Utility of an image fusion system for 3D preoperative planning and fluoroscopy in the osteosynthesis of distal radius fractures

Abstract Background Recently, computerized virtual surgery planning has been increasingly applied in various orthopedic procedures. In this study, we developed an image fusion system for 3D preoperative planning and fluoroscopy for the osteosynthesis. To assess the utility of image fusion system, we evaluated the reproducibility of preoperative planning in the osteosynthesis of distal radius fractures with using the image fusion system, and compared with the reproducibility of the patients without using the image fusion system. Methods Forty-two wrists of 42 distal radius fracture patients who underwent osteosynthesis using volar locking plates were evaluated. The patients were divided into two groups. Image fusion group utilized three-dimensional (3D) preoperative planning and image fusion system. Control group utilized only 3D preoperative planning. In both groups, 3D preoperative planning was performed in order to determine reduction, placement, and choice of implants. In the image fusion group, the outline of planned image was displayed on a monitor overlapping with fluoroscopy images during surgery. Reductions were evaluated by volar tilt and radial inclination of 3D images. Plate positions were evaluated with distance to joint surface, plate center axis position, and inclination relative to the radius axis. Screw choices were recorded for the plan and actual choices for each screw hole. Differences in the parameters between pre- and postoperative images were evaluated. Differences in reduction shape, plate positions, and screw choices were compared between groups. Results The differences in the distance from plate to joint surface were significantly smaller in the image fusion group compared to the control group (P < 0.01). The differences in the distal screw choices were significantly smaller in the image fusion group compared to the control group (P < 0.01). Conclusions The image fusion system was useful to reproduce the planned plate position and distal screw choices in the osteosynthesis of distal radius fractures. Trial registration ClinicalTrials.gov, NCT03764501

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An image fusion system for corrective osteotomy of distal radius malunion

BioMedical Engineering OnLine ◽

10.1186/s12938-021-00901-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Yuichi Yoshii ◽

Takeshi Ogawa ◽

Yuki Hara ◽

Yasukazu Totoki ◽

Tomoo Ishii

Keyword(s):

Image Fusion ◽

Distal Radius ◽

Preoperative Planning ◽

Corrective Osteotomy ◽

Reference Points ◽

Control Group ◽

Fusion System ◽

Distal Radius Malunion ◽

Preoperative Plan ◽

Radius Malunion

Abstract Background To provide surgical support for corrective osteotomy, we developed an image fusion system for three-dimensional (3D) preoperative planning and fluoroscopy. To assess the utility of this image fusion system, we evaluated the reproducibility of preoperative planning for corrective osteotomy of dorsally angulated distal radius malunion using the system and compared reproducibility without using the system. Methods Ten wrists from 10 distal radius malunion patients who underwent corrective osteotomy were evaluated. 3D preoperative planning and the image fusion system were used for the image fusion group (n = 5). Only 3D preoperative planning was used for the control group (n = 5). 3D preoperative planning was performed for both groups in order to assess reduction, placement, and the choice of implants. In the image fusion group, the outline of the planned image was displayed on a monitor and overlapped with fluoroscopy images during surgery. Reproducibility was evaluated using preoperative plan and postoperative 3D images. Images were compared with the 3D coordinates of the radial styloid process (1), the volar and dorsal edges of the sigmoid notch (2) (3), and the barycentric coordinates of the three reference points. The reproducibility of the preoperative plan was evaluated by the distance of the coordinates between the plan and postoperative images for the reference points. Results The distances between preoperative planning and postoperative reduction in the image fusion group were 2.1 ± 1.1 mm, 1.8 ± 0.7 mm, 1.9 ± 0.9 mm, and 1.4 ± 0.7 mm for reference points (1), (2), (3), and the barycenter, respectively. The distances between preoperative planning and postoperative reduction in the control group were 3.7 ± 1.0 mm, 2.8 ± 2.0 mm, 1.7 ± 0.8 mm, and 1.8 ± 1.2 mm for reference points (1), (2), (3), and the barycenter, respectively. The difference in reference point (1) was significantly smaller in the image fusion group than in the control group (P < 0.05). Conclusion Corrective osteotomy using an image fusion system will become a new surgical support method for fracture malunion. Trial registration Registered as NCT03764501 at ClinicalTrials.gov.

