Evolution of imaging in surgical fracture management

Rüden, Christian von; Trapp, Oliver; Augat, Peter; Stuby, Fabian; Friederichs, Jan

doi:10.1016/j.injury.2019.10.080

Cited by 14 publications

(10 citation statements)

References 74 publications

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“…So an adequate depiction of the articular surface and fracture is not possible in fluoroscopy [26]. Intraoperative 3D scan has been comparable in most of the cases to postoperative CT scan in terms of quality of fracture reduction, with the added ability to intraoperatively evaluate implant positioning [27], joint width and geometry as well as small dislocated fragments in the intercondylar area. Beisemann et al published an intraoperative revision rate of up to 32.4% with intraoperative 3D imaging after initial satisfying reduction under fluoroscopic control [28].…”

Section: Intraoperative 3d-imagingmentioning

confidence: 99%

The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

Frosch

Korthaus

Thiesen

et al. 2020

Eur J Trauma Emerg Surg

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Malreduction after tibial plateau fractures mainly occurs due to insufficient visualization of the articular surface. In 85% of all C-type fractures an involvement of the posterolateral-central segment is observed, which is the main region of malreduction. The choice of the approach is determined (1) by the articular area which needs to be visualized and (2) the positioning of the fixation material. For simple lateral plateau fractures without involvement of the posterolateral-central segment an anterolateral standard approach in supine position with a lateral plating is the treatment of choice in most cases. For complex fractures the surgeon has to consider, that the articular surface of the lateral plateau only can be completely visualized by extended approaches in supine, lateral and prone position. Anterolateral and lateral plating can also be performed in supine, lateral and prone position. A direct fixation of the posterolateral-central segment by a plate or a screw from posterior can be only achieved in prone or lateral position, not supine. The posterolateral approach includes the use of two windows for direct visualization of the fracture. If visualization is insufficient the approach can be extended by lateral epicondylar osteotomy which allows exposure of at least 83% of the lateral articular surface. Additional central subluxation of the lateral meniscus allows to expose almost 100% of the articular surface. The concept of stepwise extension of the approach is helpful and should be individually performed as needed to achieve anatomic reduction and stable fixation of tibial plateau fractures.

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Section: Intraoperative 3d-imagingmentioning

confidence: 99%

The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

Frosch

Korthaus

Thiesen

et al. 2020

Eur J Trauma Emerg Surg

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“…With the development of modern technology, new approaches, such as 3D printing, have opened a new era for the treatment of fractures [ 7 ]. The application of 3D printing technology varies from anatomical models mainly intended for preoperative planning to surgical guides and implants [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of 3D Printing Technology for the Treatment of Acetabular Fractures

Cao

Zhu

Gao

2021

BioMed Research International

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Purpose. Three-dimensional (3D) printing technology has been widely used in orthopedics surgery. However, its efficacy in acetabular fractures remains unclear. The aim of this systematic review and meta-analysis was to examine the effect of using 3D printing technology in the surgery for acetabular fractures. Methods. The systematic review was performed following the PRISMA guidelines. Four major electronic databases were searched (inception to February 2021). Studies were screened using a priori criteria. Data from each study were extracted by two independent reviewers and organized using a standardized table. Data were pooled and presented in forest plots. Results. Thirteen studies were included in the final analysis. Four were prospective randomized trials, and nine used a retrospective comparative design. The patients aged between 32.1 (SD 14.6) years and 51.9 (SD 18.9) years. Based on the pooled analyses, overall, 3D printing-assisted surgery decreased operation time by 38.8 minutes (95% CI: -54.9, -22.8), intraoperative blood loss by 259.7 ml (95% CI: -394.6, -124.9), instrumentation time by 34.1 minutes (95% CI: -49.0, -19.1). Traditional surgery was less likely to achieve good/excellent function of hip (RR, 0.53; 95% CI: 0.34, 0.82) and more likely to have complications than 3D printing-assisted surgery (RR, 1.19; 95% CI: 1.07, 1.33). Conclusions. 3D printing technology demonstrated efficacy in the treatment of acetabular fractures. It may improve surgery-related and clinical outcomes. More prospective studies using a rigorous design (e.g., randomized trial with blinding) are warranted to confirm the long-term effects of 3D printing technology in orthopedics surgeries.

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“…While the direction of dislocation is easily assessed by fluoroscopy, there is a lack of reliable criteria to establish the extent of angulation. Accurate assessment of the bone morphology and correct analysis of the fracture are ultimately essential for good functional outcome [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the subcapital two-part humerus fracture by fluoroscopy: objective criteria for classification and decision making

Bless

Keller

Steinitz³

et al. 2021

Arch Orthop Trauma Surg

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Background Surgical decision making in the treatment of proximal humerus fractures (PHFx) is primarily based on fracture classification using standard radiographs. Due to the lack of objective criteria, this classification process is associated with high interobserver variation. In this study, we investigate the fluoroscopic analysis of humerus fractures through the surgical neck using a semi-quantitative determination of distinct angulation patterns of the proximal humerus as they appear in the image intensifier. Methods Using a saw bone model, defined subcapital 2-part fracture configurations were generated and assessed radiographically. Anatomical landmarks—including the greater and lesser tuberosity as well as anatomical neck—were identified using an image converter, and the exact degree of fracture displacement with 10° up to 70° (in 10° increments) of posterior, varus or combined posterior-varus angulation was compared to nondisplaced controls. From the resultant series of radiographs, the appearance of these angulations in anteroposterior (AP) and scapular Y-views were also visualized and defined. Results An angulation of 50° or more of any given 2-part fracture through the surgical neck is present when the greater tuberosity becomes the most proximal point in AP view (varus and combined posterior-varus angulation) or a bimodal form is found for the superior contour of the head with the lesser tuberosity being the most proximal point in the Y-view (posterior angulation). Conclusion The radiological appearance of various PHFx constellations can be well visualized using the saw bone shoulder model. The presence of angulation in accordance with the Neer classification for group III fractures can be adequately determined by analyzing the relative position of the greater or lesser tuberosity to the humeral head calotte. This can assist the surgeon’s decision on whether to operate or opt for a conservative approach. Level of evidence Basic Science, Anatomy Study, Imaging.

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Evolution of imaging in surgical fracture management

Cited by 14 publications

References 74 publications

The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

A Systematic Review and Meta-Analysis of 3D Printing Technology for the Treatment of Acetabular Fractures

Analysis of the subcapital two-part humerus fracture by fluoroscopy: objective criteria for classification and decision making

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