Utility of 3-Dimensional Intraoperative Imaging in Pelvic and Acetabular Fractures

AbstractPelvic fractures may range from highly severe, life-threatening injuries to less acute clinical entities. There are several sub-entities that are summed up as pelvic injuries. Anatomically, there are fractures of the anterior or posterior pelvic ring. Apart from these, there are fractures of the acetabulum that make up about one fifth of all pelvic injuries. The indication for surgical treatment of pelvic ring injuries depends on the type of injury, involvement of anterior and/or posterior elements of the pelvic ring, demands and the general condition of the patient. In acetabular fractures, indications depend on the dislocation of the fracture and of course also the needs of the patient and his general condition. An intraarticular step-off of more than 2 mm is usually considered as an indication for open reduction and osteosynthesis. Usually in all these injuries, a preoperative CT scan is mandatory to allow precise planning of the operative approach and technique. Intraoperatively, the surgeon should be familiar with the acquisition of the 2D standard views, including 2D imaging of the pelvic ring and the acetabulum. These consist of the anteroposterior view for both pelvic ring and acetabular osteosyntheses. For further assessment of pelvic ring treatments, inlet and outlet views are achievable by angulating the C-arm cranially and caudally. To assess aspects of the anterior and posterior column of the acetabulum, iliac oblique views are used. Here, the C-arm is rotated laterally. As evaluation of 2D views can be limited due to anatomy and superposing structures, intraoperative 3D imaging has become common in the last decade. Special C-arms allow the automatic acquisition of large numbers of projections and create CT-like views of the central volume. Although this method has significantly widened the possibilities of intraoperative imaging, some issues remain. Depending on the amount of implants placed in the imaging field, assessment can be seriously impaired due to artefacts caused by the implants. Intraoperative CT imaging promises enhanced image quality for artefacts and allows a considerably larger field of view. The use of radiation-free navigation facilitates implant placement in minimally invasive procedures like screw placement in the sacroiliacal joint or the acetabulum by visualisation of instruments and implants in a pre- or intraoperative 3D data set.

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Fixation of Superomedially Displaced Acetabular Fractures Using an Anatomical Suprapectineal Quadrilateral Surface Plate Through Modified Stoppa Approach

10.21203/rs.3.rs-1214030/v1 ◽

2022 ◽

Author(s):

Dae-Kyung Kwak ◽

Seunghun Lee ◽

Yongmin Lee ◽

Ji-Hyo Hwang ◽

Je-Hyun Yoo

Keyword(s):

Surgical Outcomes ◽

Operation Time ◽

Acetabular Fractures ◽

3 Dimensional ◽

Vas Score ◽

Stoppa Approach ◽

Post Traumatic ◽

The Mean ◽

Traumatic Arthritis

Abstract Treatment of superomedially displaced acetabular fractures including a quadrilateral surface (QLS) is challenging. We present a surgical technique using an anatomical suprapectineal QLS plate through the modified Stoppa approach and report the availability of this plate to treat this fracture type along with the surgical outcomes. Thirteen consecutive patients (11 men and 2 women) who underwent surgical treatment using an anatomical suprapectineal QLS plate through a modified Stoppa approach for superomedially displaced acetabular fractures between June 2018 and June 2020, were enrolled retrospectively. These fractures included 10 both-column fractures and 3 anterior-column and posterior hemitransverse fractures, which were confirmed on preoperative 3-dimensional computed tomography. Surgical outcomes were clinically assessed using the Postel Merle d’Aubigné (PMA) score and visual analog scale (VAS) score at the final follow-up, and radiological evaluations were performed immediately after the operation and at the final follow-up. The follow-up period was longer than 1 year in all patients with a mean 22.9 months. The mean operation time was 103 min. Anatomical reduction was achieved in 11 (84.6%) patients, while imperfect reduction was achieved in the remaining two (15.3%) patients. At the final follow-up, radiographic grades were excellent, fair, and poor in 11 (84.6%), one (7.6%), and one patient, respectively. The mean PMA score was 16.3 (range, 13-18) and the mean VAS score was 1.0 (range, 0-3). No secondary reduction loss or implant loosening was observed. However, two patients underwent conversion to total hip arthroplasty due to post-traumatic arthritis and subsequent joint pain. No other complications were observed. Simultaneous reduction and fixation using an anatomical suprapectineal QLS plate through the modified Stoppa approach can provide satisfactory outcomes in superomedially displaced acetabular fractures, resulting in shorter operation times and fewer complications.

