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3D-navigierte Fersenbeinosteosynthese

Offene und minimal-invasive Technik

3D navigated osteosynthesis of calcaneal fractures

Open and minimally invasive techniques

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Zusammenfassung

Hintergrund

Als Arbeitshypothese wird formuliert, dass Fehlplatzierungen gelenknah positionierter Sustentakulumschrauben im Rahmen der Osteosynthese von intraartikulären Fersenbeinfrakturen prinzipiell vermieden werden können. Hierzu werden ein Verfahren zur 3D-navigierten Implantation von Sustentakulumschrauben vorgestellt und erste Ergebnisse präsentiert.

Material und Methoden

Bei 11 Patienten wurden insgesamt 15 intraartikuläre Fersenbeinfrakturen operativ 3D-navigiert (3D-Bildwandler mit integrierter Navigation) versorgt. Bei 12 Frakturen erfolgte die Osteosynthese über einen“extended lateral approach”, bei 3 weiteren in minimal-invasiver Technik. Ein zweiter intraoperativer 3D-Scan dokumentierte das definitive Osteosyntheseergebnis.

Ergebnisse

Insgesamt wurden 20 Sustentakulumschrauben 3D-navigiert implantiert. Alle Schrauben lagen präzise im Sustentakulumfragment ohne Gelenkkontakt. Der Einsatz der Navigation bedingte eine durchschnittliche Verlängerung der Operationszeit um 11,9±2,2 Minuten.

Schlussfolgerung

Durch die Synthese von intraoperativer bildwandlergestützter 3D-Bildgebung und -Navigation ist die Implantation von Sustentakulumschrauben präzise möglich. Dadurch kann bei minimal-invasiver Operationstechnik eine hohe Osteosynthesequalität erreicht werden.

Abstract

Background

It is hypothesized that misplacement of sustentacular screws during osteosynthesis of intraarticular calcaneal fractures can be reduced with the help of navigation. A method for three-dimensional (3D) navigated placement of sustentacular screws for treating intraarticular calcaneal fractures is presented and evaluated.

Material and Methods

11 consecutive patients with 15 intraarticular calcaneal fractures were treated using 3D navigation. In 12 cases osteosynthesis was done through an extended lateral approach; in three cases, it was achieved through a minimally invasive percutaneous approach. For verification and documentation of the placed screws, a second 3D scan was performed.

Results

A total of 20 screws were placed using 3D navigation. None of the navigated screws was misplaced. Extra operating time due to navigation averaged 11.9 minutes (±2.2 min).

Conclusion

Through a combination of intraoperative 3D imaging and navigation, placement of sustentacular screws is possible and can yield precise and reliable results. Especially in minimally invasive treatment, a high quality of osteosynthesis can be achieved.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyer Str. 1, 48149, Münster, Deutschland

    A. Rübberdt, V.R. Hofbauer, M. Herbort, L. Löhrer, S. Ochman & M.J. Raschke

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  1. A. Rübberdt
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  2. V.R. Hofbauer
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  3. M. Herbort
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  4. L. Löhrer
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  5. S. Ochman
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  6. M.J. Raschke
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Correspondence to A. Rübberdt.

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Rübberdt, A., Hofbauer, V., Herbort, M. et al. 3D-navigierte Fersenbeinosteosynthese. Unfallchirurg 112, 15–22 (2009). https://doi.org/10.1007/s00113-008-1520-y

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  • DOI: https://doi.org/10.1007/s00113-008-1520-y

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