Intraoperative 3D imaging in plate osteosynthesis of proximal humerus fractures

Abstract

Introduction Proximal humerus fractures are common and often associated with osteoporosis in the elderly. Unfortunately, the complication and revision rate for joint-preserving surgical treatment using locking plate osteosynthesis is still high. Problems include insufficient fracture reduction and implant misplacement. Using conventional intraoperative two dimensional (2D) X-ray imaging control in only two planes, a completely error-free assessment is not possible. Materials and methods The feasibility of intraoperative three-dimensional (3D) imaging control for locking plate osteosynthesis with screw tip cement augmentation of proximal humerus fractures was retrospectively studied in 14 cases with an isocentric mobile C-arm image intensifier set up parasagittal to the patients. Results The intraoperative digital volume tomography (DVT) scans were feasible in all cases and showed excellent image quality. One patient showed inadequate fracture reduction in the imaging control, which then could be corrected. In another patient, a protruding head screw was detected, which could be replaced before augmentation. Cement distribution in the humeral head was consistent around the screw tips with no leakage into the joint. Conclusion This study shows that insufficient fracture reduction and implant misplacement can be easily and reliably detected by intraoperative DVT scan with an isocentric mobile C-arm set up in the usual parasagittal position to the patient.

3D C-arm navigated acromioclavicular joint stabilization

“…In a recently published study, we have already demonstrated, contrary to previous opinion, that it is possible to perform intraoperative 3D DVT on the shoulder with an isocentric mobile C-arm in the usual parasagittal position to the patient [ 15 , 38 ]. In a retrospective evaluation of these images, we were able to additionally demonstrate the imageability of the entire AC joint (lateral clavicle, coracoid, and acromion) with regard to the current question.…”

“…In our present DVT navigated SD study, the conditions were adapted to everyday surgical practice and the system setup in the operating room was identical to the in vivo study on intraoperative 3D C-arm visualization of the shoulder joint [ 15 ]. As in the two studies by Stübig et al, the CC drill channels in our study could be placed very precisely in a line always centered on the clavicle and the coracoid [ 16 ].…”

“…The feasibility of intraoperative 3D DVT imaging of the shoulder in vivo has only been published so far for proximal humerus fractures and for accurate positioning of the baseplate in reverse shoulder arthroplasty [13][14][15]39]. However, in combination with navigation it might also be useful for accurate assessment of AC joint repositioning, accurate drill channel placement, and control of SD implantation.…”

“…The system setup in the operating room was identical to that of the study “intraoperative 3D imaging in plate osteosynthesis of proximal humerus fractures” [ 15 ]. The same operating table and the same C-arm were used in exactly the same position to each other as shown in Fig.…”

“…In addition to SD stabilization of the CC ligaments, the application of a horizontal AC cerclage is recommended by some authors [9][10][11][12]. For better intraoperative visual assessment of the shoulder joint, digital volume tomography (DVT) can be performed using a mobile C-arm [13][14][15]. Under laboratory conditions, Stübig et al were able to demonstrate more accurate drill channel placement CC on nine cadaver shoulders using navigation with a non-isocentric flat detector C-arm in three dimensions (3D) than under conventional two-dimensional (2D) radiographic control [16].…”