Progress of fracture mapping technology based on CT three-dimensional reconstruction

Abstract

Fracture Mapping is a new technology developed in recent years. This technology visually representing the morphology of fractures by overlaying fracture lines from multiple fracture models onto a standard model through three-dimensional reconstruction. Fracture mapping has been widely used in acetabular fracture, proximal humerus fractures, Pilon fracture, tibial plateau fractures, and so on. This technology provides a new research method for the diagnosis, classification, treatment selection, internal fixation design, and statistical analysis of common fracture sites. In addition, the fracture map can also provide a theoretical basis for the establishment of a biomechanical standardized fracture model. Herein, we reviewed various methods and the most advanced techniques for fracture mapping, and to discuss the issues existing in fracture mapping techniques, which will help in designing future studies that are closer to the ideal. Moreover, we outlined the fracture morphology features of fractures in various parts of the body, and discuss the implications of these fracture mapping studies for fracture treatment, thereby providing reference for research and clinical decision-making on bone and joint injuries to improve patient prognosis.

Keywords: classification; fracture mapping; fractures; heat map; morphology; three-dimensional.

FIGURE 1

Search and screening flow chat.

FIGURE 2

Type and number of fractures involved in the included studies.

FIGURE 3

Annual publication volume of studies on fracture mapping.

FIGURE 4

A series of images showing the process of 2D fracture mapping, starting with (A) a computed tomography image, (B) mapping the fracture line onto a matching standard template, and (C) ending with the fracture line mapped onto the standard template. (D–G) Superimposition of CT transverse images for fracture mapping: (D) CT cross-sectional image 3 mm below the unreduced tibial articular surface; (E) Alignment of the CT image with the template; (F) Fracture line transcription onto the standard template; (G) Completed fracture line transcription.

FIGURE 5

Images illustrating the fracture mapping method. (A) Each fragment was reconstructed. (B) Then reduce the fractured fragments and demonstrate with a specific perspective. (C) Fracture lines are manually transcribed onto a two-dimensional template based on their relationship with anatomical landmarks (distance, orientation).

FIGURE 6

The process of fracture mapping using Mimics and Geomagic. (A) Reconstruction of the fracture model in Mimics; (B) Importation of the reconstructed fracture model into Geomagic, followed by the segmentation of the fracture model into individual fracture fragments; (C) Utilization of Geomagic’s best-fit algorithm to assist in identifying the optimal overlapping position, employing the contralateral side as a template for the reduction of fracture fragments; (D, E) With the aid of transparent mode, the fracture line is transferred onto the three-dimensional model of the contralateral side.

FIGURE 7

Representative images of the steps in the method used for three-dimensional mapping of proximal humerus fractures. In this example of a proximal humerus fractures, each fracture fragment is reconstructed (A), segmented (B), and virtually reduced (C). Adjust the size of the fracture model and the transparency of the standard model, and transcribe the fracture line onto the standard model (D). Generate a fracture heatmap based on the density of fracture lines (E).

FIGURE 8

(A) The area enclosed by the four points (1–4) connected roughly represents the trapezoidal shape area of the quadrilateral board. (B) The schematic diagram of the new classification of tetrahedral fractures proposed by Yang et al. Zones A and B are bounded by a line from the ischial spine to the iliopubic eminence. (C) The clock face position is used to describe the location of fractures on the surface of the acetabulum joint. The midpoint of the transverse acetabular ligament serves as the +180° reference point, with the 0° reference point set perpendicular to the ligament. (D) Six-zone classification of femoral neck fractures. The anterior zones were categorized as subcapital (Zone 1), transcervical (Zone 2), and basocervical (Zone 3). Likewise, the posterior zones were identified as subcapital (Zone 4), transcervical (Zone 5), and basocervical (Zone 6). (E) Schematic diagram of a triplane fracture. (F) Labronici et al. divided the distal tibia into eight zones. (G) Tibial plateau nine-column fracture classification.

FIGURE 9

Depicts the intervals for standard surgical approaches to pilon fractures. (A) Anteromedial, (B) anterolateral, (C) direct medial, (D) posteromedial, (E) posterolateral fibula, (F) posterolateral tibia.