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Intraoperative three-dimensional imaging in the treatment of distal radius fractures. Arch Orthop Trauma Surg 2018; 138:487-493. [PMID: 29322319 DOI: 10.1007/s00402-018-2867-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION In operative treatment of distal radius fractures satisfying outcome mainly relies on anatomical fracture reduction and correct implant placement. Examination with two-dimensional fluoroscopy may not provide reliable information about this. The aim of this study was to determine the effectiveness of additional intraoperative three-dimensional imaging in the operative treatment of comminuted distal radius fractures. MATERIALS AND METHODS From August 2001 to June 2015, patients with a distal radius fracture who were treated operatively and received intraoperative three-dimensional scan were included. The findings of the three-dimensional scan were documented by the operative surgeon and analyzed retrospectively with regard to incidence and the need for intraoperative revisions. Clinical evaluation included the patient's medical history, the injury pattern of the affected wrist (according to the OTA/AO fracture classification) and concomitant injuries. Intraoperative and postoperative complications and revision surgeries were evaluated as well. RESULTS Of 4515 operatively treated distal radius fractures, 307 (6.8%) received additional intraoperative three-dimensional imaging during surgery. 263 of 307 patients (85.7%) had a distal radius fracture type C. Intraoperative three-dimensional imaging revealed findings in 125 patients (40.7%) that were not detected on conventional two-dimensional fluoroscopy. In 54 patients (17.6%) these findings led to an immediate revision. Most commonly, revision was done in the case of remaining steps in the articular surface ≥ 1 mm (n = 25, 8.1%) followed by intra-articular screw placement (n = 23, 7.5%). CONCLUSIONS Intraoperative three-dimensional imaging can provide additional information compared to conventional two-dimensional fluoroscopy in the operative treatment of distal radius fractures with the possibility of immediate intraoperative revision.
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Abstract
Intraoperative 3D imaging has a marked impact on the surgical treatment of articular fractures. In theory, insufficient reduction of fracture fragments and malpositioning of implants can be corrected in the same session so that unnecessary secondary imaging and revision surgery can be avoided. Current evidence on the accuracy of 3D scans, however, relies on heterogeneous preclinical data and must be interpreted with caution. Every fourth 3D scan seems to lead to a repositioning of fracture fragments or implants, despite unproven sensitivity and specificity. The interaction between diagnostic accuracy and therapeutic consequences needs exploration before any conclusions on the (additional) benefits of intraoperative 3D imaging can be drawn.
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Borggrefe J, Bolte H, Worms W, Mahlke L, Seekamp A, Menzdorf L, Varoga D, Müller M, Weuster M, Zorenkov D, Wedel T, Lippross S. Comparison of intraoperative flat panel imaging and postoperative plain radiography for the detection of intraarticular screw displacement in volar distal radius plate ostheosynthesis. Orthop Traumatol Surg Res 2015; 101:913-7. [PMID: 26522382 DOI: 10.1016/j.otsr.2015.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 05/03/2015] [Accepted: 07/24/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate if intraoperative 3D flat panel imaging improves the detection of radiocarpal intraarticular screw misplacement (RCSM) in comparison to standard postoperative x-ray. METHODS In a study on cadaver specimens, we evaluated the sensitivity and specificity to detect RCSM using X-ray, intraoperative 3D-fluoroscopy as well as the digital volume tomography. The gold standard reference was computed tomography. RESULTS Sensitivity for the detection of RCSM for X-ray was 58% and specificity 88%. For DVT, the sensitivity to detect RCSM was 88% and the specificity 53%. For 3D-fluoroscopy, the sensitivity for RCSM was 68% and specificity 95%. When combining the methods, the best performance was found, when combining the two intraoperative imaging methods, with a resulting sensitivity of 88% and a specificity of 73%. CONCLUSIONS Intraoperative 3D fluoroscopy and digital volume tomography appear to be at least as sensitive and specific to detect RCSM than the regular postoperative radiography in two planes. However, especially discrete screw misplacements can be missed with either method. LEVEL OF EVIDENCE Level IV. Diagnostic device study.
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Affiliation(s)
- J Borggrefe
- University medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of radiology, Uniklinik Köln, Köln, Germany.
| | - H Bolte
- University medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of nuclear medicine, university-Clinics Münster, Münster, Germany
| | - W Worms
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - L Mahlke
- Saint-Vincenz hospital, Paderborn, Germany
| | - A Seekamp
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - L Menzdorf
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - D Varoga
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Müller
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Weuster
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - D Zorenkov
- Department of neurology, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Wedel
- Department of anatomy, Christian-Albrecht-aniversity, Kiel, Germany
| | - S Lippross
- Department of trauma surgery, university medical center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Beerekamp M(S, Sulkers GS, Ubbink DT, Maas M, Schep NW, Goslings JC. Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: A systematic review. Eur J Radiol 2012; 81:4019-28. [DOI: 10.1016/j.ejrad.2012.06.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/15/2012] [Accepted: 06/26/2012] [Indexed: 10/27/2022]
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