Diagnostic accuracy of 2- and 3-dimensional imaging and modeling of distal humerus fractures

Brouwer, Kim M.; Lindenhovius, Anneluuk L.C.; Dyer, George S.M.; Zurakowski, David; Mudgal, Chaitanya S.; Ring, David

doi:10.1016/j.jse.2012.01.009

Cited by 34 publications

(21 citation statements)

References 21 publications

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“…Recently, 3D imaging has been reported to facilitate hepatectomy by providing accurate evaluation of liver resection volumes and margins, stereoscopic relationship between tumor and vessels, as well as volumetric estimation of hepatic vein branch drainage area. 8 -10,20 Theoretically, 3D imaging and reconstruction have several advantages over 2D images: the stereoscopic and 360 imaging of the tumor and portal vein system would decrease the sampling and observing error of the 2D images 21 ; the precise simulation of the resection plane and the resected liver volume provide important information for hepatectomy 8 -10,20 ; the 3D imaging model could also be used as an intraoperative navigation to ensure the safety and clear resection margin of liver resection. 20 This is the first study which applied this 3D technique in the diagnosis and surgical treatment of HCC patients with macrovascular PVTT, aiming to identify whether 3D imaging could optimize the surgical procedure and improve the longterm prognosis when compared with conventional MSCT imaging.…”

Section: Discussionmentioning

confidence: 99%

The role of three-dimensional imaging in optimizing diagnosis, classification and surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus

Wei

et al. 2016

HPB

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Section: Discussionmentioning

confidence: 99%

The role of three-dimensional imaging in optimizing diagnosis, classification and surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus

Wei

et al. 2016

HPB

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“…The controversy seen in literature regarding fractures of the distal radius on agreement in a treatment plan is also seen in other types of fracture, including fractures of the proximal humerus 11-13 and fractures of the tibial plateau. 14-17 Although the CT scan has been shown to be more accurate in assessing characteristics of fractures, the studies which evaluated the agreement on treatment plans are inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Spectrum bias, a common unrecognised issue in orthopaedic agreement studies

Kleinlugtenbelt

Hoekstra

Ham

et al. 2015

Bone & Joint Research

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ObjectivesCurrent studies on the additional benefit of using computed tomography (CT) in order to evaluate the surgeons’ agreement on treatment plans for fracture are inconsistent. This inconsistency can be explained by a methodological phenomenon called ‘spectrum bias’, defined as the bias inherent when investigators choose a population lacking therapeutic uncertainty for evaluation. The aim of the study is to determine the influence of spectrum bias on the intra-observer agreement of treatment plans for fractures of the distal radius.MethodsFour surgeons evaluated 51 patients with displaced fractures of the distal radius at four time points: T1 and T2: conventional radiographs; T3 and T4: radiographs and additional CT scan (radiograph and CT). Choice of treatment plan (operative or non-operative) and therapeutic certainty (five-point scale: very uncertain to very certain) were rated. To determine the influence of spectrum bias, the intra-observer agreement was analysed, using Kappa statistics, for each degree of therapeutic certainty. ResultsIn cases with high therapeutic certainty, intra-observer agreement based on radiograph was almost perfect (0.86 to 0.90), but decreased to moderate based on a radiograph and CT (0.47 to 0.60). In cases with high therapeutic uncertainty, intra-observer agreement was slight at best (-0.12 to 0.19), but increased to moderate based on the radiograph and CT (0.56 to 0.57).ConclusionSpectrum bias influenced the outcome of this agreement study on treatment plans. An additional CT scan improves the intra-observer agreement on treatment plans for a fracture of the distal radius only when there is therapeutic uncertainty. Reporting and analysing intra-observer agreement based on the surgeon’s level of certainty is an appropriate method to minimise spectrum bias.Cite this article: Bone Joint Res 2015;4:190–194.

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“…Complex anatomical regions such as spine, pelvis or articular surfaces pose a particular high level of complexity and demand precise judgment of the fracture site to ensure successful osteosynthesis 7 . Various studies have shown that CT imaging provides significantly better diagnostic results than 2D imaging [8][9][10][11] . Wicky et al have shown that in over 50% surgical planning has been altered after preoperative 3D-reconstruction 12,13 .…”

Section: D-imagingmentioning

confidence: 99%

Diagnostic accuracy of intraoperative CT-imaging in complex articular fractures – a cadaveric study

Luxenhofer

Beisemann

Schnetzke

et al. 2020

Sci Rep

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Anatomic reconstruction of articular fractures is one of the critical factors in later achieving good functional outcome. Intraoperative 3D imaging has been shown to offer better evaluation and therefore can significantly improve the results. The purpose of this study was to assess the difference between intraoperative three-dimensional fluoroscopy (3D) and intraoperative computed tomography (iCT) imaging regarding fracture reduction, implant placement and articular impressions in a distal humeral fracture model. AO type 13-B2 fracture pattern were created in upper extremity cadaver specimens. Articular step-offs, intra-articular screw placement and intraarticular impressions of different degrees of severity were created. All specimens had imaging performed. For each articular pattern 3D fluoroscopy in standard (3Ds) and high quality (3Dh) were performed (Arcadis Orbic, Siemens, Germany) as well as an intraoperative CT scan (iCT, Airo, Brainlab, Germany). Three observers evaluated all imaging studies regarding subjective and objective parameters. iCT is more precise than 3D fluoroscopic imaging for detection of articular impressions. Articular step-offs and intraarticular screw placement are similar for iCT and 3D. Subjective imaging quality is the highest for iCT and lowest for 3Ds. Intraoperative CT may be particularly useful in assessing articular impressions and providing a good subjective image quality for the surgeon. Distal humeral fractures. Fractures of the distal humerus are rather rare in adults, they comprise approximately 2% of all fractures overall and one-third of all humeral fractures 1,2. The incidence of distal humerus fractures in adults is 5-6/100.000/year 3 with the average age being 48.4 years 1. Distal humerus fractures are often results of high-energy trauma in young, active, male patients (motor vehicle accidents and sporting activities) and low-energy injuries in elder women 3-5. Fractures of the distal humerus with their complex anatomical structures, high biomechanical load applied to the implants as well as associated soft tissue damage pose difficult challenges for the surgeon 3. Fractures of the distal humerus, some of which are treated with multiple osteosynthesis plates, are therefore a good example for testing the limits of intraoperative imaging.

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Diagnostic accuracy of 2- and 3-dimensional imaging and modeling of distal humerus fractures

Cited by 34 publications

References 21 publications

The role of three-dimensional imaging in optimizing diagnosis, classification and surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus

The role of three-dimensional imaging in optimizing diagnosis, classification and surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus

Spectrum bias, a common unrecognised issue in orthopaedic agreement studies

Diagnostic accuracy of intraoperative CT-imaging in complex articular fractures – a cadaveric study

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