Intraoperative three-dimensional imaging in tibial plateau fractures with complex depressions

Ruan, Zhiyong; Luo, Congfeng; Feng, Danni; Zhang, Changqing; Zeng, Bingfang

doi:10.3233/thc-2011-0613

Cited by 7 publications

(9 citation statements)

References 13 publications

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“…One reason for this was that tibial plateau fractures were viewed as a subgroup. Ruan et al and Kendoff et al obtained similar results for the revision rate (20% and 21%, respectively) as observed in this study [11, 13].…”

Section: Discussionsupporting

confidence: 88%

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Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases

et al. 2019

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Introduction The aim of this study was to evaluate the intraoperative revision rate and reasons for revision following 3D imaging in the management of dislocated articular tibial plateau fractures based on a large patient sample. Methods This retrospective cohort study included all patients who underwent open reduction and internal fixation due type B or C tibial plateau fracture according to the AO/OTA classification between August 2001 and December 2017 using intraoperative cone beam CT (3D imaging) for the analysis of fracture reduction and implant placement. The findings of the 3D scan were categorized regarding the amount and type of revision. Furthermore, demographic data was examined. Results Five hundred and fifty-nine consecutive fractures were included in the study. Evaluation of the image data records revealed an intraoperative revision due to the usage of 3D imaging in 148 out of 559 cases (26.5%). The most common reasons for an intraoperative revision were insufficient fracture reduction (114 cases) and screw length (21 cases). Conclusion This study reveals indications for a limited analysis of fracture reduction and implant placement during the operative treatment of dislocated articular tibial plateau fractures using conventional fluoroscopy. In view of the high revision rate during open reduction and internal fixation of tibial plateau fractures due to 3D imaging the usage of intraoperative cone beam, CT may be considered. If this is not possible, a postoperative computed tomography may therefore be reasonable.

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Section: Discussionsupporting

confidence: 88%

“…Furthermore, relatively small numbers of fractures were investigated; in some studies, proximal tibia fracture was only analyzed as a subgroup. These publications report a revision rate from 11 to 21% based on 3D imaging [10–13].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases

et al. 2019

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“…They also detected relevant intraarticular fragments, which would have remained undetected in conventional fluoroscopy [28]. Also, other authors have confirmed the benefit of intraoperative 3D imaging [29,30]. Synoptically, in general the intraoperative 3D scan offers an advantage over conventional imaging.…”

Section: Intraoperative 3d-imagingmentioning

confidence: 83%

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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“…1 . There were seven prospective cohort studies [ 20 , 21 , 24 , 27 , 28 , 32 , 34 ], four retrospective cohort studies [ 16 , 19 , 26 , 29 ], five case series [ 22 , 23 , 30 , 31 , 33 ], two case reports [ 17 , 18 ], one descriptive study [ 8 ], and one observational study [ 25 ]. No Randomized controlled trials were found.…”

Section: Resultsmentioning

confidence: 99%

“…Eventually, 22 articles were included for full-text screening of which two articles were excluded [14,15]. Twenty studies met the inclusion criteria of this systematic review [8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The review process is summarized in Fig.…”

Section: Searchmentioning

confidence: 99%

Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients

Assink

Reininga

Duis

et al. 2021

Eur J Trauma Emerg Surg

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Purpose The aim of this systematic review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess whether 3D-assisted surgery results in improved clinical outcome as compared to surgery based on conventional imaging modalities. Methods A literature search was performed in Pubmed and Embase for articles reporting on the use of 3D techniques in operative management of tibial plateau fractures. This systematic review was performed in concordance with the PRISMA-guidelines. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Differences in terms of operation time, blood loss, fluoroscopy frequency, intra-operative revision rates and patient-reported outcomes between 3D-assisted and conventional surgery were assessed. Data were pooled using the inverse variance weighting method in RevMan. Results Twenty articles evaluating 948 patients treated with 3D-assisted surgery and 126 patients with conventional surgery were included. Five different concepts of 3D-assisted surgery were identified: ‘3D virtual visualization’, ‘3D printed hand-held fracture models’, ‘Pre-contouring of osteosynthesis plates’, ‘3D printed surgical guides’, and ‘Intra-operative 3D imaging’. 3D-assisted surgery resulted in reduced operation time (104.7 vs. 126.4 min; P < 0.01), less blood loss (241 ml vs. 306 ml; P < 0.01), decreased frequency of fluoroscopy (5.8 vs. 9.1 times; P < 0.01). No differences in functional outcome was found (Hospital for Special Surgery Knee-Rating Scale: 88.6 vs. 82.8; P = 0.23). Conclusions Five concepts of 3D-assisted surgical management of tibial plateau fractures emerged over the last decade. These include 3D virtual fracture visualization, 3D-printed hand-held fracture models for surgical planning, 3D-printed models for pre-contouring of osteosynthesis plates, 3D-printed surgical guides, and intra-operative 3D imaging. 3D-assisted surgery may have a positive effect on operation time, blood loss, and fluoroscopy frequency.

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Intraoperative three-dimensional imaging in tibial plateau fractures with complex depressions

Cited by 7 publications

References 13 publications

Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases

Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases

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

Does 3D-assisted surgery of tibial plateau fractures improve surgical and patient outcome? A systematic review of 1074 patients

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