-articular step-off with acceptable measurement errors, using newer devices that enable the use of a conventional C-arm and reduced radiation.

Cited by 15 publications

References 20 publications

Pathogenesis and Prevention of Posttraumatic Osteoarthritis After Intra-articular Fracture

Pathogenesis and Prevention of Posttraumatic Osteoarthritis After Intra-articular Fracture

Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

Intraoperative Effect of 2D vs 3D Fluoroscopy on Quality of Reduction and Patient-Related Outcome in Calcaneal Fracture Surgery

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