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Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

Acta Orthopaedica ◽

10.3109/17453674.2015.1055690 ◽

2015 ◽

Vol 86 (6) ◽

pp. 684-689 ◽

Cited By ~ 11

Author(s):

Henrik Eckardt ◽

Dennis Lind ◽

Erik Toendevold

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Acetabular Fractures ◽

3 Dimensional

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Mandibular Fractures: Diagnosis and Management

Seminars in Plastic Surgery ◽

10.1055/s-0041-1735818 ◽

2021 ◽

Author(s):

Kanvar Panesar ◽

Srinivas M. Susarla

Keyword(s):

Fracture Fixation ◽

Intraoperative Imaging ◽

Surgical Anatomy ◽

Mandibular Fractures ◽

Non Union ◽

3 Dimensional ◽

Diagnosis And Management ◽

Facial Esthetics ◽

And Function ◽

Fixation Principles

AbstractAccurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.

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Intraoperative Cerebral Angiography by Intravenous Contrast Administration With 3-Dimensional Rotational Fluoroscopy in Patients With Intracranial Aneurysms

Operative Neurosurgery ◽

10.1227/neu.0000000000000648 ◽

2015 ◽

Vol 11 (1) ◽

pp. 119-126

Author(s):

Thomas Westermaier ◽

Thomas Linsenmann ◽

Almuth F Keßler ◽

Christian Stetter ◽

Nadine Willner ◽

...

Keyword(s):

Image Quality ◽

Contrast Agent ◽

Intracranial Aneurysms ◽

Intraoperative Imaging ◽

Image Acquisition ◽

Acquisition Time ◽

Contrast Administration ◽

Intravenous Contrast ◽

Large Space ◽

3 Dimensional

Abstract BACKGROUND Intraoperative imaging of cerebral aneurysms may be desirable in emergency situations with large space-occupying hematomas or to visualize vessels after clip placement. Mobile 3-dimensional fluoroscopes are available in a number of neurosurgical departments and may be useful in combination with simple image postprocessing to depict cerebral vessels. OBJECTIVE To assess whether intracranial aneurysms are detectable with appropriate image quality with intraoperative 3-dimensional fluoroscopy with intravenous contrast administration. METHODS Eight patients were included in the study. The patients' heads were fixed in a radiolucent Mayfield clamp. First, a rotational fluoroscopy scan was performed without contrast agent. Then, a second scan with 50 mL iodine contrast agent was performed. The DICOM (digital imaging and communications in medicine) data of both scans were transferred to an Apple PowerMac workstation, subtracted, and reconstructed with OsiriX imaging software. The images were compared with preoperative angiograms. RESULTS No adverse effects were observed during contrast administration. The entire procedure from fluoroscope positioning to the production of usable 3-dimensional images took 5 to 6 minutes with an image acquisition time of 2 × 24 seconds. The configuration of the aneurysm and the vessel anatomy were assessable. Previous coiling limited image quality in 1 patient. CONCLUSION This technique quickly provides images of adequate quality to assess the configuration of intracranial aneurysms, which may be helpful when immediate intraoperative information about intracranial vessel pathologies is required. The positioning of the fluoroscope, image acquisition, and processing can be completely integrated into the surgical workflow.

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Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate

BioMed Research International ◽

10.1155/2017/8231301 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

R. J. Egli ◽

M. J. B. Keel ◽

J. L. Cullmann ◽

J. D. Bastian

Keyword(s):

Hip Joint ◽

Fracture Fixation ◽

Intraoperative Imaging ◽

Weight Bearing ◽

Operating Time ◽

Screw Placement ◽

Acetabular Fractures ◽

Partial Weight Bearing ◽

Partial Weight ◽

Buttress Plate

Acetabular fractures involving predominantly the anterior column associated with a disruption of the quadrilateral surface can be treated with instrumentation implementing the stabilization of the quadrilateral surface. The recently introduced suprapectineal quadrilateral buttress plate is specifically designed to prevent secondary medial subluxation of the femoral head, especially in elderly patients with reduced ability for partial weight bearing. Whereas there are guidelines available for safe screw fixation for the anterior and posterior columns, there might be a concern for intra-articular placement of screws placed through the infrapectineal part of the quadrilateral buttress plate. Within this report we analyzed retrospectively screw placement in 30 plates in postoperative CT scans using algorithms for metal artifact reduction. None of the screws of the buttress plate penetrated the hip joint. We describe the placement, length, and spatial orientation of the screws used for fracture fixation and suggest that the use of intraoperative image intensifiers with a combined inlet-obturator view of 30–45° best projects the screws and the hip joint. Preoperative knowledge of approximate screw placement and information for accurate intraoperative imaging may contribute to safe acetabular fracture fixation and may reduce operating time and limit radiation exposure to the patient and the personnel. This trial is registered with KEK-BE: 266/2014.

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Intra-Operative 3-Dimensional Imaging (O-arm) in Foot and Ankle Trauma Surgery: Report of 2 Cases and Review of the Literature

The Open Orthopaedics Journal ◽

10.2174/1874325001913010189 ◽

2019 ◽

Vol 13 (1) ◽

pp. 189-197

Author(s):

L. Jeyaseelan ◽

F. Malagelada ◽

L. Parker ◽

A. Panagopoulos ◽

N. Heidari ◽

...

