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.
BackgroundIn acetabular fractures, the assessment of reduction and implant placement has limitations in conventional 2D intraoperative imaging. 3D imaging offers the opportunity to acquire CT-like images and thus to improve the results. However, clinical experience shows that even 3D imaging has limitations, especially regarding artifacts when implants are placed. The purpose of this study was to assess the difference between intraoperative 3D imaging and postoperative CT regarding reduction and implant placement.MethodsTwenty consecutive cases of acetabular fractures were selected with a complete set of intraoperative 3D imaging and postoperative CT data. The largest detectable step and the largest detectable gap were measured in all three standard planes. These values were compared between the 3D data sets and CT data sets. Additionally, possible correlations between the possible confounders age and BMI and the difference between 3D and CT values were tested.ResultsThe mean difference of largest visible step between the 3D imaging and CT scan was 2.0 ± 1.8 mm (0.0–5.8, p = 0.02) in the axial, 1.3 ± 1.4 mm (0.0–3.7, p = 0.15) in the sagittal and 1.9 ± 2.4 mm (0.0–7.4, p = 0.22) in the coronal views. The mean difference of largest visible gap between the 3D imaging and CT scan was 3.1 ± 3.6 mm (0.0–14.1, p = 0.03) in the axial, 4.6 ± 2.7 mm (1.2–8.7, p = 0.001) in the sagittal and 3.5 ± 4.0 mm (0.0–15.4, p = 0.06) in the coronal views. A positive correlation between the age and the difference in gap measurements in the sagittal view was shown (rho = 0.556, p = 0.011).ConclusionsIntraoperative 3D imaging is a valuable adjunct in assessing reduction and implant placement in acetabular fractures but has limitations due to artifacts caused by implant material. This can lead to missed malreduction and impairment of clinical outcome, so postoperative CT should be considered in these cases.
Background: Traumatic pelvic fracture (TPF) is a significant injury that results from high energy impact and has a high morbidity and mortality. Purpose: We aimed to describe the epidemiology, incidence, patterns, management, and outcomes of TPF in multinational level 1 trauma centers. Methods: We conducted a retrospective analysis of all patients with TPF between 2010 and 2016 at two trauma centers in Qatar and Germany. Results: A total of 2112 patients presented with traumatic pelvic injuries, of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41 ± 21 years. In unstable pelvic fracture, the frequent mechanism of injury was motor vehicle crash (41%) followed by falls (35%) and pedestrian hit by vehicle (24%). Apart from both extremities, the chest (37.3%) was the most commonly associated injured region. The mean injury severity score (ISS) of 16.5 ± 13.3. Hemodynamic instability was observed in 44%. Blood transfusion was needed in one third while massive transfusion and intensive care admission were required in a tenth and a quarter of cases, respectively. Tile classification was possible in 1228 patients (type A in 60%, B in 30%, and C in 10%). Patients with type C fractures had higher rates of associated injuries, higher ISS, greater pelvis abbreviated injury score (AIS), massive transfusion protocol activation, prolonged hospital stay, complications, and mortality (p value < 0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stays were 15 and 5 days, respectively. The overall mortality rate was 4.7% (86 patients). Conclusion: TPF is a common injury among polytrauma patients. It needs a careful, systematic management approach to address the associated complexities and the polytrauma nature.
Background: Being a proven method in trauma and spine surgery, intraoperative 3D imaging (CBCT) has intrinsic deficits in difficult anatomy and with artifacts because of metal implants. The purpose of this study was to evaluate the use of intraoperative computed tomography (iCT) in acetabular surgery.Methods: Ten cases of acetabular fractures that were operated with intraoperative use of the mobile CT scanner Brainlab Airo were analyzed. Data were compared with a historical group of 17 patients.Results: Additional fluoroscopy time was 24.2 seconds (6-91), which was significantly lower than in the control group where it was 211.4 seconds (77-446; P < 0.000). Operation time did not differ significantly , control group 240.8 min , P = 0.234).Conclusion: iCT provides images of a reliable high quality and assessability. Radiation exposure to the staff is reduced while surgery time is not altered significantly.Quality of intraoperative imaging and thus patient care can substantially improve patient outcome. KEYWORDS acetabular fracture, intraoperative computed tomography, intraoperative imaging, intraoperative mobile CT scanner Brainlab Airo
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