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Vorteile der intraoperativen 3D-Bildgebung

Oberes-Sprunggelenk- und Pilon-tibiale-Frakturen

Benefits of intraoperative 3D imaging

Upper ankle and tibial pilon fractures

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die intraoperative 3D-Bildgebung mit mobilen C-Bögen ist mittlerweile seit 10 Jahren im klinischen Einsatz. Neben komplexen anatomischen Regionen kommt sie häufig bei der Versorgung von OSG- (oberes Sprunggelenk) und Pilon-tibiale-Frakturen zur Anwendung. Hier lässt sich mit diesem Verfahren neben dem Repositionsergebnis der Fraktur und der Stellung der Syndesmose auch die Implantatlage beurteilen. Im eigenen Patientengut zeigte sich im Zeitraum von 2001–2009 ein Prozentsatz an intraoperativen Konsequenzen nach 3D-Scan von etwa 30%, was sich mit den Veröffentlichungen anderer Autoren deckt. Deswegen setzte sich die intraoperative 3D-Bildgebung in unserer Klinik als Routineverfahren bei diesen Indikationen durch.

Abstract

Intraoperative three-dimensional (3D) imaging with mobile c-arms has been in clinical practice for 10 years. In addition to other complex anatomic regions, it is often used in the surgical treatment of upper ankle and pilon tibiale fractures. Reduction of the fracture and the syndesmotic region as well as the position of the implant can be assessed. Our own data from 2001 to 2009 show a rate of intraoperative consequences following 3D scanning of approximately 30%. This is in accordance with the results reported by other authors. Therefore, intraoperative 3D imaging is established as a standard procedure in the treatment of these injuries in our trauma center.

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Literatur

  1. Anglen JO (1999) Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma 13(2):92–97

    Article  PubMed  CAS  Google Scholar 

  2. Atesok K, Finkelstein J, Khoury A et al (2007) The use of intraoperative three-dimensional imaging (ISO-C-3D) in fixation of intraarticular fractures. Injury 38:1163–1169

    Article  PubMed  CAS  Google Scholar 

  3. Beumer A, Hemert WL van, Niesing Ret al (2004) Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res 423:227–234

    Article  PubMed  Google Scholar 

  4. Beumer A, Swierstra BA (2003) The influence of ankle positioning on the radiography of the distal tibial tubercles. Surg Radiol Anat 25:446–450

    Article  PubMed  CAS  Google Scholar 

  5. Brage ME, Bennett CR, Whitehurst JB et al (1997) Observer reliability in ankle radiographic measurements. Foot Ankle Int 18:324–329

    PubMed  CAS  Google Scholar 

  6. Cottom JM, Hyer CF, Philbin TM, Berlet GC (2008) Treatment of syndesmotic disruptions with the Arthrex Tightrope: a report of 25 cases. Foot Ankle Int 29:773–780

    Article  PubMed  Google Scholar 

  7. Cottom JM, Hyer CF, Philbin TM, Berlet GC (2009) Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and endobutton to traditional screw fixation in 50 cases. J Foot Ankle Surg 48:620–630

    Article  PubMed  Google Scholar 

  8. Curtis MJ, Michelson JD, Urquhart MW et al (1992) Tibiotalar contact and fibular malunion in ankle fractures. A cadaver study. Acta Orthop Scand 63:326–329

    Article  PubMed  CAS  Google Scholar 

  9. Ebraheim NA, Lu J, Yang H et al (1997) Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int 18:693–698

    PubMed  CAS  Google Scholar 

  10. Ebraheim N, Sabry FF, Mehalik JN (2000) Intraoperative imaging of the tibial plafond fracture: a potential pitfall. Foot Ankle Int 21:67–72

    PubMed  CAS  Google Scholar 

  11. Ebraheim NA, Elgafy H, Padanilam T (2003) Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury. Clin Orthop Relat Res 409:260–267

    Article  PubMed  Google Scholar 

  12. Geerling J, Kendoff D, Citak M et al (2009) Intraoperative 3D imaging in calcaneal fracture care – clinical implications and decision making. J Trauma 66:768–773

    Article  PubMed  Google Scholar 

  13. Graves ML, Kosko J, Barei DP et al (2011) Lateral ankle radiographs: do we really understand what we are seeing? J Orthop Trauma 25:106–109

    Article  PubMed  Google Scholar 

  14. Hamid N, Loeffler BJ, Braddy W et al (2009) Outcome after fixation of ankle fractures with an injury to the syndesmosis: the effect of the syndesmosis screw. J Bone Joint Surg Br 91:1069–1073

    Article  PubMed  CAS  Google Scholar 

  15. Harper MC, Keller TS (1989) A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle Int 10:156–160

    CAS  Google Scholar 

  16. Jenkinson RJ, Sanders DW, Macleod MD et al (2005) Intraoperative diagnosis of syndesmosis injuries in external rotation ankle fractures. J Orthop Trauma 19:604–609

