title: Intraoperative 3D imaging: value and consequences in 248 cases.
abstract: BACKGROUND
  Intraoperative visualization of articular surfaces is technically demanding, and standard two-dimensional fluoroscopic imaging frequently does not provide adequate detail of nonplanar joints. New imaging modalities allow for intraoperative 3D visualization, which are useful in articular fractures. Purpose of this study was to evaluate the utility of 3D imaging in articular fracture reconstruction.
  
  
  METHODS
  In a prospective cohort study, we evaluated 248 consecutive patients with intra-articular fractures. After fracture fixation using standard fluoroscopy, 3D imaging was performed intraoperatively using the Iso-C3D system for all patients. Surgeons filled out questionnaires regarding the utility and perceived accuracy of the 3D system. Postoperative CT scans were performed on approximately half of the patients. Main outcome measurements were based on the surgeons decision to immediately revise the articular reduction or implant position. The setup time for the system was recorded. For patients with postoperative CT scans, articular surface gaps of 2 mm or intra-articular hardware placement was again evaluated.
  
  
  RESULTS
  In 19% of all cases, intraoperative image analysis resulted in immediate adjustment of the reduction or hardware exchange. These revisions were based on Iso-C3D views of the articular surface that were not visible using fluoroscopy. Of the 129 postoperative CT scans, five cases revealed a technical error of the joint reconstruction, and a secondary revision procedure was performed.
  
  
  CONCLUSIONS
  In conclusion, the Iso-C3D was a valuable intraoperative tool, providing additional information about the articular surface compared with conventional fluoroscopy in a variety of anatomic regions.
authors.affiliation: Trauma Department, Hannover Medical School, Hannover, Germany. kendoff.daniel@mh-hannover.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Kendoff
authors.forename: Musa
authors.initials: M
authors.lastname: Citak
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gardner
authors.forename: Timo
authors.initials: T
authors.lastname: Stübig
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.forename: Tobias
authors.initials: T
authors.lastname: Hüfner
mesh_terms: D016477:Artifacts; D005471:Fluoroscopy; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007430:Intraoperative Care; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012984:Software; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000379:methods*