title: [Intraoperative virtual implant planning for volar plate osteosynthesis of distal radius fractures].
abstract: BACKGROUND
  Digital planning of implants is in most cases conducted prior to surgery. The virtual implant planning system (VIPS) is an application developed for mobile C-arms, which assists the virtual planning of screws close to the joint line during surgery for treatment of distal radius fractures with volar plate osteosynthesis. The aim of this prospective randomized study was to acquire initial clinical experiences and to compare the VIPS method with the conventional technique.
  
  
  METHODS
  The study included 10 patients for primary testing and 30 patients with distal radius fractures of types A3, C1 and C2, divided in 2 groups. In the VIPS group, after placement of the plate and fracture reduction, a virtual 3D model of the plate was matched with the image of the plate from the fluoroscopic acquisition. Next, the length and position of the screws close to the joint line were planned on the virtual plate. The control group was treated with the same implant in the conventional way. Data were collected regarding screw replacement, fluoroscopy and operating room (OR) times.
  
  
  RESULTS
  The VIPS group included six A3, one C1 and eight C2 fractures, while the control group consisted of six A3 and nine C2 fractures. Three screws were replaced in the VIPS group and two in the control group (p = 0.24). The mean intraoperative fluoroscopy time of the VIPS group amounted to 2.58 ± 1.38 min, whereas it was 2.12 ± 0.73 min in the control group (p = 0.26). The mean OR time in the VIPS group was 53.3 ± 34.5 minutes and 42.3 ± 8.8 min (p = 0.23) in the control group.
  
  
  CONCLUSIONS
  The VIPS enables a precise positioning of screws close to joint line in the treatment of distal radius fractures; however, for routine use, further development of the system is necessary.
authors: MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland. jochen.franke@bgu-ludwigshafen.de.
authors: J
authors: J
authors: Franke
authors: MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
authors: S Y
authors: SY
authors: Vetter
authors: Klinik für Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Freiburg, Deutschland.
authors: K
authors: K
authors: Reising
authors: Klinik für Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Freiburg, Deutschland.
authors: S
authors: S
authors: Herrmann
authors: Klinik für Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Freiburg, Deutschland.
authors: N P
authors: NP
authors: Südkamp
authors: MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
authors: P A
authors: PA
authors: Grützner
authors: MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
authors: J
authors: J
authors: von Recum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005471:Fluoroscopy / Q000379:methods; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D017755:Prosthesis Fitting / Q000379:methods*; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult
keywords: Intraoperative 3D imaging; Intraoperative fluoroscopy time; Matching; Operating time; Screw misplacement
references: J Bone Joint Surg Br. 2006 Dec;88(12 ):1610-2
references: 17159173
references: Proc Inst Mech Eng H. 2007 Oct;221(7):813-20
references: 18019467
references: Comput Aided Surg. 2005 May;10 (3):141-9
references: 16321911
references: J Hand Surg Am. 2011 Jan;36(1):3-9
references: 21193123
references: Unfallchirurg. 2011 Oct;114(10):901-12
references: 20393836
references: BMC Musculoskelet Disord. 2013 Feb 28;14 :74
references: 23448230
references: Int Orthop. 2003;27(1):1-6
references: 12582800
references: Unfallchirurg. 2012 Sep;115(9):802-10
references: 21327810
references: J Orthop Trauma. 2012 Aug;26(8):466-73
references: 22357092
references: Arch Orthop Trauma Surg. 2010 Sep;130(9):1177-83
references: 20364263
references: J Hand Surg Am. 2006 Apr;31(4):615-22
references: 16632057
references: J Orthop Trauma. 2007 May;21(5):316-22
references: 17485996
references: Injury. 2011 Nov;42(11):1346-52
references: 21724185