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BMC Medical Imaging

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Open Access 01-12-2016 | Research article

Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

Authors: Marc Schnetzke, Julia Fuchs, Sven Y. Vetter, Nils Beisemann, Holger Keil, Paul-Alfred Grützner, Jochen Franke

Published in: BMC Medical Imaging | Issue 1/2016

Abstract

Background

Three-dimensional (3D) imaging with a mobile C-arm has proven to be a valuable intraoperative tool in trauma surgery. However, little data is available concerning its use in the treatment of elbow fractures. The aim of the current study was to determine the intraoperative findings and consequences of 3D imaging in the treatment of elbow fractures.

Methods

Between 2001 and 2015, prospectively collected data of 36 patients who underwent intraoperative 3D imaging during elbow surgery were recorded. The findings and consequences of the intraoperative 3D scans were analyzed in a retrospective chart review. For clinical evaluation the analysis included the patients’ medical history, the injury pattern of the affected elbow and concomitant injuries. Intraoperative and postoperative complications and revision surgeries were evaluated as well.

Results

In 6 patients (16.7 %) analysis of the intraoperative 3D scan led to an immediate revision due to the detection of intra-articular screw placement (n = 3, 8.3 %) and remaining intra-articular step of >2 mm (n = 3, 8.3 %). In all of these patients, correct implant positioning and anatomical reduction could be achieved after immediate intraoperative revision, which was verified by a repeated intraoperative 3D scan. None of the 36 patients needed surgical revision based on postoperative radiological examinations due to secondary dislocation, wrong implant placement or remaining steps in the articular surface.

Conclusions

Intraoperative 3D imaging offers additional information about fracture reduction and implant positioning in the treatment of elbow fractures compared to conventional intraoperative 2D imaging. It may therefore reduce the need for revision surgery. The value of intraoperative 3D imaging for clinical outcomes still needs to be assessed.

Carelsen B, Haverlag R, Ubbink DT, Luitse JS, Goslings JC. Does intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery? Arch Orthop Trauma Surg. 2008;128(12):1419–24. doi:10.1007/s00402-008-0740-5.CrossRefPubMed

Kendoff D, Citak M, Gardner MJ, Stubig T, Krettek C, Hufner T. Intraoperative 3D imaging: value and consequences in 248 cases. J Trauma. 2009;66(1):232–8. doi:10.1097/TA.0b013e31815ede5d.CrossRefPubMed

Franke J, von Recum J, Wendl K, Grutzner PA. Intraoperative 3-dimensional imaging - beneficial or necessary? Unfallchirurg. 2013;116(2):185–90. doi:10.1007/s00113-013-2359-4.CrossRefPubMed

Atesok K, Finkelstein J, Khoury A, Peyser A, Weil Y, Liebergall M, et al. The use of intraoperative three-dimensional imaging (ISO-C-3D) in fixation of intraarticular fractures. Injury. 2007;38(10):1163–9. doi:10.1016/j.injury.2007.06.014.CrossRefPubMed

Beerekamp MS, Sulkers GS, Ubbink DT, Maas M, Schep NW, Goslings JC. Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: a systematic review. Eur J Radiol. 2012;81(12):4019–28. doi:10.1016/j.ejrad.2012.06.021.CrossRefPubMed

Weil YA, Liebergall M, Mosheiff R, Singer SB, Joskowicz L, Khoury A. Assessment of two 3-D fluoroscopic systems for articular fracture reduction: a cadaver study. Int J Comput Assist Radiol Surg. 2011;6(5):685–92. doi:10.1007/s11548-011-0548-6.CrossRefPubMed

Wirth S, Euler E, Linsenmaier U, Heining SM, Kotsianos D, Pfeifer KJ, et al. C-arm-based mobile computed tomography: a comparison with established imaging on the basis of simulated treatments of talus neck fractures in a cadaveric study. Comput Aided Surgery off J Int Soc Comput Aided Surgery. 2004;9(1–2):27–38. doi:10.3109/10929080400006309.CrossRef

Gosling T, Klingler K, Geerling J, Shin H, Fehr M, Krettek C, et al. Improved intra-operative reduction control using a three-dimensional mobile image intensifier - a proximal tibia cadaver study. Knee. 2009;16(1):58–63. doi:10.1016/j.knee.2008.07.012.CrossRefPubMed

Carelsen B, van Loon J, Streekstra GJ, Maas M, van Kemenade P, Strackee SD. First experiences with the use of intraoperative 3D-RX for wrist surgery. Minimally Invasive Therapy Allied Tech MITAT Off J Soc Minimally Invasive Therapy. 2011;20(3):160–6. doi:10.3109/13645706.2010.518807.CrossRef

10.

Wich M, Spranger N, Ekkernkamp A. [Intraoperative imaging with the ISO C(3D)]. Der Chirurg Zeitschrift Alle Gebiete Operativen Medizen. 2004;75(10):982–7. doi:10.1007/s00104-004-0953-2.CrossRef

11.

Franke J, Wendl K, Suda AJ, Giese T, Grutzner PA, von Recum J. Intraoperative three-dimensional imaging in the treatment of calcaneal fractures. J Bone Joint Surg Am. 2014;96(9):e72. doi:10.2106/jbjs.l.01220.CrossRefPubMed

12.

