Intra-operative imaging in trauma surgery

Abstract

The reconstruction of anatomical joint surfaces, limb alignment and rotational orientation are crucial in the treatment of fractures in terms of preservation of function and range of motion. To assess reduction and implant position intra-operatively, mobile C-arms are mandatory to immediately and continuously control these parameters.Usually, these devices are operated by OR staff or radiology technicians and assessed by the surgeon who is performing the procedure. Moreover, due to special objectives in the intra-operative setting, the situation cannot be compared with standard radiological image acquisition. Thus, surgeons need to be trained and educated to ensure correct technical conduct and interpretation of radiographs.It is essential to know the standard views of the joints and long bones and how to position the patient and C-arm in order to acquire these views. Additionally, the operating field must remain sterile, and the radiation exposure of the patient and staff must be kept as low as possible.In some situations, especially when reconstructing complex joint fractures or spinal injuries, complete evaluation of critical aspects of the surgical results is limited in two-dimensional views and fluoroscopy. Intra-operative three-dimensional imaging using special C-arms offers a valuable opportunity to improve intra-operative assessment and thus patient outcome.In this article, common fracture situations in trauma surgery as well as special circumstances that the surgeon may encounter are addressed.Cite this article: EFORT Open Rev 2018;3:541-549. DOI: 10.1302/2058-5241.3.170074

Visualising the Future of Orthopaedic Surgery: A Novel Application of Wireless Smart Glasses to Visualise Intraoperative Imaging

“…Intraoperative radiation exposure is another key occupational hazard to orthopaedic surgeons [13,14].…”

A Review of Orthopaedic Surgical Set-Up and Introduction of the TULIPS Mnemonic – Six Simple Steps for Optimising Set-Up in Orthopaedic Surgery

“…For example, insertion of dynamic hip screws in the proximal femur requires regular anteroposterior (AP) and lateral views. The c-arm is positioned obliquely between the legs of the patient to enable an axial view and must then be tilted by 10-15 degrees to compensate for the anteversion of the femoral neck [21]. Similarly, in osteosyntheses of the proximal humerus, the patient is positioned in the beach-chair position, resulting in the upper arm already tilted towards the floor.…”

“…Similarly, in osteosyntheses of the proximal humerus, the patient is positioned in the beach-chair position, resulting in the upper arm already tilted towards the floor. The C-arm must be tilted to compensate such that the central beam remains perpendicular to the humeral shaft in order to get the desired AP and lateral views [21].…”

Intraoperative fluoroscopy alone versus routine post‐operative X‐rays in identifying return to theatre after fracture fixation

“…Since the discovery of X‐rays in 1895, radiographs have been an indispensable component of orthopaedic trauma care in the assessment of fracture reduction and fixation. Intraoperative fluoroscopy (IF) was first described in 1955 by Diethelm et al 1 . and allowed for the immediate assessment of fracture position and fixation.…”