Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures

Mehling, Isabella; Rittstieg, P.; Mehling, A.P.; Küchle, R.; Müller, Lars Peter; Rommens, Pol Maria

doi:10.1177/1753193413476418

Cited by 21 publications

(15 citation statements)

References 26 publications

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“…Mehling et al in reported in 2013 about 51 patients treated for distal radius fractures with the aid of intraoperative 3D scan. The authors compared the findings on conventional 2D fluoroscopy with intraoperative 3D scan and found, that in 31.3 % of the operations there were 17 malpositioned screws not shown on standard 2D fluoroscopy that were detected using intraoperative CT imaging [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…The specific radiation dose was not measured in the current study. A previous study on wrist surgery reported, that intraoperative 3D imaging raised the dose-area product by 3.2 cGycm 2 and increased the overall dose by 55.6 % on average [ 26 ]. The radiation exposure for the surgeons and the personnel staff, who are exposed to radiation almost every day, is practically reduced to zero because the 3D scan can be started from outside the controlled area (Fig.…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2016

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BackgroundThree-dimensional (3D) imaging with a mobile C-arm has proven to be a valuable intraoperative tool in trauma surgery. However, little data is available concerning its use in the treatment of elbow fractures. The aim of the current study was to determine the intraoperative findings and consequences of 3D imaging in the treatment of elbow fractures.MethodsBetween 2001 and 2015, prospectively collected data of 36 patients who underwent intraoperative 3D imaging during elbow surgery were recorded. The findings and consequences of the intraoperative 3D scans were analyzed in a retrospective chart review. For clinical evaluation the analysis included the patients’ medical history, the injury pattern of the affected elbow and concomitant injuries. Intraoperative and postoperative complications and revision surgeries were evaluated as well.ResultsIn 6 patients (16.7 %) analysis of the intraoperative 3D scan led to an immediate revision due to the detection of intra-articular screw placement (n = 3, 8.3 %) and remaining intra-articular step of >2 mm (n = 3, 8.3 %). In all of these patients, correct implant positioning and anatomical reduction could be achieved after immediate intraoperative revision, which was verified by a repeated intraoperative 3D scan. None of the 36 patients needed surgical revision based on postoperative radiological examinations due to secondary dislocation, wrong implant placement or remaining steps in the articular surface.ConclusionsIntraoperative 3D imaging offers additional information about fracture reduction and implant positioning in the treatment of elbow fractures compared to conventional intraoperative 2D imaging. It may therefore reduce the need for revision surgery. The value of intraoperative 3D imaging for clinical outcomes still needs to be assessed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…Several authors reported the use of oblique images to rule out intra-articular screw penetration ( 10 , 12 ). Alternatively, intraoperative 3D imaging of articular fracture has become an integrated part of several surgical procedures ( 20 , 21 , 23 , 26 ). Different studies described an intraoperative screw replacement rate of 10% to 20% in the treatment of distal radial fractures, which, in the authors’ opinion, spared the patients from further revision surgery ( 20 , 21 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, intraoperative 3D fluoroscopy was introduced to acquire CT-like images for the control of anatomic fracture reduction and prevention of implant misplacements, predominantly in articular fractures ( 20 - 23 ). The following two questions should be answered in this study:…”

Section: Objectivesmentioning

confidence: 99%

Tangential View and Intraoperative Three-Dimensional Fluoroscopy for the Detection of Screw-Misplacements in Volar Plating of Distal Radius Fractures

et al. 2015

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Background:Volar locking plate fixation has become the gold standard in the treatment of unstable distal radius fractures. Juxta-articular screws should be placed as close as possible to the subchondral zone, in an optimized length to buttress the articular surface and address the contralateral cortical bone. On the other hand, intra-articular screw misplacements will promote osteoarthritis, while the penetration of the contralateral bone surface may result in tendon irritations and ruptures. The intraoperative control of fracture reduction and implant positioning is limited in the common postero-anterior and true lateral two-dimensional (2D)-fluoroscopic views. Therefore, additional 2D-fluoroscopic views in different projections and intraoperative three-dimensional (3D) fluoroscopy were recently reported. Nevertheless, their utility has issued controversies.Objectives:The following questions should be answered in this study; 1) Are the additional tangential view and the intraoperative 3D fluoroscopy useful in the clinical routine to detect persistent fracture dislocations and screw misplacements, to prevent revision surgery? 2) Which is the most dangerous plate hole for screw misplacement?Patients and Methods:A total of 48 patients (36 females and 13 males) with 49 unstable distal radius fractures (22 x 23 A; 2 x 23 B, and 25 x 23 C) were treated with a 2.4 mm variable angle LCP Two-Column volar distal radius plate (Synthes GmbH, Oberdorf, Switzerland) during a 10-month period. After final fixation, according to the manufactures' technique guide and control of implant placement in the two common perpendicular 2D-fluoroscopic images (postero-anterior and true lateral), an additional tangential view and intraoperative 3D fluoroscopic scan were performed to control the anatomic fracture reduction and screw placements. Intraoperative revision rates due to screw misplacements (intra-articular or overlength) were evaluated. Additionally, the number of surgeons, time and radiation-exposure, for each step of the operating procedure, were recorded.Results:In the standard 2D-fluoroscopic views (postero-anterior and true lateral projection), 22 screw misplacements of 232 inserted screws were not detected. Based on the additional tangential view, 12 screws were exchanged, followed by further 10 screws after performing the 3D fluoroscopic scan. The most lateral screw position had the highest risk for screw misplacement (accounting for 45.5% of all exchanged screws). The mean number of images for the tangential view was 3 ± 2.5 images. The mean surgical time was extended by 10.02 ± 3.82 minutes for the 3D fluoroscopic scan. An additional radiation exposure of 4.4 ± 4.5seconds, with a dose area product of 39.2 ± 14.5 cGy/cm2 were necessary for the tangential view and 54.4 ± 20.9 seconds with a dose area product of 2.1 ± 2.2 cGy/cm2, for the 3D fluoroscopic scan.Conclusions:We recommend the additional 2D-fluoroscopic tangential view for detection of screw misplacements caused by overlength, with penetration on the dorsal cortic...

