Intraoperative Three-Dimensional Imaging With a Motorized Mobile C-Arm (SIREMOBIL ISO-C-3D) in Foot and Ankle Trauma Care

Abstract

Intraoperative 3-dimensional visualization with the ISO-C-3D can provide useful information in foot and ankle trauma care that cannot be obtained from plain films or conventional C-arms. During the same procedure, after conventional C-arm scans judged the positioning to be correct and an ISO-C-3D scan was done, the reduction and/or implant position was corrected in 39% of the cases in this study, although not unnecessarily prolonging the operation. The ISO-C-3D appears to be most helpful in procedures with a closed reduction and internal fixation, and/or when axial reformations provide information that is not possible to obtain with a conventional C-arm and/or direct visualization during open reduction and internal fixation.

Does intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery?

“…Based on the literature Wndings, a 20% diVerence in revision rates can be expected when 3D-RX imaging is used [8,14]. This diVerence was used to calculate a minimum number of 14 patients required to achieve statistical signiWcance: if for three out of 14 patients (21.4%) a revision is avoided, this outcome has a 95% conWdence interval of 5-51%, that is., the revision rate is signiWcantly above 0.…”

“…Intraoperative revision of reduction, as indicated by the 3D scan, occurred for 11-19%, and for implant position 11-26% of the operations in these studies [8,14]. These authors did not register the pre-3D-scan status based on conventional examination and 2D Xuoroscopy, but considered this to be optimal.…”

“…Intraoperative use of 3-dimensional rotational X-ray (3D-RX) for fracture surgery of the extremities has been reported regarding the Arcadis Orbic 3D in literature to lower revision in 21-39% of the cases [8,12,14,15,20]. Intraoperative revision of reduction, as indicated by the 3D scan, occurred for 11-19%, and for implant position 11-26% of the operations in these studies [8,14].…”

“…With the use of conventional C-arm Xuoroscopy in fracture surgery of the extremities, suboptimal positioning of implants (viz., screws, plates) and joint incongruities frequently remain unrevealed in clinical practice [2,4,5,14,16,17]. These imperfections are often only recognized on postoperative computed tomography (CT) scans [2,4,12,14,21].…”

“…These imperfections are often only recognized on postoperative computed tomography (CT) scans [2,4,12,14,21]. AO guidelines recommend an anatomical reduction of the fracture as a basis for optimal outcome.…”