Abstract
Anatomic reconstruction of articular fractures is one of the critical factors in later achieving good functional outcome. Intraoperative 3D imaging has been shown to offer better evaluation and therefore can significantly improve the results. The purpose of this study was to assess the difference between intraoperative three-dimensional fluoroscopy (3D) and intraoperative computed tomography (iCT) imaging regarding fracture reduction, implant placement and articular impressions in a distal humeral fracture model. AO type 13-B2 fracture pattern were created in upper extremity cadaver specimens. Articular step-offs, intra-articular screw placement and intraarticular impressions of different degrees of severity were created. All specimens had imaging performed. For each articular pattern 3D fluoroscopy in standard (3Ds) and high quality (3Dh) were performed (Arcadis Orbic, Siemens, Germany) as well as an intraoperative CT scan (iCT, Airo, Brainlab, Germany). Three observers evaluated all imaging studies regarding subjective and objective parameters. iCT is more precise than 3D fluoroscopic imaging for detection of articular impressions. Articular step-offs and intraarticular screw placement are similar for iCT and 3D. Subjective imaging quality is the highest for iCT and lowest for 3Ds. Intraoperative CT may be particularly useful in assessing articular impressions and providing a good subjective image quality for the surgeon.
Highlights
Anatomic reconstruction of articular fractures is one of the critical factors in later achieving good functional outcome
Fluoroscopic 3D fluoroscopy in standard (3Ds)-imaging with a rotating C-arm is called cone beam computed tomography (CBCT)
For differentiation between the two imaging modalities fluoroscopy generated scans with a C-arm will be called “intraoperative 3D-imaging” and CT-scans generated by a mobile traditional CT-scanner “intraoperative CT”. 11–41% of fracture reductions which have been deemed sufficient in the surgeon’s opinion after routine 2D imaging have been revised after intraoperative 3D-imaging[14,20,21]
Summary
Anatomic reconstruction of articular fractures is one of the critical factors in later achieving good functional outcome. The purpose of this study was to assess the difference between intraoperative three-dimensional fluoroscopy (3D) and intraoperative computed tomography (iCT) imaging regarding fracture reduction, implant placement and articular impressions in a distal humeral fracture model. As two-dimensional imaging is a projection imaging technique and shows limited information, it might lead to misjudgment of the fracture site and surgical result[6] Complex anatomical regions such as spine, pelvis or articular surfaces pose a particular high level of complexity and demand precise judgment of the fracture site to ensure successful osteosynthesis[7]. Intraoperative 3D-imaging improves patient care and outcome through improved evaluation of fracture reduction and implant placement, especially in complex anatomical regions[16,22,23] and became an established tool in trauma surgery. They show a good usability and precision but have not rated imaging quality
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