Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

Schnetzke, Marc; Fuchs, Julia; Vetter, Sven; Beisemann, Nils; Keil, Holger; Grützner, Paul Alfred; Franke, Jochen

doi:10.1186/s12880-016-0126-z

Cited by 19 publications

(9 citation statements)

References 27 publications

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“…In most cases, though, the quality of 3D data acquired by 3D C-arms is sufficient to assess reduction and implant placement as demonstrated by many groups in literature that show a good assessability of the 3D data [ 7 , 9 , 10 , 20 – 22 ]. However, in the special circumstance of displaced acetabular fractures with many metal implants close to the articular surface, relevant remaining steps and gaps can be missed in the intraoperative 3D imaging (see Fig.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative assessment of reduction and implant placement in acetabular fractures—limitations of 3D-imaging compared to computed tomography

et al. 2018

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BackgroundIn acetabular fractures, the assessment of reduction and implant placement has limitations in conventional 2D intraoperative imaging. 3D imaging offers the opportunity to acquire CT-like images and thus to improve the results. However, clinical experience shows that even 3D imaging has limitations, especially regarding artifacts when implants are placed. The purpose of this study was to assess the difference between intraoperative 3D imaging and postoperative CT regarding reduction and implant placement.MethodsTwenty consecutive cases of acetabular fractures were selected with a complete set of intraoperative 3D imaging and postoperative CT data. The largest detectable step and the largest detectable gap were measured in all three standard planes. These values were compared between the 3D data sets and CT data sets. Additionally, possible correlations between the possible confounders age and BMI and the difference between 3D and CT values were tested.ResultsThe mean difference of largest visible step between the 3D imaging and CT scan was 2.0 ± 1.8 mm (0.0–5.8, p = 0.02) in the axial, 1.3 ± 1.4 mm (0.0–3.7, p = 0.15) in the sagittal and 1.9 ± 2.4 mm (0.0–7.4, p = 0.22) in the coronal views. The mean difference of largest visible gap between the 3D imaging and CT scan was 3.1 ± 3.6 mm (0.0–14.1, p = 0.03) in the axial, 4.6 ± 2.7 mm (1.2–8.7, p = 0.001) in the sagittal and 3.5 ± 4.0 mm (0.0–15.4, p = 0.06) in the coronal views. A positive correlation between the age and the difference in gap measurements in the sagittal view was shown (rho = 0.556, p = 0.011).ConclusionsIntraoperative 3D imaging is a valuable adjunct in assessing reduction and implant placement in acetabular fractures but has limitations due to artifacts caused by implant material. This can lead to missed malreduction and impairment of clinical outcome, so postoperative CT should be considered in these cases.

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Section: Discussionmentioning

confidence: 99%

Intraoperative assessment of reduction and implant placement in acetabular fractures—limitations of 3D-imaging compared to computed tomography

et al. 2018

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“…11-41% of fracture reductions which have been deemed sufficient in the surgeon's opinion after routine 2D imaging have been revised after intraoperative 3D-imaging 14,20,21 . Intraoperative 3D-imaging improves patient care and outcome through improved evaluation of fracture reduction and implant placement, especially in complex anatomical regions 16,22,23 and therefore became an established tool in trauma surgery 24 . 3D-imaging appears especially helpful in operative situations with limited direct sight of the non-planar articular surface (e.g.…”

Section: D-imagingmentioning

confidence: 99%

“…3D-imaging appears especially helpful in operative situations with limited direct sight of the non-planar articular surface (e.g. distal humerus fractures AO type B and C) since it offers additional information 24 . Still, intraoperative fluoroscopic 3D-imaging with a mobile C-arm also has its limits: Overweight and unfavorable positioning of the patient partially limit free rotation and thus imaging by the motorized C-arm 13 .…”

Section: D-imagingmentioning

confidence: 99%

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

Luxenhofer

Beisemann

Schnetzke

et al. 2020

Sci Rep

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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.

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“…Some orthopedic visualization, cardiovascular diagnoses and virtual colonoscopic evaluations are also improved by 3D UI [ 21 – 23 ]. For the same reasons, 3D volume representations are appreciated by surgeons and interventional radiologists, as they help to guide complex surgery or endovascular procedures [ 24 – 26 ]. Preoperative images improve surgical success [ 27 ].…”

Section: Review Of the Literaturementioning

confidence: 99%

A review of existing and potential computer user interfaces for modern radiology

Iannessi

Marcy

Clatz³

et al. 2018

Insights Imaging

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The digitalization of modern imaging has led radiologists to become very familiar with computers and their user interfaces (UI). New options for display and command offer expanded possibilities, but the mouse and keyboard remain the most commonly utilized, for usability reasons. In this work, we review and discuss different UI and their possible application in radiology. We consider two-dimensional and three-dimensional imaging displays in the context of interventional radiology, and discuss interest in touchscreens, kinetic sensors, eye detection, and augmented or virtual reality. We show that UI design specifically for radiologists is key for future use and adoption of such new interfaces. Next-generation UI must fulfil professional needs, while considering contextual constraints.Teaching Points• The mouse and keyboard remain the most utilized user interfaces for radiologists.• Touchscreen, holographic, kinetic sensors and eye tracking offer new possibilities for interaction.• 3D and 2D imaging require specific user interfaces.• Holographic display and augmented reality provide a third dimension to volume imaging.• Good usability is essential for adoption of new user interfaces by radiologists.

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Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

Cited by 19 publications

References 27 publications

Intraoperative assessment of reduction and implant placement in acetabular fractures—limitations of 3D-imaging compared to computed tomography

Intraoperative assessment of reduction and implant placement in acetabular fractures—limitations of 3D-imaging compared to computed tomography

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

A review of existing and potential computer user interfaces for modern radiology

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