An image fusion system for corrective osteotomy of distal radius malunion

Abstract

Background To provide surgical support for corrective osteotomy, we developed an image fusion system for three-dimensional (3D) preoperative planning and fluoroscopy. To assess the utility of this image fusion system, we evaluated the reproducibility of preoperative planning for corrective osteotomy of dorsally angulated distal radius malunion using the system and compared reproducibility without using the system. Methods Ten wrists from 10 distal radius malunion patients who underwent corrective osteotomy were evaluated. 3D preoperative planning and the image fusion system were used for the image fusion group (n = 5). Only 3D preoperative planning was used for the control group (n = 5). 3D preoperative planning was performed for both groups in order to assess reduction, placement, and the choice of implants. In the image fusion group, the outline of the planned image was displayed on a monitor and overlapped with fluoroscopy images during surgery. Reproducibility was evaluated using preoperative plan and postoperative 3D images. Images were compared with the 3D coordinates of the radial styloid process (1), the volar and dorsal edges of the sigmoid notch (2) (3), and the barycentric coordinates of the three reference points. The reproducibility of the preoperative plan was evaluated by the distance of the coordinates between the plan and postoperative images for the reference points. Results The distances between preoperative planning and postoperative reduction in the image fusion group were 2.1 ± 1.1 mm, 1.8 ± 0.7 mm, 1.9 ± 0.9 mm, and 1.4 ± 0.7 mm for reference points (1), (2), (3), and the barycenter, respectively. The distances between preoperative planning and postoperative reduction in the control group were 3.7 ± 1.0 mm, 2.8 ± 2.0 mm, 1.7 ± 0.8 mm, and 1.8 ± 1.2 mm for reference points (1), (2), (3), and the barycenter, respectively. The difference in reference point (1) was significantly smaller in the image fusion group than in the control group (P < 0.05). Conclusion Corrective osteotomy using an image fusion system will become a new surgical support method for fracture malunion. Trial registration Registered as NCT03764501 at ClinicalTrials.gov.

Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review

“…This highlights the potential of both image-based and inertial-based technologies to significantly enhance the quantitative evaluation of angles between segments or bones, as these systems typically offer higher levels of accuracy compared to the surgeon’s visuospatial perception alone [ 84 ]. Furthermore, systems equipped with orientation-tracking technology, such as inertial or camera tracking systems, empower surgeons to execute 3D angular deformity corrections, mitigating the limitations often associated with 2D technologies like radiographic imaging [ 36 , 119 , 141 , 142 ]. When conducting a comparative analysis between image-based and non-image-based technologies, the central point revolves around the requisite level of accuracy (when radiation exposure is not a factor).…”

3D Reconstruction of Wrist Bones from C-Arm Fluoroscopy Using Planar Markers

“…Due to the recent advances in preoperative 3D programs for various procedures in orthopedic surgery [3,26,27], it is necessary to establish a method for comparing 3D models of a preoperative plan to 3D models during surgery. The method developed here has the potential to facilitate the comparison of intraoperative 3D models with 3D images of preoperative planning.…”