Intraoperative Computed Tomography in Orthopaedic Trauma Surgery

Abstract

Background When using mobile 3D C-arms, impairments in image quality occur due to artefacts caused by metal implants as well as to the limited field of view. To avoid these restrictions, special computed tomography devices were designed, in order to improve image quality and to meet requirements for intraoperative usage. Objectives To analyse practicability and benefits of a mobile intraoperative CT device (Airo, Brainlab, Munich, Germany) on the basis of several parameters that were obtained during a 40-month period. Materials and Methods All procedures that were performed with usage of intraoperative CT between January 2017 and April 2020 were analysed with respect to anatomical region, count of scans, duration of scans, consequences drawn from the scans and use of navigation. Results 354 CT-scans were performed in 171 patients (mean 2.07 [1 – 6] scans per procedure). 47.81% of the procedures were spinal, 52.19% affected the pelvis. 83% of the procedures were navigated. In 22% of patients, improvement in implant placement or reduction was achieved; in most patients (55%), a guidewire for pedicle screws was corrected. The mean scan duration was 10.33 s (3.54 – 21.72). Conclusions Use of intraoperative CT was reliable and helpful. Integration in OR standards requires more effort than mobile 3D C-arms. Image quality was outstanding for intraoperative conditions and allowed proper assessment of implant placement and reduction in all cases. Due to the high financial outlay of the system and the good image quality of 3D C-arms in the extremities, we assume that this procedure can be applied in intraoperative CT in traumatological cases in spinal and pelvic surgery in high-level trauma centres.

Corona mortis and pelvic dissection: Understanding the relationship between anatomical structures and bone areas

“…In addition to these new techniques, laparoscopic dissection could help pelvic surgeons to evaluate visually the reduction during the surgery instead of X‐rays. The value of intraoperative CT scanning for reduction control has been demonstrated (Keil et al., 2022; Pisquiy et al., 2021). However, in addition to having better control over the fracture, endoscopy allows for joint reduction to be performed using instrumentation ports.…”

“…In addition to these new techniques, laparoscopic dissection could help pelvic surgeons to evaluate visually the reduction during the surgery instead of X-rays. The value of intraoperative CT scanning for reduction control has been demonstrated (Keil et al, 2022;Pisquiy et al, 2021).…”

First clinical experience with a novel, mobile cone-beam CT system for treatment quality assurance in brachytherapy

“…Concurrently, they show significant image quality limitations compared to conventional CT, especially regarding image artifacts [15][16][17][18]. The clinical use of respective devices may require more effort than three-dimensional (3D) C-arms [19], due to larger space requirements. In this respect, a compact device design is considered important for the smooth integration in interventional workflows.…”