BACKGROUND: Intraoperative visualization of articular surfaces is technically demanding, and standard two-dimensional fluoroscopic imaging frequently does not provide adequate detail of nonplanar joints. New imaging modalities allow for intraoperative 3D visualization, which are useful in articular fractures. Purpose of this study was to evaluate the utility of 3D imaging in articular fracture reconstruction. METHODS: In a prospective cohort study, we evaluated 248 consecutive patients with intra-articular fractures. After fracture fixation using standard fluoroscopy, 3D imaging was performed intraoperatively using the Iso-C3D system for all patients. Surgeons filled out questionnaires regarding the utility and perceived accuracy of the 3D system. Postoperative CT scans were performed on approximately half of the patients. Main outcome measurements were based on the surgeons decision to immediately revise the articular reduction or implant position. The setup time for the system was recorded. For patients with postoperative CT scans, articular surface gaps of 2 mm or intra-articular hardware placement was again evaluated. RESULTS: In 19% of all cases, intraoperative image analysis resulted in immediate adjustment of the reduction or hardware exchange. These revisions were based on Iso-C3D views of the articular surface that were not visible using fluoroscopy. Of the 129 postoperative CT scans, five cases revealed a technical error of the joint reconstruction, and a secondary revision procedure was performed. CONCLUSION: In conclusion, the Iso-C3D was a valuable intraoperative tool, providing additional information about the articular surface compared with conventional fluoroscopy in a variety of anatomic regions.
BACKGROUND: Intraoperative visualization of articular surfaces is technically demanding, and standard two-dimensional fluoroscopic imaging frequently does not provide adequate detail of nonplanar joints. New imaging modalities allow for intraoperative 3D visualization, which are useful in articular fractures. Purpose of this study was to evaluate the utility of 3D imaging in articular fracture reconstruction. METHODS: In a prospective cohort study, we evaluated 248 consecutive patients with intra-articular fractures. After fracture fixation using standard fluoroscopy, 3D imaging was performed intraoperatively using the Iso-C3D system for all patients. Surgeons filled out questionnaires regarding the utility and perceived accuracy of the 3D system. Postoperative CT scans were performed on approximately half of the patients. Main outcome measurements were based on the surgeons decision to immediately revise the articular reduction or implant position. The setup time for the system was recorded. For patients with postoperative CT scans, articular surface gaps of 2 mm or intra-articular hardware placement was again evaluated. RESULTS: In 19% of all cases, intraoperative image analysis resulted in immediate adjustment of the reduction or hardware exchange. These revisions were based on Iso-C3D views of the articular surface that were not visible using fluoroscopy. Of the 129 postoperative CT scans, five cases revealed a technical error of the joint reconstruction, and a secondary revision procedure was performed. CONCLUSION: In conclusion, the Iso-C3D was a valuable intraoperative tool, providing additional information about the articular surface compared with conventional fluoroscopy in a variety of anatomic regions.
Authors: Erin J Smith; Hisham A Al-Sanawi; Braden Gammon; Paul J St John; David R Pichora; Randy E Ellis Journal: Int J Comput Assist Radiol Surg Date: 2011-06-25 Impact factor: 2.924
Authors: Thomas Dienstknecht; Michael Müller; Richard Sellei; Michael Nerlich; Franz Josef Müller; Bernd Fuechtmeier; Arne Berner Journal: Int Orthop Date: 2012-12-19 Impact factor: 3.075
Authors: Steven M Cherney; Jacob A Haynes; Amanda G Spraggs-Hughes; Christopher M McAndrew; William M Ricci; Michael J Gardner Journal: J Orthop Trauma Date: 2015-09 Impact factor: 2.512
Authors: Joseph Görres; Michael Brehler; Jochen Franke; Karl Barth; Sven Y Vetter; Andrés Córdova; Paul A Grützner; Hans-Peter Meinzer; Ivo Wolf; Diana Nabers Journal: Int J Comput Assist Radiol Surg Date: 2014-04-18 Impact factor: 2.924