Abstract
Previous studies have demonstrated a frequent occurrence of screw/K-wire malpositioning during surgical fracture treatment under 2D fluoroscopy and a correspondingly high revision rate as a result of using intraoperative 3D imaging. In order to facilitate and accelerate the diagnosis of implant malpositioning in 3D data sets, this study investigates two versions of an implant detection software for mobile 3D C-arms in terms of their detection performance based on comparison with manual evaluation. The 3D data sets of patients who had received surgical fracture treatment at five anatomical regions were extracted from the research database. First, manual evaluation of the data sets was performed, and the number of implanted implants was assessed. For 25 data sets, the time required by four investigators to adjust each implant was monitored. Subsequently, the evaluation was performed using both software versions based on the following detection parameters: true-positive-rate, false-negative-rate, false-detection-rate and positive predictive value. Furthermore, the causes of false positive and false negative detected implants depending on the anatomical region were investigated. Two hundred fourteen data sets with overall 1767 implants were included. The detection parameters were significantly improved (p<.001) from version 1 to version 2 of the implant detection software. Automatic evaluation required an average of 4.1±0.4 s while manual evaluation was completed in 136.15±72.9 s (p<.001), with a statistically significant difference between experienced and inexperienced users (p=.005). In summary, version 2 of the implant detection software achieved significantly better results. The time saved by using the software could contribute to optimizing the intraoperative workflow.
Highlights
In the surgical treatment of fractures, the control of reduction and implant position by means of intraoperative imaging is an essential prerequisite for the best possible outcome [1–3]
The use of intraoperative 3D imaging results in an intraoperative revision rate of up to 40% depending on the anatomical region, there was no evidence of inadequate reduction or implant malposition in previous 2D fluoroscopy [7, 9, 11, 15]
The respective number of data sets from the different anatomical regions can be read from Fig. 2
Summary
In the surgical treatment of fractures, the control of reduction and implant position by means of intraoperative imaging is an essential prerequisite for the best possible outcome [1–3]. The use of intraoperative 3D imaging results in an intraoperative revision rate of up to 40% depending on the anatomical region, there was no evidence of inadequate reduction or implant malposition in previous 2D fluoroscopy [7, 9, 11, 15]. In the event that no intraoperative 3D control is performed, findings requiring revision may only become apparent in postoperative computed tomography This leads either to acceptance of the suboptimal findings with the risk of a worse functional outcome or alternatively to revision surgery with a potentially increased complication rate [16]. As both should be avoided, intraoperative 3D imaging is becoming increasingly established [17, 18]
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