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A Comparison of Radiographic Outcomes between 3D Preoperative Planning and Conventional Planning in the Osteosynthesis of Distal Radius Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500383 ◽

2019 ◽

Vol 24 (03) ◽

pp. 303-310 ◽

Cited By ~ 1

Author(s):

Yuichi Yoshii ◽

Yasukazu Totoki ◽

Wen-lin Tung ◽

Kenichi Akita ◽

Tomoo Ishii

Keyword(s):

Distal Radius ◽

Preoperative Planning ◽

Distal Radius Fractures ◽

Control Group ◽

Radius Fractures ◽

Correction Loss ◽

Radiographic Outcomes ◽

Radiographic Parameters ◽

Healthy Side ◽

And Control

Background: To assess the usefulness of three-dimensional (3D) digital pre-operative planning, we compared the radiographic parameters of the distal radius from 3D planning and conventional planning after osteosynthesis of distal radius fractures. We hypothesized that the use of 3D digital planning may improve radiographic outcomes for reduction and decrease the risk of correction loss.Methods: Sixty wrists of 60 distal radius fracture patients were randomly divided into two groups according to the order of hospital visits. Thirty wrists were treated with 3D preoperative planning as the plan group. Another thirty wrists were treated with conventional preoperative planning as the control group. Both groups were treated with volar locking plates. In the plan group, 3D digital preoperative planning and a surgical simulation were performed in order to determine the reduction and placement of the implants in addition to the plate/screw size prior to surgery. In the control group, conventional preoperative planning was performed. Ulnar variance, volar tilt, and radial inclination were measured at one week, three and six months after surgery. Difference of the measurement of radiographic parameters between operated and healthy side wrists were compared between plan and control groups at one week after surgery. Loss of corrections for radiographic parameters were compared between plan and control groups.Results: The differences between the operated and healthy side wrists were significantly smaller in the plan group compared to the control group for the volar tilt and radial inclination (p < 0.05).The loss of corrections for ulnar variance and volar tilt were significantly smaller in the plan group compared to the control group at six months after surgery (p < 0.05).Conclusions: 3D preoperative planning offers better reduction accuracy and reduces correction loss in the osteosynthesis of distal radius fractures.

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Screw Length Optimization of a Volar Locking Plate Using Three Dimensional Preoperative Planning in Distal Radius Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500522 ◽

2018 ◽

Vol 23 (04) ◽

pp. 520-527 ◽

Cited By ~ 2

Author(s):

Yasukazu Totoki ◽

Yuichi Yoshii ◽

Takuya Kusakabe ◽

Kenichi Akita ◽

Tomoo Ishii

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Preoperative Planning ◽

Three Dimensional ◽

Distal Radius Fractures ◽

Control Group ◽

3D Image ◽

Radius Fractures ◽

Screw Length ◽

Operative Planning

Background: A three-dimensional (3D) digital pre-operative planning system for the osteosynthesis of distal radius fracture was developed. The objective of this study was to evaluate screw choices for three-dimensional (3D) digital pre-operative planning of osteosynthesis of distal radius fractures and to compare with the screw choices for the conventional method.Methods: Distal radius fracture patients who underwent osteosynthesis using volar locking plates were evaluated. Thirty wrists in the plan group utilized 3D preoperative planning, and nineteen wrists in the control group utilized conventional preoperative assessment. In the plan group, the 3D preoperative planning was performed prior to surgery. The reduction was simulated with 3D image, and the implant choice/placement also simulated on the 3D image. In the control group, standard preoperative planning was performed using posterior-anterior and lateral view radiographs, and CT scan. After the planning, osteosynthesis was performed. During the surgery, the operator performed the reduction and the placement of the plate while comparing images between the pre-operative plan and fluoroscopy. The distal screw lengths and the anteroposterior diameter of the radius along the axis of the distal screws were measured. The ratios of the screw length and radius diameter were evaluated. The screw/radius ratios within the range of 0.75–1.00 were considered appropriate. The screw choices less than 0.75, or greater than 1.00 were considered inappropriate. The rate of appropriate screw choices were compared between plan and control groups.Results: The results of appropriate screw choices were 86.1% and 74.8% in the plan group and the control group, respectively. The inappropriate screw choices were 14.0% and 25.2% in the plan group and the control group, respectively. The three-dimensional planning significantly increased appropriate screw choices compared to the conventional planning (p < 0.05).Conclusions: Three-dimensional digital preoperative planning is useful for the optimization of screw lengths in osteosynthesis of distal radius fractures.

