Intraoperative assessment of reduction and implant placement in acetabular fractures—limitations of 3D-imaging compared to computed tomography

Keil, Holger; Beisemann, Nils; Schnetzke, Marc; Vetter, Sven; Swartman, Benedict; Grützner, Paul Alfred; Franke, Jochen

doi:10.1186/s13018-018-0780-7

Cited by 26 publications

(28 citation statements)

References 26 publications

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“…The amount of intraoperative blood loss was calculated as previously described. [18][19][20][21] The intraoperative fluoroscopy screening time was defined as the duration of intraoperative observation of fracture reduction or internal fixation. Hip function was evaluated using the Harris hip score (HHS).…”

Section: Discussionmentioning

confidence: 99%

Traditional three-dimensional printing technology versus three-dimensional printing mirror model technology in the treatment of isolated acetabular fractures: a retrospective analysis

Cong

Mao

et al. 2020

J Int Med Res

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Objective This study was performed to compare the clinical outcomes of traditional three-dimensional (3D) printing technology and 3D printing mirror model technology in the treatment of isolated acetabular fractures. Methods Prospectively maintained databases were reviewed to retrospectively compare patients with an isolated acetabular fracture who were treated with traditional 3D printing technology (Group T) or 3D printing mirror model technology (Group M) from 2011 to 2017. In total, 146 advanced-age patients (146 hips) with an isolated acetabular fracture (Group T, n = 72; Group M, n = 74) were assessed for a mean follow-up period of 29 months (range, 24–34 months). The primary endpoint was the postoperative Harris hip score (HHS). The secondary endpoints were the operation time, intraoperative blood loss, fluoroscopy screening time, fracture reduction quality, and incidence of postoperative complications at the final follow-up. Results The HHS, operation time, intraoperative blood loss, fluoroscopy screening time, and incidence of postoperative complications were significantly different between the groups, with Group M showing superior clinical outcomes. Conclusion In patients with an isolated acetabular fracture, 3D printing mirror model technology might lead to more accurate and efficient treatment than traditional 3D printing technology.

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Section: Discussionmentioning

confidence: 99%

Traditional three-dimensional printing technology versus three-dimensional printing mirror model technology in the treatment of isolated acetabular fractures: a retrospective analysis

Cong

Mao

et al. 2020

J Int Med Res

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“…For differentiation between the two imaging modalities fluoroscopy generated scans with a C-arm will be called "intraoperative 3D-imaging" and CT-scans generated by a mobile traditional (fan beam) CT-scanner "intraoperative CT (iCT)". 11-41% of fracture reductions which have been deemed sufficient in the surgeon's opinion after routine 2D imaging have been revised after intraoperative 3D-imaging 14,20,21 . Intraoperative 3D-imaging improves patient care and outcome through improved evaluation of fracture reduction and implant placement, especially in complex anatomical regions 16,22,23 and therefore became an established tool in trauma surgery 24 .…”

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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“…Due to the principles on which this technology is based, 3D imaging with a C-arm is prone to artefacts which always occur around implants. Depending on the actual configuration of the osteosynthesis as well as the patientʼs bone quality and soft-tissue quantity, image interpretation can be limited, especially at the acetabulum [17]. Thus, in some cases a postoperative CT scan is still required to reliably determine reduction and implant position.…”

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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Intraoperative assessment of reduction and implant placement in acetabular fractures—limitations of 3D-imaging compared to computed tomography

Cited by 26 publications

References 26 publications

Traditional three-dimensional printing technology versus three-dimensional printing mirror model technology in the treatment of isolated acetabular fractures: a retrospective analysis

Traditional three-dimensional printing technology versus three-dimensional printing mirror model technology in the treatment of isolated acetabular fractures: a retrospective analysis

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

Intraoperative Imaging in Pelvic Surgery

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