Intraoperative revision rates due to three-dimensional imaging in orthopedic trauma surgery: results of a case series of 4721 patients

Abstract

Purpose Intraoperative 3D imaging has become a valued tool in assessing the quality of reduction and implant placement in orthopedic trauma surgery. In our institution, 3D imaging is used routinely since 2001. To evaluate the intraoperative findings and consequences of this technique, intraoperative revision rates in cases with 3D imaging were analyzed. Methods All operative procedures carried out with intraoperative 3D imaging between August 2001 and December 2016 were included. The scans were assessed intraoperatively and documented thereafter. In case of malreduction or misplaced implants, an immediate revision was performed. The number of scans per case as well as the findings and consequences drawn regarding the anatomical region were analyzed. Results 4721 cases with 7201 3D scans were included in this study. The most common anatomical regions were the ankle (22.3%), the calcaneus (14.8%) and the tibial head (9.5%). In 19.1% of all cases, an intraoperative revision was performed. The highest revision rates were found with 36.0% in calcaneal fractures, 24.8% in fractures of the tibial plateau, 22.3% in injuries of the ankle. In 52.0% of revisions, the reduction was improved regarding intra-articular steps or joint congruency. In 30.5% an implant was corrected. Conclusion Intraoperative revision due to results of 3D imaging was performed in almost one-fifth of cases. This illustrates the improved possibilities to detect malreduction and implant misplacements intraoperatively and thus the abilities to improve surgical outcome. Level of evidence III.

Investigating focal spot position drift in a mobile imaging system equipped with a monobloc‐based x‐ray generator

“…High-resolution 3D-CBCT imaging enables intraoperative detection of implant misplacement and may reduce the need for post-operative diagnostic CT imaging. 5 Combined with advancements in technologies such as virtual and augmented realityassisted screw planning, new workflow options arise. 6,7 Furthermore, adaptive treatment planning in IGBT 1 and IORT 2 can be achieved.…”

“…The ImagingRing‐m features 2D planar, 3D‐CBCT, as well as fluoroscopic imaging. High‐resolution 3D‐CBCT imaging enables intraoperative detection of implant misplacement and may reduce the need for post‐operative diagnostic CT imaging 5 . Combined with advancements in technologies such as virtual and augmented reality‐assisted screw planning, new workflow options arise 6,7 .…”