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Fixation Strength in Full and Limited Fixation of Osteoporotic Distal Radius Fractures

Hand ◽

10.1177/1558944717708032 ◽

2017 ◽

Vol 13 (4) ◽

pp. 461-465 ◽

Cited By ~ 1

Author(s):

P. Kaveh Mansuripur ◽

Joseph A. Gil ◽

Dale Cassidy ◽

Patrick Kane ◽

Augusta Kluk ◽

...

Keyword(s):

Distal Radius ◽

Peak Load ◽

Distal Radius Fractures ◽

Volar Plate ◽

Fixation Strength ◽

Joint Surface ◽

Clinical Failure ◽

Radius Fractures ◽

Yield Load ◽

Load Peak

Background: The purpose of this investigation is to determine whether osteoporotic intra-articular distal radius fractures surgically treated by filling all 7 distal screws of a volar plate will have a higher load to failure than those treated by filling only 4 distal screws. Methods: Ten matched pairs of fresh frozen cadaveric forearms were randomized within each pair to be treated by using either all 7 of the distal holes of a volar plate or only 4 distal screws. The distal radius fixation was performed with unicortical screws going to but not through the dorsal cortex, and the most distal screws were placed within 4 mm of the joint surface. An AO C2 type fracture was then created. All specimens were tested cyclically, with an axial load of 60 N, at 3 Hz for 1000 cycles to simulate early postoperative motion. All specimens were subsequently tested to mechanical failure. Results: There were no failures in either group during cyclic testing. There was no difference detected between groups for mean stiffness, yield load, peak load, or load to clinical failure. In both groups, the yield load, peak load, and load to clinical failure were higher than the 60- to 100-N forces encountered during postoperative rehabilitation. Conclusions: There was no difference detected between osteoporotic intra-articular distal radius fractures treated by utilizing all 7 of the distal screws of a volar plate compared with those treated with only 4 distal screws.

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Local injection of leukocyte rich platelet rich plasma produced higher radius union scoring system than local injection of pure platelet rich plasma in conservative therapy of intra-articular closed distal radius fractures

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20212502 ◽

2021 ◽

Vol 9 (7) ◽

pp. 1878

Author(s):

I. Made Sunaria ◽

I Wayan Suryanto Dusak ◽

I. Gede Eka Wiratnaya

Keyword(s):

Distal Radius ◽

Conservative Therapy ◽

Platelet Rich Plasma ◽

Distal Radius Fractures ◽

Local Injection ◽

Control Group ◽

P Value ◽

Homogeneity Test ◽

Radius Fractures ◽

Significant Difference

Background: Distal radius fracture often occurs both extra-articular and intra-articular, covering all ages. The use of autologous platelet rich plasma (PRP) consisting of leucocytes rich-PRP (L-PRP) and pure-PRP (P-PRP) thought can help in bone healing process. This study aimed to determine that the administration of L-PRP provides a better healing rate than P-PRP in intra-articular closed distal radius fractures after conservative treatment.Methods: This was a single-blinded experimental study with stratified randomized post-test only group design involving 51 patients with closed distal fractures undergoing closed reduction, consisting of 17 patients per study group. Group 1 received placebo, group 2 received P-PRP, and group 3 with L-PRP. Each group was then re-evaluated using x-ray at week 2, 3, and 6. RUSS score was then measured. Data was analysed using descriptive statistics and normality test, homogeneity test and inferential test were performed to determine the effect of L-PRP, P-PRP on the union rate of fracture distal radius. All obtained data was analysed using SPSS statistics 22 software.Results: Between control and P-PRP group, there was significant difference in mean RUSS with p value of 0.012. Between control and L-PRP injection group, there was a significant difference in mean RUSS with p value of 0.000. Between P-PRP and L-PRP group, there was also significant mean RUSS difference with p value of 0.003.Conclusions: There was a significant difference between the control group given placebo and the group P-PRP and L-PRP in closed fractures of the intraarticular radius after conservative therapy.

