Diagnostic accuracy of intraoperative CT-imaging in complex articular fractures – a cadaveric study

Abstract

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.

Automatic Registration and Error Color Maps to Improve Accuracy for Navigated Bone Tumor Surgery Using Intraoperative Cone-Beam CT

“…Alternatively, automatic registration techniques using optical technology, such as the Machine-vision Image Guided Surgery (MvIGS) system (7D Surgical), provide radiation-free scanning 43 but require bone exposure, which may be challenging in some settings (e.g., pelvic resection). Advantages associated with intraoperative CT imaging have recently been reported 44 , and as this becomes more widely available, our automatic registration method could be employed to improve surgical efficiency. Our software was developed in-house, building on open-source software toolkits, and we surmise that this could also be applied in collaboration with multidisciplinary translational navigation laboratories at other centers to enable more widespread clinical evaluation.…”

CT-Navigated Percutaneous Posterior Positioning of Pedicle Screws in The Cervical Spine

“…Regarding the lower cervical spine, C-arm based 3D imaging has limitations due to the presence of thoracic and shoulder structures, limiting visibility of the spine. CT imaging generally offers higher image quality with less artifact generation, especially with implants in place [14,26]. Thus, the use of intraoperative CT data additionally increases visualization and safety of screw positioning [25].…”

Effect Evaluation of Perioperative Fast‐Track Surgery Nursing for Tibial Fracture Patients with Computerized Tomography Images under Intelligent Algorithm

“…Tibial fractures are complicated as the articular surface and the overlap of the fracture fragments are involved. CT and three-dimensional reconstruction technology can be used not only to determine the range and degree of the fracture of the tibial articular plateau surface accurately but also to measure the distance of the fracture and the depth and width of the collapse [ 18 , 19 ]. In this study, the graph cuts algorithm under the intelligent algorithm was introduced to reconstruct the traditional CT images, to evaluate the recovery of tibial fracture patients after FTS nursing in the perioperative period, and to explore the application value of the graph cuts algorithm.…”