Kerry G, Ruedinger C, Steiner HH. Intraoperative three-dimensional fluoroscopy after transpedicular positioning of Kirschner-wire versus conventional intraoperative biplanar fluoroscopic control: A retrospective study of 345 patients and 1880 pedicle screws. J Craniovertebral Junction Spine. 2014;5(3):125–30. doi:10.4103/0974-8237.142307.CrossRef

13.

Sembrano JN, Santos ER, Polly Jr DW. New generation intraoperative three-dimensional imaging (O-arm) in 100 spine surgeries: does it change the surgical procedure? J Clin Neurosci Off J Neurosurgical Soc Australasia. 2014;21(2):225–31. doi:10.1016/j.jocn.2013.04.011.

14.

Grossterlinden L, Nuechtern J, Begemann PG, Fuhrhop I, Petersen JP, Ruecker A, et al. Computer-assisted surgery and intraoperative three-dimensional imaging for screw placement in different pelvic regions. J Trauma. 2011;71(4):926–32. doi:10.1097/TA.0b013e31820333dd.CrossRefPubMed

15.

Clavert P, Ducrot G, Sirveaux F, Fabre T, Mansat P. Outcomes of distal humerus fractures in patients above 65 years of age treated by plate fixation. Orthopaedics Traumatol Surgery Res OTSR. 2013;99(7):771–7. doi:10.1016/j.otsr.2013.08.001.CrossRef

16.

Schmidt-Horlohe K, Bonk A, Wilde P, Becker L, Hoffmann R. Functional results after osteosynthesis of the distal humerus fracture with an anatomically precontoured, angular-stable double plate system. Zeitschrift Orthopadie Unfallchirurgie. 2010;148(3):300–8. doi:10.1055/s-0029-1240736.

17.

Pereles TR, Koval KJ, Gallagher M, Rosen H. Open reduction and internal fixation of the distal humerus: functional outcome in the elderly. J Trauma. 1997;43(4):578–84.CrossRefPubMed

18.

Ring D, Quintero J, Jupiter JB. Open reduction and internal fixation of fractures of the radial head. J Bone Joint Surg Am. 2002;84-a(10):1811–5.PubMed

19.

Chen X, Wang SC, Cao LH, Yang GQ, Li M, Su JC. Comparison between radial head replacement and open reduction and internal fixation in clinical treatment of unstable, multi-fragmented radial head fractures. Int Orthop. 2011;35(7):1071–6. doi:10.1007/s00264-010-1107-4.CrossRefPubMedPubMedCentral

20.

Müller ME NS, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Berlin: Springer; 1990.CrossRef

21.

Ring D, Gulotta L, Chin K, Jupiter JB. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma. 2004;18(7):446–9.CrossRefPubMed

22.

Wagener ML, Dezillie M, Hoendervangers Y, Eygendaal D. Clinical results of the re-fixation of a Chevron olecranon osteotomy using an intramedullary cancellous screw and suture tension band. Strategies Trauma Limb Reconstruct (Online). 2015;10(1):1–4. doi:10.1007/s11751-015-0211-9.CrossRef

23.

Franke J, von Recum J, Suda AJ, Grutzner PA, Wendl K. Intraoperative three-dimensional imaging in the treatment of acute unstable syndesmotic injuries. J Bone Joint Surg Am. 2012;94(15):1386–90. doi:10.2106/jbjs.k.01122.CrossRefPubMed

24.

Kendoff D, Pearle A, Hufner T, Citak M, Gosling T, Krettek C. First clinical results and consequences of intraoperative three-dimensional imaging at tibial plateau fractures. J Trauma. 2007;63(1):239–44. doi:10.1097/TA.0b013e31804a8007.CrossRefPubMed

25.

Geerling J, Kendoff D, Citak M, Zech S, Gardner MJ, Hufner T, et al. Intraoperative 3D imaging in calcaneal fracture care-clinical implications and decision making. J Trauma. 2009;66(3):768–73. doi:10.1097/TA.0b013e31816275c7.CrossRefPubMed

26.

Mehling I, Rittstieg P, Mehling AP, Kuchle R, Muller LP, Rommens PM. Intraoperative C-arm CT imaging in angular stable plate osteosynthesis of distal radius fractures. J Hand Surg Eur Vol. 2013;38(7):751–7. doi:10.1177/1753193413476418.CrossRefPubMed

27.

Hufner T, Stubig T, Gosling T, Kendoff D, Geerling J, Krettek C. Cost-benefit analysis of intraoperative 3D imaging. Unfallchirurg. 2007;110(1):14–21. doi:10.1007/s00113-006-1202-6.CrossRefPubMed

Title: Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases
Authors: Marc Schnetzke
Julia Fuchs
Sven Y. Vetter
Nils Beisemann
Holger Keil
Paul-Alfred Grützner
Jochen Franke
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Medical Imaging / Issue 1/2016
Electronic ISSN: 1471-2342
DOI: https://doi.org/10.1186/s12880-016-0126-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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