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Comparison of different intraoperative reduction monitoring methods in a cadaveric intraarticular calcaneal fracture model: 3D scan vs arthroscopy vs nanoscopy

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

Abstract

Aims

Visualization of the subtalar joint surface in surgical management of calcaneal factures remains a big challenge and anatomic reduction of the articular surface is essential for a good clinical outcome. We hypothesize that video-assistance can provide superior fracture reduction compared to fluoroscopy and that nanoscopy (NSC) achieves more extensive visualization compared to fracturoscopy (FSC).

Methods

Ten human cadaveric feet with artificially pre-fractured intraarticular calcaneal fractures with involvement of the posterior facet were treated via a minimal invasive subtalar approach. After initial control of reduction by 2D fluoroscopy, the reduction was further analyzed intraoperatively by FSC and NSC. 3D Scan served as gold standard control of reduction. Need of revision of reduction after the different visualization techniques was recorded and the extent of visualization of the subtalar joint surface in the medio-lateral dimension was compared for FSC and NSC. To quantify access and visualization of the medial and posterior facet, a depth gauge was used to measure from laterally at the clinically widest portion of the calcaneus targeted to the sustentaculum tali. The distance in millimetres was referred to the complete medio-lateral distance seen on paracoronal CT at the widest portion of the calcaneus.

Results

Fracture analysis in preoperative CT-scans according to Sanders classification revealed four type IC, two IIA, three IIC and one IIIAC fractures. Mean visualization of the medial and posterior facet was significantly improved with NSC (30.4 ± 3.78 mm) compared to FSC (23.6 ± 6.17 mm) (p = 0.008). An imperfect reduction requiring revision was more often required with NSC compared to FSC. Insufficient reduction using video-assistance was found in two cases.

Conclusion

In order to optimize subtalar joint reduction and congruency, video-assisted techniques, especially NSC, provide superior visualization and thus can improve reduction in the surgical treatment of intraarticular calcaneal fractures.

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Acknowledgements

None.

Funding

This research project was funded by Arthrex Inc. Arthrex GmbH, Siemens Healthineers, Deutsche Kniegesellschaft.

Author information

Author notes

  1. Dehoust Julius, Berninger Markus Thomas contributed equally.

Authors and Affiliations

  1. Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Bergedorfer Straße 10, 21033, Hamburg, Germany

    Julius Dehoust, Nico Hinz, Karl-Heinz Frosch & Maximilian Hartel

  2. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Markus Thomas Berninger, Peter Behrendt, Grégoire Thürig, Fidelius von Rehlingen-Prinz, Karl-Heinz Frosch & Maximilian Hartel

  3. Department of Trauma Surgery, Orthopedics and Sports Orthopedics, St. Georg, Hamburg, Germany

    Peter Behrendt

  4. Institute of Anatomy, Christian-Albrechts-University, Kiel, Germany

    Peter Behrendt

  5. Department of Orthopedics and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland

    Grégoire Thürig

  6. Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Jan-Hendrik Christensen

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  1. Julius Dehoust
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Contributions

Conceptualization JD, MB, PB, KHF, MJH; methodology JD, MB, PB, KHF, MJH; validation JD, MB, PB, KHF, MJH; formal analysis JD, MB; investigation JD, MB, PB, KHF, MJH, JK, GT, FRP; writing—original draft preparation JD, MB; writing—review and editing. All authors; visualization JD, MB, PB, NH; supervision KHF, MJH.; project administration JD, MB, PB, KHF, MJH; funding acquisition PB, KHF, MJH. All authors have read and agreed to the final version of this manuscript.

Corresponding author

Correspondence to Julius Dehoust.

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Conflict of interest

The authors declare that this study was supported by Arthrex Inc. and Siemens. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. PB and GT received a fellowship by the German Knee Society (DKG) financed by Arthrex during the study.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the institutional Ethics Committee of the University of Hamburg.

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Dehoust, J., Berninger, M.T., Behrendt, P. et al. Comparison of different intraoperative reduction monitoring methods in a cadaveric intraarticular calcaneal fracture model: 3D scan vs arthroscopy vs nanoscopy. Eur J Trauma Emerg Surg 49, 2561–2567 (2023). https://doi.org/10.1007/s00068-023-02330-9

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  • DOI: https://doi.org/10.1007/s00068-023-02330-9

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