    Article  PubMed  Google Scholar 

  17. Kaye RA (1989) Stabilization of ankle syndesmosis injuries with a syndesmosis screw. Foot Ankle Int 9:290–293

    CAS  Google Scholar 

  18. Kendoff D, Citak M, Gardner MJ et al (2009) Intraoperative 3D imaging: value and consequences in 248 cases. J Trauma 66:232–238

    Article  PubMed  Google Scholar 

  19. Leeds HC, Ehrlich MG (1984) Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg Am 66:490–503

    PubMed  CAS  Google Scholar 

  20. Muratli HH, Biçimoğlu A, Celebi L et al (2005) Magnetic resonance arthrographic evaluation of syndesmotic diastasis in ankle fractures. Arch Orthop Trauma Surg 125:222–227

    Article  PubMed  Google Scholar 

  21. Oae K, Takao M, Naito K et al (2003) Injury of the tibiofibular syndesmosis: value of MR imaging for diagnosis. Radiology 227:155–161

    Article  PubMed  Google Scholar 

  22. Pneumaticos SG, Noble PC, Chatziioannou SN, Trevino SG (2002) The effects of rotation on radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle Int 23:107–111

    PubMed  Google Scholar 

  23. Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 58:356–357

    PubMed  CAS  Google Scholar 

  24. Richter M, Zech S (2003) Intraoperative 3-dimensional imaging in foot and ankle trauma-experience with a second-generation device (ARCADIS-3D). J Orthop Trauma 23:213–220

    Article  Google Scholar 

  25. Richter M, Geerling J, Zech S et al (2005) Intraoperative three-dimensional imaging with a motorized mobile C-arm (SIREMOBIL ISO-C-3D) in foot and ankle trauma care: a preliminary report. J Orthop Trauma 19:259–266

    Article  PubMed  Google Scholar 

  26. Rock C, Linsenmaier U, Brandl R et al (2001) Vorstellung eines neuen mobilen C-Bogen-/CT-Kombinationsgerät (ISO-C-3D) – Erste Ergebnisse der 3D-Schnittbildgebung. Unfallchirurg 104:827–833

    Article  PubMed  CAS  Google Scholar 

  27. Robert RS (1983) Surgical treatment of displaced ankle fractures. Clin Orthop Relat Res 172:164–169

    Google Scholar 

  28. Rübberdt A, Feil R, Stengel D et al (2006) Die klinische Wertigkeit des ISO-C3D bei der Osteosynthese des Fersenbeins. Unfallchirurg 109:112–118

    Article  PubMed  Google Scholar 

  29. Taser F, Shafiq Q, Ebraheim NA (2006) Three-dimensional volume rendering of tibiofibular joint space and quantitative analysis of change in volume due to tibiofibular syndesmosis diastases. Skeletal Radiol 35:935–941

    Article  PubMed  CAS  Google Scholar 

  30. Tornetta P, Gorup J (1996) Axial computed tomography of pilon fractures. Clin Orthop Relat Res 323:273–276

    Article  PubMed  Google Scholar 

  31. Wich M, Spranger N, Ekkernkamp A (2004) Intraoperative Bildgebung mit dem ISO C3D. Chirurg 75:982–987

    Article  PubMed  CAS  Google Scholar 

  32. Wikerøy AKB, Høiness PR, Andreassen GS et al (2010) No difference in functional and radiographic results 8.4 years after quadricortical compared with tricortical syndesmosis fixation in ankle fractures. J Orthop Trauma 24:17–23

    Article  PubMed  Google Scholar 

  33. Xenos JS, Hopkinson WJ, Mulligan ME et al (1195) The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am 77:847–856

    Google Scholar 

  34. Yablon IG, Leach RE (1989) Reconstruction of malunited fractures of the lateral malleolus. J Bone Joint Surg Am 71:521–527

    PubMed  CAS  Google Scholar 

  35. Zwipp H (2004) Techniken Syndesmoseninsuffizienz. Videosymposium MHH Unfallchirurgie, Hannover, S 25–26

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin:

Der Autor gibt an, dass ein Kooperationsvertrag mit der Firma Siemens zur Erforschung, Evaluierung und Einführung von neuen Technologien, Produkten und Applikationen im Bereich der medizinischen Bildgebung und bildgeführten Chirurgie besteht.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Unfallchirurgische Klinik, Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland

    J. Franke, J. von Recum, P.A. Grützner & K. Wendl

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  1. J. Franke
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  2. J. von Recum
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  3. P.A. Grützner
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  4. K. Wendl
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Correspondence to J. Franke.

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Franke, J., von Recum, J., Grützner, P. et al. Vorteile der intraoperativen 3D-Bildgebung. Trauma Berufskrankh 13, 160–165 (2011). https://doi.org/10.1007/s10039-011-1750-z

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