[3D safety in osteosynthesis adjacent to joints].
BACKGROUND
The results and immediate consequences of intraoperative three-dimensional (3D) imaging in the treatment of AO classification type C fractures of the distal radius, the tibial head and the tibial pilon were analyzed and compared with published results on general intraoperative revision rates following intraoperative 3D-imaging.


METHODS
In this retrospective study 279 patients with AO type C fractures of the distal radius (n = 84), tibial head (n = 109) and tibial pilon (n = 86) who underwent intraoperative 3D-imaging were included. The findings of the 3D-imaging and the intraoperative revision rates were analyzed and compared with previously published results of our working group.


RESULTS
In 70 out of 279 patients (25 %) an intraoperative revision was carried out following 3D-imaging. The revision rates were 15 % for fractures of the distal radius, 27 % for fractures of the tibial head and 32 % for fractures of the tibial pilon. The most common reason for immediate intraoperative revision was the necessity for improved repositioning due to a remaining step in the articular surface in 51 out of 279 patients (18%).


CONCLUSIONS
Intraoperative revision rates following 3D-imaging increased with the severity of the injury pattern. Intraoperative 3D-imaging should be routinely used in the treatment of fractures of the tibial head, tibial pilon and even in comminuted distal radius fractures due to the high intraoperative revision rates found in the present study. Alternatively, a postoperative computed tomography (CT) control should be performed.
Klinik für Unfallchirurgie und Orthopädie, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
J
J
Franke
Klinik für Unfallchirurgie und Orthopädie, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
S Y
SY
Vetter
Klinik für Unfallchirurgie und Orthopädie, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
N
N
Beisemann
Klinik für Unfallchirurgie und Orthopädie, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
B
B
Swartman
Klinik für Unfallchirurgie und Orthopädie, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
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PA
Grützner
Klinik für Unfallchirurgie und Orthopädie, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, AGiTEC - Arbeitsgemeinschaft für intraoperative Bildgebung und Technologie Integration der DGOU, Unfallchirurgische Klinik an der Ruprecht-Karls-Universität Heidelberg, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland. Marc.Schnetzke@bgu-ludwigshafen.de.
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M
Schnetzke
D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome
Distal radius; Intraoperative 2D fluoroscopy; Intraoperative 3D imaging; Tibial head; Tibial pilon