Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;49(1):373-381.
doi: 10.1007/s00068-022-02083-x. Epub 2022 Sep 1.

Intraoperative revision rates due to three-dimensional imaging in orthopedic trauma surgery: results of a case series of 4721 patients

Holger Keil  1 , Nils Beisemann  2 , Benedict Swartman  2 , Marc Schnetzke  2 , Sven Yves Vetter  2 , Paul Alfred Grützner  2 , Jochen Franke  3
Affiliations

Intraoperative revision rates due to three-dimensional imaging in orthopedic trauma surgery: results of a case series of 4721 patients

Holger Keil et al. Eur J Trauma Emerg Surg. 2023 Feb.

Abstract

Purpose: Intraoperative 3D imaging has become a valued tool in assessing the quality of reduction and implant placement in orthopedic trauma surgery. In our institution, 3D imaging is used routinely since 2001. To evaluate the intraoperative findings and consequences of this technique, intraoperative revision rates in cases with 3D imaging were analyzed.

Methods: All operative procedures carried out with intraoperative 3D imaging between August 2001 and December 2016 were included. The scans were assessed intraoperatively and documented thereafter. In case of malreduction or misplaced implants, an immediate revision was performed. The number of scans per case as well as the findings and consequences drawn regarding the anatomical region were analyzed.

Results: 4721 cases with 7201 3D scans were included in this study. The most common anatomical regions were the ankle (22.3%), the calcaneus (14.8%) and the tibial head (9.5%). In 19.1% of all cases, an intraoperative revision was performed. The highest revision rates were found with 36.0% in calcaneal fractures, 24.8% in fractures of the tibial plateau, 22.3% in injuries of the ankle. In 52.0% of revisions, the reduction was improved regarding intra-articular steps or joint congruency. In 30.5% an implant was corrected.

Conclusion: Intraoperative revision due to results of 3D imaging was performed in almost one-fifth of cases. This illustrates the improved possibilities to detect malreduction and implant misplacements intraoperatively and thus the abilities to improve surgical outcome.

Level of evidence: III.

Keywords: 3D imaging; Fractures; Intraoperative imaging; Osteosynthesis.

PubMed Disclaimer

Conflict of interest statement

The research group, that all authors are part of, receives financial support by Siemens Healthcare (Erlangen, Germany). This did neither influence the concept nor the results of this study.

Figures

Fig. 1
Fig. 1
Male Patient, 49 y/o, Two-Column-Fracture of the right acetabulum. In the fluoroscopic ap view, the joint seems well reduced (a). In the 3D-Scan, an intraarticular step in the weight-bearing zone is revealed (b, arrow). After re-reduction, no step is left (c)
Fig. 2
Fig. 2
Workflow of intra-operative 3D imaging
Fig. 3
Fig. 3
Representation of the revision rates and measures of the anatomical regions. The bars represent the revision rate of the respective region
Fig. 4
Fig. 4
Male Patient, 32 y/o, Sanders Type III fracture of the calcaneus. Axial 3D scan of the calcaneus with positioned implants. Only in 3D, reconstruction of the calcaneo-cuboidal joint can be properly assessed, as well as the position of the implants
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Hahn DM. Current principles of treatment in the clinical practice of articular fractures. Clin Orthop Relat Res. 2004;423:27–32. doi: 10.1097/01.blo.0000131234.91264.9e. - DOI - PubMed
    1. Schnetzke M, Vetter SY, Beisemann N, Swartman B, Grützner PA, Franke J. Management of syndesmotic injuries: What is the evidence? World J Orthop. 2016;7:718. doi: 10.5312/wjo.v7.i11.718. - DOI - PMC - PubMed
    1. Vetter SY, Euler F, von Recum J, Wendl K, Gru tzner PA, Franke J. Impact of Intraoperative Cone Beam Computed Tomography on Reduction Quality and Implant Position in Treatment of Tibial Plafond Fractures. Foot & Ankle International [Internet]. 2016 [cited 2017 Mar 2];37:977–82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27188693 - PubMed
    1. Sebaaly A, Riouallon G, Zaraa M, Jouffroy P. The added value of intraoperative CT scanner and screw navigation in displaced posterior wall acetabular fracture with articular impaction. Orthop Traumatol Surg Res. 2016;102:947–950. doi: 10.1016/j.otsr.2016.07.005. - DOI - PubMed
    1. Franke J, Wendl K, Suda AJ, Giese T, Grützner PA, von Recum J. Intraoperative three-dimensional imaging in the treatment of calcaneal fractures. J Bone Joint Surg-Am Vol. 2014;96:72. doi: 10.2106/JBJS.L.01220. - DOI - PubMed

MeSH terms