Inter-rater variability of three-dimensional fracture reduction planning according to the educational background

Abstract

Background Computer-assisted three-dimensional (3D) planning is increasingly delegated to biomedical engineers. So far, the described fracture reduction approaches rely strongly on the performance of the users. The goal of our study was to analyze the influence of the two different professional backgrounds (technical and medical) and skill levels regarding the reliability of the proposed planning method. Finally, a new fragment displacement measurement method was introduced due to the lack of consistent methods in the literature. Methods 3D bone models of 20 distal radius fractures were presented to nine raters with different educational backgrounds (medical and technical) and various levels of experience in 3D operation planning (0 to 10 years) and clinical experience (1.5 to 24 years). Each rater was asked to perform the fracture reduction on 3D planning software. Results No difference was demonstrated in reduction accuracy regarding rotational (p = 1.000) and translational (p = 0.263) misalignment of the fragments between biomedical engineers and senior orthopedic residents. However, a significantly more accurate planning was performed in these two groups compared with junior orthopedic residents with less clinical experience and no 3D planning experience (p < 0.05). Conclusion Experience in 3D operation planning and clinical experience are relevant factors to plan an intra-articular fragment reduction of the distal radius. However, no difference was observed regarding the educational background (medical vs. technical) between biomedical engineers and senior orthopedic residents. Therefore, our results support the further development of computer-assisted surgery planning by biomedical engineers. Additionally, the introduced fragment displacement measure proves to be a feasible and reliable method. Level of Evidence Diagnostic Level II

Computer-Assisted Preoperative Planning of Bone Fracture Fixation Surgery: A State-Of-The-Art Review

“…As an example, Chen et al have performed multiple studies on the effects of VSP on surgical outcomes and the planning and actual surgery were always performed by the senior author who had the opportunity to improve over the course of seven years. However, it is likely that the technology is relatively easy to adopt by different surgeons with different technical backgrounds as demonstrated by Zindel et al (2021), Jia et al (2020) and Wang et al (2020c). Lastly, a question that remains is whether VSP will prove to be cost-effective and whether the demonstrated clinical benefits are clinically relevant.…”

“…For the subsequent steps, it is often necessary to generate a mesh (i.e., a collection of vertices, edges, and faces) from such a CT stack, e.g., for automated reduction methods (Figure 3 -step 2) and analysis (Figure 3 -step 4). For mesh generation, the marching cubes algorithm, as introduced by Lorensen and Cline (1987) (Lorensen and Cline, 1987) is most widely used (Fornaro et al, 2010a;Boudissa et al, 2021b;Casari et al, 2021;Zindel et al, 2021). The outlined methods are often integrated in commercial medical imaging software such as Materialise Mimics (Leuven, Belgium), AMIRA (ThermoFisher, Berlin, Germany) or SimpleWare (Synopsys, CA, USA).…”

Computer-assisted planning vs. conventional surgery for the correction of symptomatic mid-shaft clavicular nonunion and malunion

“… 5 , 8 Subsequently, 3D planning software (CASPA, Balgrist CARD, Zurich, Switzerland) was used to analyze these 3D models using a recently published a 3D displacement description method. 27 This method describes a 3D displacement of an obstacle with only two parameters: a pure shift and a pure rotation. For the pre to postoperative analysis of osteotomies, the method can be used to represent the deviation in height/length and rotation of the lateral bone part of the OT between the planned and the performed surgery.…”

Precision of the Wilson corrective osteotomy of the first metacarpal base using specific planning and instruments for treatment of basal thumb arthritis

“…All patients received a second computed tomography (Siemens Somotom Edge Plus, Germany) postoperatively and three-dimensional (3D) models were segmented as described above. Consecutively, the segmented bone models were compared to preoperative models using a recently published 3D displacement description method [ 15 ]. This method described a 3D displacement of an obstacle with just two parameters: a pure shift and a pure rotation.…”