Keyword(s):

Lower Limb ◽

Intraoperative Imaging ◽

X Rays ◽

Pilon Fracture ◽

Aofas Score ◽

3 Dimensional ◽

Articular Fractures ◽

Major Trauma Centre ◽

Limb Trauma ◽

Lower Limb Trauma

Background: Intraoperative two-dimensional (2D) fluoroscopy is the standard imaging modality available to orthopaedic surgeons worldwide. It is well-accepted, however, multiplanar 3 dimensional (3D) CT scanning is superior to 2D imaging for visualising joint surfaces and is now a fundamental feature of the pre-operative planning of intra-articular fractures. Objective: We present two cases in which the use of 3D intraoperative imaging and the O-arm® (Medtronic, Minneapolis, USA) led to immediate intraoperative revision to optimise fixation and articular congruity. A review of the current literature is also provided. Methods: During the trial period of the O-arm at our major trauma centre, intra-operative imaging was used in the lower limb trauma setting. The O-arm was used intra-operatively in a comminuted pilon fracture and a displaced talus fracture. We recorded all the intra-operative events, including quality of reduction, implant positioning and operation time. Each patient was followed-up for 12 months post-operation and was finally assessed with x-rays and the AOFAS score. Results: In both the cases, either fracture reduction or the implant position/usage that was observed with 2D fluoroscopy was revised following a 3D intra-operative scan. No postoperative complications were noted and the healing process was uneventful. X-rays at the final follow-up were excellent and acceptable for the talus and pilon fracture, respectively, with corresponding clinical results and AOFAS score. Conclusion: Although frequently used in spinal surgery, to the best of our knowledge, the use of intra-operative 3D techniques in lower limb trauma is sparse and sporadically reported. We present our cases in which the most current innovative imaging techniques influenced intra-operative outcomes without compromising patient safety. We feel that this is a real example of how innovation can positively influence patient care.

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Three-Dimensional Reconstruction Using Stereo Pairs from Serial Thick Sections

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100080249 ◽

1977 ◽

Vol 35 ◽

pp. 562-563

Author(s):

Robert Glaeser ◽

Thomas Bauer ◽

David Grano

Keyword(s):

Three Dimensional ◽

Dimensional Structure ◽

Serial Sections ◽

Thin Sections ◽

3 Dimensional ◽

Transmission Electron ◽

Freeze Dried ◽

Dimensional Reconstruction ◽

Stereo Imagery ◽

Whole Mounts

In transmission electron microscopy, the 3-dimensional structure of an object is usually obtained in one of two ways. For objects which can be included in one specimen, as for example with elements included in freeze- dried whole mounts and examined with a high voltage microscope, stereo pairs can be obtained which exhibit the 3-D structure of the element. For objects which can not be included in one specimen, the 3-D shape is obtained by reconstruction from serial sections. However, without stereo imagery, only detail which remains constant within the thickness of the section can be used in the reconstruction; consequently, the choice is between a low resolution reconstruction using a few thick sections and a better resolution reconstruction using many thin sections, generally a tedious chore. This paper describes an approach to 3-D reconstruction which uses stereo images of serial thick sections to reconstruct an object including detail which changes within the depth of an individual thick section.

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Structural preservation and absolute contrast of catalase crystal sections prepared with tannic acid

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010007597x ◽

1983 ◽

Vol 41 ◽

pp. 448-449

Author(s):

C.W. Akey ◽

M. Szalay ◽

S.J. Edelstein

Keyword(s):

Tannic Acid ◽

Beef Heart ◽

X Rays ◽

Screw Axis ◽

General Applicability ◽

Thin Sections ◽

Beef Liver ◽

3 Dimensional ◽

Dimensional Reconstruction ◽

Structural Preservation

Three methods of obtaining 20 Å resolution in sectioned protein crystals have recently been described. They include tannic acid fixation, low temperature embedding and grid sectioning. To be useful for 3-dimensional reconstruction thin sections must possess suitable resolution, structural fidelity and a known contrast. Tannic acid fixation appears to satisfy the above criteria based on studies of crystals of Pseudomonas cytochrome oxidase, orthorhombic beef liver catalase and beef heart F1-ATPase. In order to develop methods with general applicability, we have concentrated our efforts on a trigonal modification of catalase which routinely demonstrated a resolution of 40 Å. The catalase system is particularly useful since a comparison with the structure recently solved with x-rays will permit evaluation of the accuracy of 3-D reconstructions of sectioned crystals.Initially, we re-evaluated the packing of trigonal catalase crystals studied by Longley. Images of the (001) plane are of particular interest since they give a projection down the 31-screw axis in space group P3121. Images obtained by the method of Longley or by tannic acid fixation are negatively contrasted since control experiments with orthorhombic catalase plates yield negatively stained specimens with conditions used for the larger trigonal crystals.

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