Evaluation der Stellung der distalen Fibula nach geschlossener Reposition und Stellschraubenplatzierung mit intraoperativer dreidimensionaler Bildgebung (ISO-C-3D)

Abstract

Purpose An incorrect position of the distal fibula results in an incongruence of the ankle. In this study, the potential benefit of an intraoperative three-dimensional imaging with ISO-C-3D™ for evaluation of the distal fibula position after closed reduction and syndesmotic screw placement was intended. Methods The ISO-C-3D™ was used between June 1, 2003 and May 3, 2005 in all patients, in whom closed reduction and syndesmotic screw placement had been performed. The ISO-C-3D™ was used after reduction and implant position was judged to be correct with conventional fluoroscopy. In cases with incorrect reduction and/or implant position, a correction was performed after ISO-C-3D™ use in the same operative procedure. The percentage of such corrections, time spent with the ISO-C-3D and surgeons' rating of the ISO-C-3D™ (Visual Analogue Scale (VAS), 0–10, feasibility, image quality and clinical benefit) were recorded and analyzed. Result A total of 18 cases were included (Weber-B fracture, n = 3; Weber-C fracture, n = 15, among those Maisonneuve injuries, n = 7). In seven cases (39%), a correction of reduction and/or implant position after ISO-C-3D use was performed. The operative procedure was on average interrupted for ISO-C-3D™ use for 400 s (scan, image processing, image analysis by the surgeon). The ratings of the eight surgeons involved were as follows: feasibility, 9; image quality, 9.1; clinical benefit, 8.5. Conclusions Intraoperative three-dimensional visualization with ISO-C-3D™ can provide important information during the operative treatment of Weber-C fractures which cannot be obtained from plain films or c-arm use alone (ISO-C-3D™ alone recognized that 40% of cases needed correction). The use of ISO-C-3D™ is not considerably time consuming.