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Intraoperative 3-D imaging beneficial during ORIF of calcaneal fractures
In up to 40% of cases, surgeons altered reductions or implant positioning after using the technology.
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VANCOUVER, British Columbia — Using intraoperative three-dimensional imaging during open reduction and internal fixation of calcaneal fractures allows surgeons to immediately assess and correct the surgical reduction and implant positioning.
“Intraoperative 3-D imaging really improves the intraoperative visualization,” Martinus Richter, MD, PhD, said during his presentation at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. “It is helpful, and the less experienced that you are, the more helpful it probably is. Even for experienced surgeons, it gives more security. It may potentially reduce the number of reoperations, but that is not proven.”
In a pilot study, Richter and colleagues assessed the potential benefits of using a first-generation intraoperative 3-D imaging device that incorporated a mobile C-arm (Siremobil ISO-C-3D, Siemens) during calcaneal fracture reduction.
Assessing plan
The study included 32 calcaneal fractures. Surgeons treated five of the fractures with closed reduction and 27 fractures with open reduction and internal fixation (ORIF). After placing the implant and judging the reduction using conventional C-arms, the surgeons used intraoperative 3-D imaging to assess their initial operative plan.
“In 31% of the cases, the implant was corrected and most were because the screws penetrated the joint,” he said.
The investigators also discovered that the reduction was corrected in 16% of cases after intraoperative 3-D imaging was used and that using the imaging caused an average interruption of 420 seconds during the operation.
Second-generation device
In a follow-up study of 32 patients who underwent ORIF using the second generation of the same device, the investigators found that surgeons changed the reduction or implant placement in 40% of the cases. They also discovered that the operations were interrupted for an average of 320 seconds, and the patients were subjected to half of the radiation exposure found in the pilot study.
Richter noted that the research did not have a randomized design.
“I am waiting for anybody to do a prospective randomized study on this,” he said. “I will not do it because, for me, this tool is so great that I will not treat any calcaneal fracture without this device.”
Even if surgeons do not make corrections after using intraoperative 3-D imaging, Richter said the technology can guarantee a good reduction.
“I do not say that this correlates to the clinical outcome and that someone who does not use it will have a bad outcome, but it is really hard to convince us [otherwise],” he said.
For more information:
- Martinus Richter, MD, PhD, can be reached at Coburg Clinical Center, Ketschendorfer Street, 33, 96450 Coburg, Germany; 49-700-3877-872862; e-mail: martinus.richter@klinikum-coburg.de. He has no direct financial interest in any products or companies mentioned in this article.
Reference:
- Richter, M. Intraoperative 3D imaging for ORIF of calcaneal fractures. Presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 15-18, 2009. Vancouver, British Columbia.