Abstract
ObjectivesTo compare intraoperative 3D fluoroscopy with a ceiling-mounted flat panel detector in plate osteosynthesis of distal radius fractures (AO/OTA 2R3C1.2) with volar locking plate systems to conventional 2D fluoroscopy for detection of insufficient fracture reduction, plate misplacement and protruding screws.MethodsUsing a common volar approach on 12 cadaver forearms, total intraarticular distal radius fractures were induced, manually reduced and internally fixated with a 2.4 distal radius locking compression plate. 2D (anterior-posterior and lateral) and 3D (rotational) fluoroscopic images were taken as well as computed tomographies. Fluoroscopic images, Cone Beam CT (CBCT), 360° rotating sequences (so called “Movies”) and CT scans were co-evaluated by a specialist orthopedic surgeon and a specialist radiologist regarding quality of fracture reduction, position of plate, position of the three distal locking screws and position of the three diaphyseal screws. In reference to gold standard CT, sensitivity and specifity were analyzed.Results“Movie” showed highest sensitivity for detection of insufficient fracture reduction (88%). Sensitivity for detection of incorrect position of plate was 100% for CBCT and 90% for “Movie.” For intraarticular position of screws, 2D fluoroscopy and CBCT showed highest sensitivity and specifity (100 and 91%, respectively). Regarding detection of only marginal intraarticular position of screws, sensitivity and specifity of 2D fluoroscopy reached 100% (CBCT: 100 and 83%). “Movie” showed highest sensitivity for detection of overlapping position of screws (100%). When it comes to specifity, CBCT achieved 100%. Regarding detection of only marginal overlapping position of screws, 2D fluoroscopy and “Movie” showed highest sensitivity (100%). CBCT achieved highest specifity (100%).ConclusionAs for assessment of quality of fracture reduction and detection of incorrect position of plate as well as overlapping position of the three diaphyseal screws CBCT and “Movie” are comparable to CT – especially when combined. Particularly sensitivity is high compared to standard 2D fluoroscopy.
Highlights
Distal radius fractures are amongst the most common fractures [1, 2]
Major complications – amongst others – are early posttraumatic arthrosis in the radiocarpal joint and irritations/ruptures of flexor and extensor tendons. The former derives from insufficient fracture reduction [12, 13] and intraarticular positioned screws [8, 14], the latter from plate misplacement [15, 16] or dorsally protruding screws [8, 14, 17]
The purpose of this study is to show that, by using Allura Xper FD 20 with FlexMove in plate osteosynthesis of distal radius fractures with volar locking plate systems, insufficient fracture reduction, plate misplacement and protruding screws are more likely to be discovered intraoperatively and corrected immediately than by using conventional intraoperative 2D fluoroscopy alone
Summary
Distal radius fractures are amongst the most common fractures [1, 2]. In recent studies, they accounted for estimated 19% of all incident fractures and occasionedSeuthe et al BMC Musculoskelet Disord (2021) 22:9243% of the total costs of over 16.9 billion dollars in the United States (US) alone [3] – not taken into consideration decreased school attendance, lost work hours, loss of independence and lasting disability [4]. Major complications – amongst others – are early posttraumatic arthrosis in the radiocarpal joint and irritations/ruptures of flexor and extensor tendons The former derives from insufficient fracture reduction [12, 13] and intraarticular positioned screws [8, 14], the latter from plate misplacement (especially ruptures of the flexor pollicis longus tendon) [15, 16] or dorsally protruding screws (especially ruptures of the extensor pollicis longus tendon) [8, 14, 17]. To correct these mistakes intraoperatively and avoid postoperative CT and revision surgery, the surgeon needs competent knowledge of the complex distal radius anatomy [7, 18] and high-quality imaging [1, 8]
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