Novel computer-assisted preoperative planning system for humeral shaft fractures: report of 43 cases

et al. 2017

J Orthop Surg Res

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BackgroundThe objective of this study is to evaluate the value of computed tomography (CT) post-processing images in postoperative assessment of Lisfranc injuries compared with plain radiographs.MethodsA total of 79 cases with closed Lisfranc injuries that were treated with conventional open reduction and internal fixation from January 2010 to June 2016 were analyzed. Postoperative assessment was performed by two independent orthopedic surgeons with both plain radiographs and CT post-processing images. Inter- and intra-observer agreement were analyzed by kappa statistics while the differences between the two postoperative imaging assessments were assessed using the χ 2 test (McNemar’s test). Significance was assumed when p < 0.05.ResultsInter- and intra-observer agreement of CT post-processing images was much higher than that of plain radiographs. Non-anatomic reduction was more easily identified in patients with injuries of Myerson classifications A, B1, B2, and C1 using CT post-processing images with overall groups (p < 0.05), and poor internal fixation was also more easily detected in patients with injuries of Myerson classifications A, B1, B2, and C2 using CT post-processing images with overall groups (p < 0.05).ConclusionsCT post-processing images can be more reliable than plain radiographs in the postoperative assessment of reduction and implant placement for Lisfranc injuries.

Section: Methodsmentioning

confidence: 99%

Evaluation of computed tomography post-processing images in postoperative assessment of Lisfranc injuries compared with plain radiographs

Chen

et al. 2017

J Orthop Surg Res

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“…A previous study has proved that an efficient and reliable system for computer-assisted preoperative planning (CAPP) provides excellent clinical outcomes in the treatment of humeral shaft fractures with locking plates [17]. Therefore, we presumed that the CAPP system could also provide a new approach with respect to preoperative design in PFNA-II treatment of intertrochanteric femoral fractures and lower the learning difficulty of this surgical procedure for beginners.…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures

Wang

Kun

BMC Musculoskelet Disord

et al. 2020

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Background: Intertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments. Proximal femoral nail antirotation Asian version (PFNA-II) is widely used for intertrochanteric fracture treatment. The computer-assisted preoperative planning (CAPP) system has the potential to reduce the difficulty of PFNA-II in the treatment of intertrochanteric fractures. The aim of the study was to investigate and compare the learning curves of PFNA-II treatment with CAPP and conventional preoperational planning methods for intertrochanteric femoral fractures.Methods: A total of 125 patients with intertrochanteric fracture who were treated with PFNA-II between March 2012 and June 2015 were retrospectively analyzed. Patients who underwent surgery with CAPP procedure by a junior surgeon were regarded as group A (n = 53); patients who underwent the conventional surgery by another junior surgeon were regarded as group B (n = 72). Each group was divided into three subgroups (case 1-20, case 21-40, case 41-53 or case 41-72). Results:The average operation time of group A was 45.00(42.00, 50.00) minutes, and in group B was 55.00 (50.00, 60.00) minutes (P < 0.01). Average radiation frequency and blood loss were 13.02 ± 2.32, 160.00 (140.00, 170.00) ml and 20. 92 ± 3.27, 250.00 (195.00, 279.50) ml, respectively, with significant differences (P < 0.01). The learning curve of the surgical procedure in group A was steeper than that in group B. There were no significant differences in patient reported outcomes, hospital stay and complication rate between the two groups. Significant differences were observed between group A and B in Harris score at last follow-up in the AO/OTA type 31-A2 intertrochanteric fracture (P < 0.05).Conclusion: Compared with conventional preoperative planning methods, CAPP system significantly reduced operation time, radiation frequency and blood loss, thus reshaped the learning curve of PFNA-II treatment with lower learning difficulty.

“…So up to now, 3D CT has not been extensively applied in posterior malleolar fracture evaluation nor has it been reported in a study on large sample [22,23]. With the upgrading of computer technology, an efficient system for computer-assisted preoperative planning has been developed [24][25][26]. e use of computer technology enables multilevel and multiangle evaluation of fracture planes.…”

Section: Introductionmentioning

confidence: 99%

“…e use of computer technology enables multilevel and multiangle evaluation of fracture planes. Surgeons can also perform a virtual operation efficiently and conveniently, including reducing the fracture fragments and selecting a suitable internal fixation device [24,25]. With this technology, detailed evaluation and accurate measurement of posterior malleolar fracture may be promoted to a higher level.…”

Section: Introductionmentioning

confidence: 99%

Quantitative Evaluation of Articular Involvement of Posterior Malleolus Associated with Operative Indication: A Comparative Study of Six Methods Based on Radiography and CT

Kun

Jia

BioMed Research International

et al. 2020

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The aim of this study was to compare the values of six methods in measuring the involvement of posterior malleolus and to demonstrate the reliability and reproducibility of each method. Three independent orthopaedic surgeons, retrospectively, measured 106 cases. The difference between the six methods was analyzed using Bonferroni-corrected paired t-tests after one-way ANOVA. The agreement between the six methods was analyzed using Bland–Altman analysis. The intraclass correlation coefficient (ICC) was used to assess intraobserver reproducibility and interobserver reliability. Significant differences were observed between values of any two of the six measurement methods (P<0.0033), except between any two of the plane radiograph linear, axial CT linear, sagittal CT linear, and 3D CT linear. The Bland–Altman plots demonstrated poor agreement between values of any two of the six methods. The lowest intraobserver reproducibility was 0.46 (moderate) for resident surgeon using plain radiographs. The intraobserver reproducibility for three surgeons using two-dimensional (2D) and 3D images was almost perfect (ICC, 0.82–0.96). The lowest interobserver reliability was 0.41 (moderate) between chief and attending surgeon using plain radiographs, and it improved to almost perfect (ICC, 0.81–0.95) with the use of 3D CT images. The standard error of measurement showed almost the same results as ICC values. The existing operative indications which were determined based on plain radiography are neither reliable nor suitable for other measurement methods. Both 3D linear and 3D surface measurement methods are reliable and reproducible in measuring posterior fragment involvement, and experience is not so crucial. Operative indications for posterior malleolar fractures need to be redefined based on the 3D measurement method.