title: Intraoperative three-dimensional imaging with a motorized mobile C-arm (SIREMOBIL ISO-C-3D) in foot and ankle trauma care: a preliminary report.
abstract: OBJECTIVE
  The aim of the study was to assess the feasibility and benefit of the intraoperative use of a mobile C-arm with 3-dimensional imaging (ISO-C-3D).
  
  
  METHODS
  Prospective consecutive clinical study.
  
  
  METHODS
  University hospital, level I trauma center.
  
  
  METHODS
  The ISO-C-3D was used for intraoperative visualization in foot and ankle trauma care. Conventional C-arms were used to judge the reduction and implant position before the ISO-C-3D was used. Time spent, changes resulting from use of the ISO-C-3D, and surgeons' ratings (visual analogue scale, 0-10 points) were recorded.
  
  
  METHODS
  Between January 1, 2003 and March 15, 2004, the ISO-C-3D was used in 62 cases (factures: pilon, n = 1; Weber-C ankles, n = 7; isolated dorsal Volkmann, n = 1; talus, n = 3; calcaneus, n = 20; navicular, n = 1; cuboid, n = 1; Lisfranc fracture-dislocation, n = 6; hindfoot arthrodesis with or without correction, n = 12).
  
  
  RESULTS
  On average, the operation was interrupted for 440 seconds (range 330-700); 120 seconds, on average, for the ISO-C-3D scan and 210 seconds, on average, for evaluation of the images by the surgeon. In 39% of the cases (24 of 62), the reduction and/or implant position was corrected during the same procedure after the ISO-C-3D scan. The ratings of the 8 surgeons who used the ISO-C-3D were 9.2(5.2-10) for feasibility, 9.5 (6.1-10) for accuracy, and 8.2 (4.5-10) for clinical benefit.
  
  
  CONCLUSIONS
  Intraoperative 3-dimensional visualization with the ISO-C-3D can provide useful information in foot and ankle trauma care that cannot be obtained from plain films or conventional C-arms. During the same procedure, after conventional C-arm scans judged the positioning to be correct and an ISO-C-3D scan was done, the reduction and/or implant position was corrected in 39% of the cases in this study, although not unnecessarily prolonging the operation. The ISO-C-3D appears to be most helpful in procedures with a closed reduction and internal fixation, and/or when axial reformations provide information that is not possible to obtain with a conventional C-arm and/or direct visualization during open reduction and internal fixation.
authors.affiliation: Trauma Department, Hannover Medical School, Hannover, Germany. martinus@mh-hannover.de
authors.forename: Martinus
authors.initials: M
authors.lastname: Richter
authors.forename: Jens
authors.initials: J
authors.lastname: Geerling
authors.forename: Stefan
authors.initials: S
authors.lastname: Zech
authors.forename: Thomas
authors.initials: T
authors.lastname: Goesling
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
mesh_terms: D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D001863:Bone Screws; D005240:Feasibility Studies; D005471:Fluoroscopy / Q000295:instrumentation*; D018409:Foot Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D007432:Intraoperative Period; D011446:Prospective Studies