Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases

Beisemann, Nils; Keil, Holger; Swartman, Benedict; Schnetzke, Marc; Franke, Jochen; Grützner, Paul Alfred; Vetter, Sven

doi:10.1186/s13018-019-1286-7

Cited by 31 publications

(39 citation statements)

References 21 publications

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“…Intraoperative 3D scan has been comparable in most of the cases to postoperative CT scan in terms of quality of fracture reduction, with the added ability to intraoperatively evaluate implant positioning [27], joint width and geometry as well as small dislocated fragments in the intercondylar area. Beisemann et al published an intraoperative revision rate of up to 32.4% with intraoperative 3D imaging after initial satisfying reduction under fluoroscopic control [28]. They also detected relevant intraarticular fragments, which would have remained undetected in conventional fluoroscopy [28].…”

Section: Intraoperative 3d-imagingmentioning

confidence: 99%

“…Beisemann et al published an intraoperative revision rate of up to 32.4% with intraoperative 3D imaging after initial satisfying reduction under fluoroscopic control [ 28 ]. They also detected relevant intraarticular fragments, which would have remained undetected in conventional fluoroscopy [ 28 ]. Also, other authors have confirmed the benefit of intraoperative 3D imaging [ 29 , 30 ].…”

Section: Intraoperative 3d-imagingmentioning

confidence: 99%

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The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

Frosch

Korthaus

Thiesen

et al. 2020

Eur J Trauma Emerg Surg

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Malreduction after tibial plateau fractures mainly occurs due to insufficient visualization of the articular surface. In 85% of all C-type fractures an involvement of the posterolateral-central segment is observed, which is the main region of malreduction. The choice of the approach is determined (1) by the articular area which needs to be visualized and (2) the positioning of the fixation material. For simple lateral plateau fractures without involvement of the posterolateral-central segment an anterolateral standard approach in supine position with a lateral plating is the treatment of choice in most cases. For complex fractures the surgeon has to consider, that the articular surface of the lateral plateau only can be completely visualized by extended approaches in supine, lateral and prone position. Anterolateral and lateral plating can also be performed in supine, lateral and prone position. A direct fixation of the posterolateral-central segment by a plate or a screw from posterior can be only achieved in prone or lateral position, not supine. The posterolateral approach includes the use of two windows for direct visualization of the fracture. If visualization is insufficient the approach can be extended by lateral epicondylar osteotomy which allows exposure of at least 83% of the lateral articular surface. Additional central subluxation of the lateral meniscus allows to expose almost 100% of the articular surface. The concept of stepwise extension of the approach is helpful and should be individually performed as needed to achieve anatomic reduction and stable fixation of tibial plateau fractures.

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Section: Intraoperative 3d-imagingmentioning

confidence: 99%

Section: Intraoperative 3d-imagingmentioning

confidence: 99%

The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

Frosch

Korthaus

Thiesen

et al. 2020

Eur J Trauma Emerg Surg

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show abstract

“…For example, after flipping back the osteotomized tibial condyle, it is challenging to exactly double check on the final reduction result centrally. An intraoperative 3D scan or fracturoscopy is required in such a situation to be sure [5,[25][26][27]. Secondly, the extended lateral approach as decribed in this paper, especially if carried out in prone positioning, allows direct access to the posterior-lateral corner from posteriorly.…”

Section: Discussionmentioning

confidence: 99%

“…The arrow and numbers 1 and 2 show once again the depression and the two main fragments corresponding to the markings on a; c Intraoperative coronar 3D scan after allograft implantation and first preliminary reduction attempt secured with wires, below a lateral fluoroscopic image which shows the double plate placement; d Final intraoperative 3D scan after allograft implantation and finalized ORIF the cases after a median follow-up of 8.3 (IQR 4.3 range 3-14.5) months. None of the ten cases required a postoperative revision surgery.The clinical Rasmussen-Score had a median value of 25 (IQR 2.8, range[21][22][23][24][25][26][27][28][29]. Two patients (20%) had excellent (with score > 27) and the eight (80%) had good (score 20-26) clinical results.…”

mentioning

confidence: 99%

Extended approach to the lateral tibial plateau with central meniscal subluxation in fracture repair: feasibility and first clinical and radiographic results

Korthaus

Ballhause

Kolb

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Anatomic reduction in tibial plateau fractures remains to be demanding. For further visualisation of and approach to the joint surface an extended lateral approach using a lateral femoral epicondyle osteotomy and subluxation of the lateral meniscus was recently described. First clinical and radiographic mid-term results of this technique are presented in this feasibility study. Method Ten complex tibial plateau fractures treated with extended lateral approach and lateral meniscal subluxation were prospectively analysed. Clinical and radiographic results were objectified according to the Rasmussen scores. Results After a median follow-up of 8.6 (IQR 4.3) months good to excellent clinical and radiographic results were noted. The clinical Rasmussen Score showed a median of 25 (IQR 2.8) and radiographic a median of 17 (IQR 2.0) points. Conclusion Good to excellent clinical and radiological scores were obtained after using an extended lateral approach with lateral femoral epicondyle osteotomy and central meniscus subluxation. No approach specific complications could be observed.

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“…They can be an essential help in complex anatomic regions and joint fractures. 94 Intraoperative 3D image acquisition can also be obtained through the use of a fixed or mobile fan-beam-CT. They ensure a high image quality, but lack the possibility of intraoperative fluoroscopy.…”

Section: Principal Technologies To Meet Needsmentioning

confidence: 99%

Finding NEEMO: towards organizing smart digital solutions in orthopaedic trauma surgery

et al. 2020

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There are many digital solutions which assist the orthopaedic trauma surgeon. This already broad field is rapidly expanding, making a complete overview of the existing solutions difficult. The AO Foundation has established a task force to address the need for an overview of digital solutions in the field of orthopaedic trauma surgery. Areas of new technology which will help the surgeon gain a greater understanding of these possible solutions are reviewed. We propose a categorization of the current needs in orthopaedic trauma surgery matched with available or potential digital solutions, and provide a narrative overview of this broad topic, including the needs, solutions and basic rules to ensure adequate use in orthopaedic trauma surgery. We seek to make this field more accessible, allowing for technological solutions to be clearly matched to trauma surgeons’ needs. Cite this article: EFORT Open Rev 2020;5:408-420. DOI: 10.1302/2058-5241.5.200021

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Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases

Cited by 31 publications

References 21 publications

The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

Extended approach to the lateral tibial plateau with central meniscal subluxation in fracture repair: feasibility and first clinical and radiographic results

Finding NEEMO: towards organizing smart digital solutions in orthopaedic trauma surgery

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