Quantitative 3D measurements of tibial plateau fractures

Assink, Nick; Kraeima, Joep; Slump, C. H.; Duis, Kaj ten; Vries, J.P.P.M. de; Meesters, Anne M. L.; Ooijen, Peter M. A. van; Witjes, Max J. H.; IJpma, Frank F. A.

doi:10.1038/s41598-019-50887-6

Cited by 19 publications

(27 citation statements)

References 23 publications

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“…Previous studies from our research group showed that 3D fracture quantification may improve outcome prediction of various fracture types. Our results have already shown better agreement on the measures with excellent interobserver agreement (ICC = 0.81), which are comparable with the agreement found in our previous studies (ICC = 0.99 and 0.94) [ 17 , 18 ]. Additionally, the 3D gap area fracture quantification is based on the whole intra-articular aspect of the fracture, rather than one CT-slice.…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, conventional 2D-CT slices are often insufficient to display the whole extent of complex intra-articular fractures [9][10][11][12][13]. In the last two decades, there is a trend towards fracture classification and analysis based on 3D models [14][15][16][17][18]. Recent studies showed that 3D fracture imaging modalities depict the true extent of the fracture and are less prone to intra-and interobserver variability [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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A new quantitative 3D gap area measurement of fracture displacement of intra-articular distal radius fractures: Reliability and clinical applicability

et al. 2022

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Introduction Gap and step-off measurements are generally used in the surgical decision-making process of distal radius fractures. Unfortunately, there is no consensus on treatment choice as these measurements are prone to inter- and intraobserver variability. In this study, we aim to introduce a new 3D fracture quantification method and compare it to conventional fracture analysis. Methods Forty patients with a minimally displaced intra-articular distal radius fracture that was treated nonoperatively between 2008–2015 were included. 2D-CT images were reassessed by three orthopedic trauma surgeons who performed gap and step-off measurements. Subsequently, 3D models were created and a 3D measurement method for fracture displacement was developed. For each fracture, the ‘3D gap area’ (3D surface between all fracture fragments) was determined by three observers. Interobserver agreements were calculated for all measurements, and the intraobserver agreement was calculated for the new 3D measurement. All patients completed two questionnaires in order to link our measurements to functional outcome. Results The interobserver agreement of the 2D measurements was fair (ICC = 0.54) for the gap and poor (ICC = 0.21) for the step-off. The median gap was 2.8 (IQR: 1.9–3.5) mm and step-off was 0.9 (IQR: 0.0–1.6) mm. Interobserver agreement on 3D gap area measurements was excellent (ICC = 0.81), with a median difference between measurements of 6.0 (IQR: 2.0–19.0) mm2, which indicates reliable assessment of 3D fracture displacement. Intraobserver agreement was also excellent (ICC = 0.98), with a median difference of 4.0 (IQR: 1.5–5.5) mm2. No significant differences in clinical outcome were found between the above and below 2mm displacement groups. The score of the DASH was 3.4 (IQR: 0.4–8.8) versus 4.2 (IQR: 0.0–11.6) respectively. Results from the PRWE questionnaire shows a similar result of 3.5 (IQR: 0.0–12.6) versus 5.0 (IQR: 0.0–25.5). Conclusion 3D gap area is a more objective measurement method compared to the conventional gap and step-off measurements to quantify the level of fracture displacement of distal radius fractures. 3D fracture assessment can be used in addition to the currently used classification systems of distal radius fractures.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

A new quantitative 3D gap area measurement of fracture displacement of intra-articular distal radius fractures: Reliability and clinical applicability

et al. 2022

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“…With these modalities, it is difficult to fully comprehend the true extent of these injuries, since the fracture fragments are often displaced and rotated in multiple directions. 3D visualization and printing modalities have the potential to provide the physician with a better understanding of the fracture pattern and could improve treatment strategy and patient outcome [ 4 , 5 ].…”

Section: Introductionmentioning

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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“…Therapieplanung stets -nach Durchführung einer entsprechenden Diagnostik, die mindestens aus einer Röntgen-und CT-Bildgebung mit multiplanarer und 3D-Rekonstruktion bestehen sollte [7] -die durchdachte Anwendung einer Frakturklassifikation.…”

Section: Hintergrundunclassified

Klassifikationen der Tibiaplateaufraktur

Schröter

Schreiner

2020

Knie J.

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Klassifikationen der TibiaplateaufrakturCT-basierte Klassifikationen für eine umfassende Frakturbeurteilung und gezielte Operationsplanung 10 Varusstress, axiale Krafteinleitung LCL (bis 70 %), PLC, proximale Fibula, AN V Bikondyläre Fraktur 3 Komplex Meniskus (50 %), Ligamente (85 %) VI Vollständige Unterbrechung von Epi-und Metaphyse 20 Komplex, hochenergetisch Offen (1/3), 79 % Begleitverletzungen MCL mediales kollaterales Ligament/Innenband, IM Innenmeniskus, LCL laterales kollaterales Ligament/Außenband, PLC posterolateral Corner/posterolaterale Ecke, AN Arterien-Nerven

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Quantitative 3D measurements of tibial plateau fractures

Cited by 19 publications

References 23 publications

A new quantitative 3D gap area measurement of fracture displacement of intra-articular distal radius fractures: Reliability and clinical applicability

A new quantitative 3D gap area measurement of fracture displacement of intra-articular distal radius fractures: Reliability and clinical applicability

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

Klassifikationen der Tibiaplateaufraktur

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