Does intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery?

Carelsen, Bart; Haverlag, Robert; Ubbink, Dirk T.; Luitse, Jan S. K.; Goslings, J. Carel

doi:10.1007/s00402-008-0740-5

Cited by 33 publications

(20 citation statements)

References 17 publications

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“…Not in all cases, fracture reduction and implant positioning can be reliably assessed using intraoperative fluoroscopy [10]. Especially in patients requiring osteosynthesis of the acetabulum and the posterior pelvic ring, there are limitations to the assessment of joint congruence and implant positioning [11,12].…”

Section: Intraoperative 3d Imagingmentioning

confidence: 99%

Intraoperative Imaging in Pelvic Surgery

et al. 2018

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Pelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.

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Section: Intraoperative 3d Imagingmentioning

confidence: 99%

Intraoperative Imaging in Pelvic Surgery

et al. 2018

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“…Usually, the 3D scan is performed when reduction and implant placement are considered correct in fluoroscopy. Several studies show intraoperative revision rates, depending on the anatomical region, of up to 40% as a consequence of the 3D imaging . Because of these results, 3D imaging has become very common in the operative treatment of complex articular fractures including acetabular fractures.…”

Section: Introductionmentioning

confidence: 99%

First experiences with the Airo mobile intraoperative CT scanner in acetabular surgery—An analysis of 10 cases

Keil

Beisemann

Schnetzke

et al. 2019

Robotics Computer Surgery

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Background: Being a proven method in trauma and spine surgery, intraoperative 3D imaging (CBCT) has intrinsic deficits in difficult anatomy and with artifacts because of metal implants. The purpose of this study was to evaluate the use of intraoperative computed tomography (iCT) in acetabular surgery.Methods: Ten cases of acetabular fractures that were operated with intraoperative use of the mobile CT scanner Brainlab Airo were analyzed. Data were compared with a historical group of 17 patients.Results: Additional fluoroscopy time was 24.2 seconds (6-91), which was significantly lower than in the control group where it was 211.4 seconds (77-446; P < 0.000). Operation time did not differ significantly , control group 240.8 min , P = 0.234).Conclusion: iCT provides images of a reliable high quality and assessability. Radiation exposure to the staff is reduced while surgery time is not altered significantly.Quality of intraoperative imaging and thus patient care can substantially improve patient outcome. KEYWORDS acetabular fracture, intraoperative computed tomography, intraoperative imaging, intraoperative mobile CT scanner Brainlab Airo

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“…Intraoperative fluoroscopy is routinely used during human fracture repair [5][6][7][8][9] and is slowly being integrated in small animal orthopedics [10][11][12][13][14]. The use of fluoroscopy allows surgeons to accurately assess fracture reduction while facilitating and confirming proper implant placement.…”

Section: Introductionmentioning

confidence: 99%

Fluoroscopic-Assisted Olecranon Fracture Repair in Three Dogs

Jones

Lewis

Winter

2015

Case Reports in Veterinary Medicine

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Olecranon fractures in dogs are often both comminuted and intra-articular. Anatomic reduction and stable internal fixation are thus paramount to achieving primary bone healing and mitigating the development of posttraumatic osteoarthritis. Intraoperative fluoroscopy can be useful to confirm accurate fracture reduction and facilitate precise implant placement, potentially reducing the surgical exposure required and additional trauma. Despite widespread use in human surgery, reports of fluoroscopic-assisted fracture repair in dogs are limited. Presented here are three dogs in which intraoperative fluoroscopy was used to facilitate accurate olecranon fracture reduction and implant positioning. The olecranon fractures appeared to heal by primary bone union, although the anconeal process failed to obtain osseous union in one dog. Despite the development of mild-to-moderate osteoarthritis in all three dogs, and the nonunion of the anconeal process in one dog, the clinical outcome was considered successful with all dogs subjectively free of lameness at long-term follow-up evaluation. Intraoperative fluoroscopy was found to be a useful modality during fracture reduction and implant placement in dogs with olecranon fractures.

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Does intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery?

Cited by 33 publications

References 17 publications

Intraoperative Imaging in Pelvic Surgery

Intraoperative Imaging in Pelvic Surgery

First experiences with the Airo mobile intraoperative CT scanner in acetabular surgery—An analysis of 10 cases

Fluoroscopic-Assisted Olecranon Fracture Repair in Three Dogs

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