Background This study evaluates image quality of a new flat‐panel three‐dimensional (3D) C‐arm to the current generation and to intraoperative and stationary computed tomography (CT) in spinal surgery. Methods Three‐dimensional‐imaging of 44 posterior screws acquired with two generations of 3D C‐arms (Arcadis Orbic, AO and Cios Spin, CS, Siemens, Germany) and CT scans (mobile intraoperative CT Airo, iCT, Brainlab, Germany and stationary CT Aquilion 32, sCT, Toshiba, Japan) were performed. Evaluation regarded assessability and measurements of implant position. Results Assessability score was 0.11 in AO, 0.56 in sCT, 0.91 in iCT and 1.46 in CS (p < 0.0005). AO and CS showed a significant difference in accuracy (p = 0.001) as well as CS and iCT (p < 0.001). Measurements of protrusion over the anterior edge did not show a significant difference (p = 0.341). Conclusions Image quality of the new generation of flat‐panel 3D C‐arms competes with CT imaging and offers significant advantages compared to the former generation.
Anatomic reconstruction of articular fractures is one of the critical factors in later achieving good functional outcome. Intraoperative 3D imaging has been shown to offer better evaluation and therefore can significantly improve the results. The purpose of this study was to assess the difference between intraoperative three-dimensional fluoroscopy (3D) and intraoperative computed tomography (iCT) imaging regarding fracture reduction, implant placement and articular impressions in a distal humeral fracture model. AO type 13-B2 fracture pattern were created in upper extremity cadaver specimens. Articular step-offs, intra-articular screw placement and intraarticular impressions of different degrees of severity were created. All specimens had imaging performed. For each articular pattern 3D fluoroscopy in standard (3Ds) and high quality (3Dh) were performed (Arcadis Orbic, Siemens, Germany) as well as an intraoperative CT scan (iCT, Airo, Brainlab, Germany). Three observers evaluated all imaging studies regarding subjective and objective parameters. iCT is more precise than 3D fluoroscopic imaging for detection of articular impressions. Articular step-offs and intraarticular screw placement are similar for iCT and 3D. Subjective imaging quality is the highest for iCT and lowest for 3Ds. Intraoperative CT may be particularly useful in assessing articular impressions and providing a good subjective image quality for the surgeon. Distal humeral fractures. Fractures of the distal humerus are rather rare in adults, they comprise approximately 2% of all fractures overall and one-third of all humeral fractures 1,2. The incidence of distal humerus fractures in adults is 5-6/100.000/year 3 with the average age being 48.4 years 1. Distal humerus fractures are often results of high-energy trauma in young, active, male patients (motor vehicle accidents and sporting activities) and low-energy injuries in elder women 3-5. Fractures of the distal humerus with their complex anatomical structures, high biomechanical load applied to the implants as well as associated soft tissue damage pose difficult challenges for the surgeon 3. Fractures of the distal humerus, some of which are treated with multiple osteosynthesis plates, are therefore a good example for testing the limits of intraoperative imaging.
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