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Beneficial Effects of Pulsed Electromagnetic Field during Cast Immobilization in Patients with Distal Radius Fracture

BioMed Research International ◽

10.1155/2020/6849352 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Lucyna Krzyżańska ◽

Anna Straburzyńska-Lupa ◽

Patrycja Rąglewska ◽

Leszek Romanowski

Keyword(s):

Electromagnetic Field ◽

Distal Radius ◽

Upper Limb ◽

Distal Radius Fractures ◽

Control Group ◽

Pulsed Electromagnetic Field ◽

Radius Fractures ◽

Cast Immobilization ◽

Beneficial Effects ◽

Pulsed Electromagnetic

To assess whether pulsed electromagnetic field therapy during cast immobilization of distal radius fractures has beneficial effects on pain and limb function, the study included 52 patients (mean age 60.8 ± 15.0 years) with distal radius fractures treated with cast immobilization. Patients were allocated to a pulsed electromagnetic field group (n = 27) or a control group (n = 25). Pain; forearm and arm circumference; range of motion; disabilities of the arm, shoulder, and hand score; and touch sensation were evaluated on the day of the plaster cast dressing and 3 and 6 weeks after. In comparison to the control group, the pulsed electromagnetic field group reported significant changes after 3 and 6 weeks of treatment: lower pain levels (p=0.0052; p<0.0001, respectively), greater mobility of upper-limb joints, improvement in exteroceptive sensation, and reduction in disability of the upper limb (disabilities of the arm, shoulder, and hand) (p=0.0003; p<0.0001, respectively). Our results suggest that early addition of pulsed electromagnetic field treatment, during cast immobilization of distal radius fractures, has beneficial effects on the pain, exteroceptive sensation, range of motion, and daily functioning of patients.

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The effect of distal radius fractures involving the distal radioulnar articular joint on forearm rotation

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02091-w ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Lingde Kong ◽

Meng Fu ◽

Jian Lu ◽

Yanqing Zhou ◽

Zuzhuo Zhang ◽

...

Keyword(s):

Distal Radius ◽

Articular Surface ◽

Distal Radius Fractures ◽

Control Group ◽

Case Group ◽

Radius Fractures ◽

Forearm Rotation ◽

Sigmoid Notch ◽

Significant Difference ◽

And Control

Abstract Background The objective of this study was to predict the function of the forearm rotation on the basis of the articular surface of the sigmoid notch from three-dimensional reconstruction images. Methods We retrospectively reviewed patients who underwent volar plate fixation for intra-articular distal radius fractures (DRFs) in our institution between January 2017 and July 2019. The 3D image of the sigmoid notch on the fractured distal radius was reconstructed and looked up from the ulnar view to determine the existence of gaps or steps. Patients with or without gaps/steps on the sigmoid notch were included in the case group or control group, respectively. The patients’ basic data and postoperative data were collected and compared. Results A total of 81 patients were included. There were 33 patients in the case group, and 48 patients in the control group. There was no significant difference between the two groups at baseline. The total range of motion (ROM) of rotation in the case group and control group was 130.3 ± 6.2° and 145.3 ± 6.7°, respectively (P < 0.001). The percentage of rotation ROM of contralateral limb in the case group and control group was 72.3 ± 3.1% and 80.7 ± 3.6%, respectively (P < 0.001). VAS during forearm rotation was 2.1 ± 0.7 in the case group, which is significantly higher than that in the control group (1.5 ± 0.5, P < 0.001). Conclusion This study proposed a new method to assess the articular surface of the sigmoid notch which is based on 3D reconstruction images. With the assistance of this method, we found that gaps or steps on the sigmoid notch not only limit forearm pronation rotation and supination rotation, but also cause apparent wrist pain during forearm rotation movement and poor wrist ability.

