Development of three-dimensional preoperative planning system for the osteosynthesis of distal humerus fractures

Abstract

Background: To reproduce anatomical reduction and appropriate implant placement/choices during osteosynthesis for elbow fractures, we developed a 3D preoperative planning system. To assess the utility of 3D digital preoperative planning for the osteosynthesis of distal humerus fractures, we evaluated the reproducibility of implant reduction shapes and placements in patients with distal humerus fractures. Methods: Twelve patients with distal humerus fractures who underwent osteosynthesis using 3D preoperative planning were evaluated. Reduction shapes were evaluated by the angle between the diaphysis axis and a line connecting the vertices of the medial epicondyle and the lateral epicondyle (epicondyle angle), and the angle between the diaphysis axis and the articular surface (joint angle) in the coronal plane, and the distance between the anterior diaphysis and the anterior articular surface in the sagittal plane (anterior distance) based on 3D images of the distal humerus. In addition, the implant positions were evaluated by the positions of the proximal and posterior edge of the plate, and the angle of the plate to the epicondyle line. The reproducibility was evaluated by intra-class correlation coefficients of the parameters between pre-and postoperative images. Results: The intra-class correlation coefficients were 0.545, 0.802, and 0.372 for the epicondyle angle, joint angle, and anterior distance, respectively. The differences in the measurements between the preoperative plan and postoperative reduction were 2.1 ± 2.1 degrees, 2.3 ± 1.8 degrees, and 2.8 ± 2.0 mm, for the epicondyle angle, joint angle, and anterior distance, respectively. The intra-class correlation coefficients were 0.983, 0.661, and 0.653 for the proximal and posterior plate positions, and the angle to the epicondyle, respectively. The differences in the measurements between the preoperative plan and postoperative reduction were 3.3 ± 2.1 mm, 2.7 ± 1.7 mm and 9.7 ± 9.8 degrees, for the plate positions of proximal and posterior edge, and the angle of the plate to the epicondyle line, respectively. There were significant correlations for the epicondyle angle, joint angle, and plate positions. Conclusions: 3D preoperative planning for osteosynthesis of distal humerus fracture was reproducible for the reduction shape of the coronal view and the plate positions.

An Experimental Study of a 3D Bone Position Estimation System Based on Fluoroscopic Images

“…3D printed models and computer-assisted navigation also provide a secure way to successfully perform minimally invasive techniques. In our previous studies, we clinically applied the 3D preoperative planning system to the osteosynthesis of distal radius and humerus fractures [ 6 , 7 ]. It was found that 3D preoperative planning reduced postoperative correction loss and optimized implant selections [ 8 , 9 ].…”

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.…”

Computer-assisted preoperative planning of bone fracture fixation surgery: A state-of-the-art review

“…This approach was evaluated using artificial plastic SYNBONE models with fractures and was shown to work on cylindrical fragments but performed poorly at fractures near joints. Yoshii et al (2020) also separated the fragments automatically according to the fracture lines and showed that imaging slices of less than 2 mm are required to reach enough accuracy. A multiple region growing method with an automatic seed-point assignment was used by Lee et al (2014) to separate the fragments.…”

“…distal radius stage (LEXI Co., Ltd. Tokyo, Japan)Yoshii et al, 2017, Yoshii et al, 2019b, Yoshii et al, 2019a, Yoshii et al, 2020, Yoshii et al, 2021, Washington, United States)Moldovan et al (2020) Tibia fractures (n = 1) PSBM (Boudissa et al, France)Boudissa et al, 2018;Boudissa et al, 2021a;…”