title: Intraoperative 3D imaging in calcaneal fracture care-clinical implications and decision making.
abstract: BACKGROUND
  In operative calcaneal fracture care malposition of screws and joint line incongruity frequently remain unrecognized using fluoroscopy intraoperatively, and are frequently only recognized on postoperative computed tomography scans. The purpose of this study was to analyze the feasibility and utility of a new C-arm-based three-dimensional imaging technology for calcaneal trauma care.
  
  
  METHODS
  The C-arm-based three- dimensional imaging device (ISO-C-3D) was used in 32 patients during a 2-year period. Patients were indicated for open reduction and internal fixation using standard techniques and fluoroscopy. After reduction and implant placement was determined to be correct, the ISO-C-3D procedure was performed. The time for setup and use, and the consequences were recorded. An assessment was obtained from the surgeon regarding the feasibility and the adequacy and quality of the data provided, using a Visual Analog Scale.
  
  
  RESULTS
  The average total time required for ISO-C-3D use was 610 seconds. The information obtained from the scan led the surgeon to alter the reduction or screw placement during the procedure in 41% of the patients. Surgeons rating according to a Visual Analog Scale: feasibility 9.5, accuracy and quality 9.2, clinical benefit 8.2.
  
  
  CONCLUSIONS
  Intraoperative three- dimensional visualization with the ISO-C-3D provides important information in the operative treatment of calcaneal fractures which cannot always be obtained from plain films or standard fluoroscopy alone. The use of the device adds minimal time to the overall procedure, and was found to be extremely useful in evaluating reduction and implant position intraoperatively in calcaneal fractures.
authors.affiliation: Trauma Department, Hannover Medical School, Hannover, Germany. jens.geerling@planet-interkom.de
authors.forename: Jens
authors.initials: J
authors.lastname: Geerling
authors.forename: Daniel
authors.initials: D
authors.lastname: Kendoff
authors.forename: Musa
authors.initials: M
authors.lastname: Citak
authors.forename: Stefan
authors.initials: S
authors.lastname: Zech
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gardner
authors.forename: Tobias
authors.initials: T
authors.lastname: Hüfner
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.forename: Martinus
authors.initials: M
authors.lastname: Richter
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001860:Bone Plates; D001863:Bone Screws; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D015331:Cohort Studies; D003661:Decision Support Techniques; D005240:Feasibility Studies; D005471:Fluoroscopy; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D010147:Pain Measurement; D011446:Prospective Studies; D036542:Tomography, Spiral Computed / Q000295:instrumentation*