BACKGROUND: The intraoperative assessment of the articular surface in displaced intra-articular distal tibia fractures can be challenging using conventional fluoroscopy. The aim of the study was to determine the frequency and the method of intraoperative corrections of fracture reductions or implant placements during open reduction, internal fixation by using cone beam computed tomography (CT) after conventional fluoroscopy. METHODS: Displaced intra-articular distal tibia fractures were retrospectively analyzed from August 2001 until December 2011. The fractures were classified according to the standards of the AO/OTA as type B or C and treated with open reduction and internal plate fixation. After primary reduction using conventional fluoroscopy, an additional cone beam CT scan was used to determine the alignment of the joint line and the implant position. The number of intraoperative revisions of the primary reduction due to the use of cone beam CT was analyzed. RESULTS: A total of 143 patients with an intra-articular tibial plafond fracture were included in the analysis. In 43 patients (30%), an intraoperative correction was performed after the cone beam CT scan. In 34 (24%) of these cases, intraoperative correction was required because of inadequate joint line reduction. Nine (6%) corrections were required as a result of a malposition of the implant. The revision rate did not differ by fracture classification. CONCLUSION: Despite its acceptance as the standard method of imaging, intraoperative conventional fluoroscopy for the assessment of implant positioning and fracture reduction of tibial plafond fractures is limited. The intraoperative utilization of cone beam CT provided additional information for the surgeon to detect insufficient reduction or implant malposition. LEVEL OF EVIDENCE: Level III, retrospective comparative series.
BACKGROUND: The intraoperative assessment of the articular surface in displaced intra-articular distal tibia fractures can be challenging using conventional fluoroscopy. The aim of the study was to determine the frequency and the method of intraoperative corrections of fracture reductions or implant placements during open reduction, internal fixation by using cone beam computed tomography (CT) after conventional fluoroscopy. METHODS: Displaced intra-articular distal tibia fractures were retrospectively analyzed from August 2001 until December 2011. The fractures were classified according to the standards of the AO/OTA as type B or C and treated with open reduction and internal plate fixation. After primary reduction using conventional fluoroscopy, an additional cone beam CT scan was used to determine the alignment of the joint line and the implant position. The number of intraoperative revisions of the primary reduction due to the use of cone beam CT was analyzed. RESULTS: A total of 143 patients with an intra-articular tibial plafond fracture were included in the analysis. In 43 patients (30%), an intraoperative correction was performed after the cone beam CT scan. In 34 (24%) of these cases, intraoperative correction was required because of inadequate joint line reduction. Nine (6%) corrections were required as a result of a malposition of the implant. The revision rate did not differ by fracture classification. CONCLUSION: Despite its acceptance as the standard method of imaging, intraoperative conventional fluoroscopy for the assessment of implant positioning and fracture reduction of tibial plafond fractures is limited. The intraoperative utilization of cone beam CT provided additional information for the surgeon to detect insufficient reduction or implant malposition. LEVEL OF EVIDENCE: Level III, retrospective comparative series.
Authors: Nils Beisemann; Antonella M Tilk; Jula Gierse; Paul A Grützner; Jochen Franke; Jeffrey H Siewerdsen; Sven Y Vetter Journal: BMC Med Imaging Date: 2022-10-19 Impact factor: 2.795
Authors: Maxim Privalov; Benedict Swartman; Nils Beisemann; Jan El Barbari; Jochen Franke; Paul Alfred Grützner; Sven Vetter Journal: Eur J Trauma Emerg Surg Date: 2021-06-17 Impact factor: 3.693
Authors: Sven Y Vetter; Maxim Privalov; Nils Beisemann; Benedict Swartman; Holger Keil; Joachim Kirsch; Paul Alfred Grützner; Jochen Franke Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240
Authors: Maxim Privalov; Finn Euler; Holger Keil; Benedict Swartman; Nils Beisemann; Jochen Franke; Paul Alfred Grützner; Sven Y Vetter Journal: BMC Musculoskelet Disord Date: 2019-11-13 Impact factor: 2.362
Authors: Holger Keil; Nils Beisemann; Marc Schnetzke; Sven Yves Vetter; Benedict Swartman; Paul Alfred Grützner; Jochen Franke Journal: J Orthop Surg Res Date: 2018-04-10 Impact factor: 2.359