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“…Intra-articular screw penetration may not be determined on radiographs [15] and the correct extraarticular position of the subchondral screw may not be obtained on standard PA and lateral fluoroscopic images. [16][17][18] In a study by Mehling et al, [19] volar plate was applied to 51 patients with unstable, distal radius fractures and 3-D tomography was taken in addition to intraoperative 2-D fluoroscopy. Incorrect placement of the screw was determined in 31.3% of the patients and immediate correction was made during the operation.…”

Section: Discussionmentioning

confidence: 99%

Is it possible to avoid intra-articular screw penetration with minimal use of fluoroscopy in the application of distal radius volar plate?

Aldemir¹

2017

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada distal radius volar plak uygulamasında minimum floroskopi kullanılarak eklem içi vida penetrasyonundan kaçınmanın ve böylece cerrahi ekibin radyasyona maruz kalma riskinin minimuma indirilmesinin mümkün olup olmadığı araştırıldı. Hastalar ve yöntemler: Haziran 2014 -Mayıs 2016 tarihleri arasında instabil distal radius kırığı olan 50 hastada (22 erkek, 28 kadın; ort. yaş 43.52 yıl; dağılım 18-76 yıl) kırık redüksiyonunu takiben distal vida ile volar plak uygulaması minimum floroskopi kullanımı ile gerçekleştirildi. Özel tasarlanmış volar anatomik plak lunat fossanın fasetinin ucundan proksimale doğru 3 mm mesafe oluşturularak uygulandı. Bulgular: Vida yataklarına özel açı verilerek tasarlanmış plak ile tarif edilen cerrahi tekniğe dikkat ederek ve minimum düzeyde floroskopi kullanarak yaptığımız plakvida uygulamalarında eklem içi vida komplikasyonu ile karşılaşılmadı. Ameliyat sırasında floroskopi minimum düzeyde uygulandı ve eklem içi vida kullanımını düşündürecek herhangi bir bulguya rastlanmadı. Ameliyat sırasında ve sonrasında el bileği hareketlerinde kısıtlılık, takılma ya da sürtünme bulgularına rastlanmadı. Sonuç: Volar plak ve distal kilit vida yatağı tasarımındaki iyileştirmeler ile eklem içi vida komplikasyonları olasılığını ve erken dönem tekrar cerrahi düzeltme ihtiyacını ortadan kaldırmak ve cerrahi ekibin radyasyona maruz kalma riskini minimuma indirmek mümkündür.Anahtar sözcükler: Distal radius kırığı; floroskopi, volar anatomik plak. ABSTRACTObjectives: This study aims to investigate whether or not it is possible to avoid intra-articular screw penetration in the application of distal radius volar plate with minimal use of fluoroscopy and thereby reduce to a minimum the risk of exposure of the surgical team to radiation. Patients and methods: Volar plate with distal screw application with minimal use of fluoroscopy was performed in a total of 50 patients (22 males, 28 females; mean age 43.52 years; range 18 to 76 years) with unstable distal radius fracture following reduction of fracture between June 2014 and May 2016. A specially designed volar anatomic plate was applied by creating a 3 mm gap proximal from the tip of the facet of the lunate fossa. Results: No intra-articular screw complication was observed during plate-screw applications that we performed by using fluoroscopy at a minimum level and paying attention to the surgical technique described with the plate designed by giving a specific angle to screw beds. During the operation, fluoroscopy was performed at a minimum level and no finding was observed which could suggest use of intra-articular screw. No findings of restriction in wrist movements, locking or friction were observed intra-or postoperatively. Conclusion: With improvements in the design of the volar plate and the distal locking screw bed, it is possible to rule out the possibility of intra-articular screw complications and the need for surgical re-correction in the early-term, and to reduce to a minimum the risk of exposure of the surgical team to radiation.

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Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures

Cited by 21 publications

References 26 publications

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

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

Tangential View and Intraoperative Three-Dimensional Fluoroscopy for the Detection of Screw-Misplacements in Volar Plating of Distal Radius Fractures

Is it possible to avoid intra-articular screw penetration with minimal use of fluoroscopy in the application of distal radius volar plate?

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