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The distal radius palmar cortical angle in adolescent versus adult populations

Journal of Orthopaedic Surgery ◽

10.1177/2309499018772378 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901877237

Author(s):

Shane Breheny ◽

Angela Christine Chang ◽

April De Silva ◽

Paul Allcock

Keyword(s):

Distal Radius ◽

Age Groups ◽

Open Reduction Internal Fixation ◽

Distal Radius Fractures ◽

Control Group ◽

Loss Of Function ◽

Radius Fractures ◽

Interclass Correlation ◽

Adolescents And Adults ◽

The Mean

Purpose: Volar distal radius plates are pre-contoured to aid restoration of anatomy during open reduction internal fixation of distal radius fractures. Incorrectly contoured plates can result in malreduction, leading to malunion, pain, and loss of function. The purpose of this study was to investigate whether adolescent distal radius anatomy on the palmar cortical surface differs from that in adults, in order to determine whether adult plates are suitable for use in adolescents. Methods: Lateral wrist radiographs were used to measure the distal radius palmar cortical angle (PCA) in adolescent age groups (12–13, 14–15, and 16–17 years old) and compared to a skeletally mature control group (30–50 years old). Two assessors measured 423 PCAs twice. Results: There was a statistically significant ( p = <0.05) difference in the PCA of the control group compared to each adolescent group. The mean PCA for both males and females decreased as age increased (increasing curvature of the volar distal radius with age). The mean PCA (male/female) was 164.38°/163.00° in ages 12–13, 162.14°/160.92° in ages 14–15, 157.52°/158.18° in ages 16–17, and 149.65°/154.03° in the control group aged 30–50 years. Agreement between assessors was high with an Interclass correlation coefficient (ICC) of 0.97. Conclusion: There is a statistically significant and potentially clinically important difference in the curvature of the distal radius volar cortex between adolescents and adults. This difference persists even in the 16–17 age group. As the PCA curvature is significantly greater in adults compared to adolescents, plates pre-contoured for adults may lead to malreduction of distal radius fractures into flexion in adolescent patients.

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Arthroscopic Management of Intra-articular Ligament Lesions on Distal Radius Fractures

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1730393 ◽

2021 ◽

Vol 49 (01) ◽

pp. 024-036

Author(s):

Marcio Aurelio Aita ◽

Ricardo Kaempf ◽

Bruno Gianordoli Biondi ◽

Gary Alan Montano ◽

Fernando Towata ◽

...

Keyword(s):

Return To Work ◽

Distal Radius ◽

Patient Reported Outcomes ◽

Distal Radius Fractures ◽

Joint Surface ◽

Wrist Arthroscopy ◽

X Rays ◽

Radius Fractures ◽

Patient Reported ◽

The Mean

AbstractArticular distal radius fractures (DRFs) have increased in incidence in recent years, especially among the economically active population. Most of the treatment approaches are based on plain X- rays, and do not give us any information on how to treat these fractures. In the search for solutions with greater precision in diagnosis, in reducing the joint surface of the fracture, and envolving minimally-invasive techniques, we found arthroscopy as the main tool for these patients. Therefore, an enhanced understanding of the biomechanics of the different types of fracture associated with ligamentous lesions should facilitate the right decision regarding the treatment. The present paper aims at providing a management-oriented concept to diagnose and treat ligamentous lesions associated with intra-articular DRFs based on a arthroscopy-assisted procedure, and showing the objective and patient-reported outcomes and a new classification. The objective and patient-reported outcomes were: the mean range of motion (ROM) was of 94.80% on the non-affected side; the mean score on the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was of 3.6 (range: 1 to 12). The score on the Visual Analog Scale (VAS) was of 1.66 (range: 1 to 3). Complications were observed in 2 (13.33%) patients: extensor tendon synovitis in 1 patient, and a limitation (stiffness) in ROM in 1 patient, both treated with wrist arthroscopy release. The mean time until the return to work was of 6.4 weeks. In patients with unstable intra-articular DRFs associated with ligamentous lesions, the fixation of specific osseous-ligamentous fragments and ligamentous repair/reconstruction by wrist arthroscopy prove to be a safe and reliable treatment. The clinical and functional results predict that the patients can return to work more quickly.

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