The correlation between intra-operative 2D- and 3D fluoroscopy with postoperative CT-scans in the treatment of calcaneal fractures.

Autor: Beerekamp MSH; Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands. Electronic address: m.s.beerekamp@amc.nl., de Muinck Keizer RJO; Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands., Schepers T; Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands., Beenen LFM; Department of Radiology, Amsterdam University Medical Center, Amsterdam, the Netherlands., Luitse JSK; Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands., Schep NW; Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands., Ubbink DT; Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands., Goslings JC; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of radiology [Eur J Radiol] 2019 Mar; Vol. 112, pp. 222-228. Date of Electronic Publication: 2019 Jan 18.
DOI: 10.1016/j.ejrad.2019.01.013
Abstrakt: Objectives: The aim of this study was to determine the correlation of the intra-operative fluoroscopic 2D- and 3D-images compared with a postoperative CT-scan, in terms of quality of reduction and fixation of calcaneal fractures.
Methods: Patients requiring open reduction and internal fixation (ORIF) of a calcaneal fracture were recruited as part of the EF3X-trial. During surgery, intra-operative images of fluoroscopic 2D- and 3D-imaging were obtained to assess the quality of the reduction and implant position. All patients received a postoperative CT-scan within one week. The operating surgeon evaluated intra-operatively both 2D- and 3D-images according to a 23-item scoring protocol on a 3-point Likert scale. A scoring panel, consisting of three clinical experts, evaluated all images in a blinded and independent fashion. Intraclass correlation coefficients (ICC) with their 95% confidence intervals (CI) were calculated using a two-way-random model with absolute agreement.
Results: A total of 102 calcaneal fractures were included. Agreement of 3D-imaging for the quality of reduction was better than 2D-imaging, although still fair, but for fixation moderate to good. Agreement between the 2D-images and the CT-scans was poor to fair. Intra-operative 2D-imaging received the highest ratings for image quality and interpretability, followed by CT-scanning.
Conclusion: Implant position can be evaluated satisfactory with the aid of intra-operative 3D imaging. Although intra-operative 3D imaging had a better agreement with postoperative CT-scanning than 2D-imaging, there is a need to improve image quality and suppress scattering from implants to improve the additional value of intra-operative 3D imaging in calcaneal fracture reduction and fixation.
(Copyright © 2019 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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