Abstract
BackgroundThe purpose of this study was to investigate the accuracy of perforation detection with multiplanar reconstructions using a mobile 3D image intensifier.MethodsIn 12 paired human humeri, K-wires perforating the subchondral bone and placed just below the cartilage level were directed toward five specific regions in the humeral head. Image acquisition was initiated by a fluoroscopy scan. Within a range of 90°, 45° external rotation (ER) and 45° internal rotation (IR). The number and percentage of detected perforating screws were grouped and analyzed. Furthermore, the fluoroscopic images were converted into multiplanar CT-like reconstructions. Each K-wire perforation was characterized as “detected” or “not detected”.ResultsIn the series of fluoroscopy images in the standard neutral position at 30° internal rotation, and 30° external rotation, the perforations of all K-wires (n = 56) were detected. Twenty-nine (51.8%) of them were detected in one AP view, 22 (39.3%) in two AP views, and five (8.9%) in three AP views. All K-wire perforations (100%, n = 56) were detected in multiplanar reconstructions.ConclusionIn order to reveal all of the intraoperative and postoperative screw perforations in a “five screw configuration”, conventional AP images should be established in both the neutral positions (0°), at 30° internal rotation and 30° external rotation. Alternatively, the intraoperative 3D scan with multiplanar reconstructions enables a 100% rate of detection of the screw perforations.
Highlights
The purpose of this study was to investigate the accuracy of perforation detection with multiplanar reconstructions using a mobile 3D image intensifier
Twenty-nine (51.8%) of them were detected in one anterior-posterior radiographic (AP) view, 22 (39.3%) in two AP views, and five (8.9%) in three AP views
In the “45° internal rotation (IR) – 0°–45° external rotation (ER)” series, one perforation was not detected (1.8%, one posterior K-wire), while 35 (62.5%) of them were detected in one AP view, 19 (33.9%) in two AP views, and one (1.8%) in three AP views
Summary
The purpose of this study was to investigate the accuracy of perforation detection with multiplanar reconstructions using a mobile 3D image intensifier. High complication rates, comprising primary and secondary screw perforation, malreduction, malunion, nonunion, avascular necrosis, and infection, have been observed [5]. The introduction of mobile 3D fluoroscopy has made intraoperative multiplanar imaging possible and it is used in navigated spinal surgery [14], pelvic operations [15], and for fractures of several extremeties [16,17,18,19]. The purpose of this study was to determine the AP views that are necessary to detect primary screw perforation of the humeral head under a controlled “in-vitro” setup. The secondary goal was to investigate the accuracy of perforation detection via multiplanar reconstructions using a mobile 3D image intensifier
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