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Comparison of intraoperative 2D vs. 3D imaging in open reduction and fixation of distal radius fractures

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

In the volar plating of distal radius fractures, intraoperative three-dimensional (3D) imaging is designed to allow better judgment regarding screw and implant positioning compared with conventional intraoperative two-dimensional (2D) imaging. We evaluated the impact of these two imaging modalities on the rates of intraoperative revision and secondary surgery, as well as the need for implant removal during follow-up.

Methods

A retrospective analysis of consecutive patients who underwent volar plate osteosynthesis for isolated distal radius fractures between January 2008 and April 2016 was performed. Patient files were evaluated for intraoperative imaging findings, intraoperative and postoperative revision rates, and implant removal during follow-up. Additional analyses of radiation exposure, operation time, and hospitalization time were performed.

Results

A total of 314 patients were analyzed (mean age: 54 ± 19 years; 210 females). For 246 patients, only 2D imaging was performed, while the remaining 68 patients underwent both 2D and 3D imaging (O-Arm, Medtronic). The intraoperative revision rate was significantly (p < 0.001) higher with 3D imaging (32.4%) compared with 2D imaging (2.0%). The postoperative revision rates were similar between both the groups (2.9% vs. 2.0%; p = 0.674). Compared with 2D imaging, the use of the Medtronic O-Arm resulted in a significantly lower implant removal rate (8.8% vs. 18.7%; p = 0.036) during follow-up.

Conclusion

Compared with conventional 2D imaging, the use of intraoperative 3D imaging significantly increased the intraoperative revision rate and has the potential for positive long-term effects for lowering the risk of requiring an implant removal.

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Funding

No benefits or funding have been received or will be received from a commercial party, related directly or indirectly, to the subject of this article.

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Authors and Affiliations

  1. Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St.Gallen, Rorschacher Strasse 95, 9007, St.gallen, Switzerland

    Diego Hammerle

  2. Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

    Georg Osterhoff

  3. Klinik für Traumatologie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland

    Florin Allemann

  4. Ortho Clinic Zürich, Seestrasse 315, 8038, Zurich, Switzerland

    Clement Max Léonard Werner

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  1. Diego Hammerle
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  4. Clement Max Léonard Werner
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Corresponding author

Correspondence to Diego Hammerle.

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Ethical approval

The study has been conducted in compliance with ethical standards. This study was conducted following approval from the local ethics committee and was performed in accordance with the principles of the Declaration of Helsinki.

Conflict of interest

Diego Hammerle, Georg Osterhoff, Florin Allemann and Clement Werner declare that they have no conflict of interest.

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Only patients that signed an informed consent to have their data used for research oat the University Hospital of Zürich where included in this study.

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Hammerle, D., Osterhoff, G., Allemann, F. et al. Comparison of intraoperative 2D vs. 3D imaging in open reduction and fixation of distal radius fractures. Eur J Trauma Emerg Surg 46, 557–563 (2020). https://doi.org/10.1007/s00068-018-1036-2

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