The purpose of this study was to analyze the practicability and benefit of intraoperative C-arm computed tomography (CT) imaging in volar plate osteosynthesis of unstable distal radius fractures. During a 1 year period, intraoperative three dimensional (3D) imaging with the ARCADIS Orbic 3D was performed in addition to standard fluoroscopy in 51 cases. The volar angular stable plate oesteosyntheses were analyzed intraoperatively and, if necessary, improved immediately. The duration of the scan and radiation exposure dose were measured. On average, performance of the scan and analysis of the CT dataset took 6.7 minutes. In 31.3% of the surgeries a misplacement of screws was detected and correction was done immediately. C-arm CT imaging can easily be integrated in the normal course of surgery. As a complement to the standard 2D-fluoroscopy, the C-arm CT is a useful tool to evaluate the quality of osteosynthesis.
AtesokKFinkelsteinJKhouryA. The use of intraoperative three-dimensional imaging (ISO-C-3D) in fixation of intraarticular fractures. Injury. 2007, 38: 1163–9.
2.
CarelsenBHaverlagRUbbinkDTLuitseJSGoslingsJC. Does intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery?Arch Orthop Trauma Surg. 2008, 128: 1419–24.
3.
ChenNCJupiterJB. Management of distal radial fractures. J Bone Joint Surg Am. 2007, 89: 2051–62.
4.
DrobetzHBryantALPokornyTSpitalerRLeixneringMJupiterJB. Volar fixed-angle plating of distal radius extension fractures: influence of plate position on secondary loss of reduction – a biomechanic study in a cadaveric model. J Hand Surg Am. 2006, 31: 615–22.
5.
DyCJYoungKCCarlsonMG. The maximum distal and ulnar position of a fixed-angle plate to avoid intra-articular penetration: a cadaveric study. J Hand Surg Eur. 2012, 37: 895–7.
6.
EulerEWirthSLinsenmaierUMutschlerWPfeiferKJHebeckerA. Comparative study of the quality of C-arm based 3D imaging of the talus. Unfallchirurg. 2001, 104: 839–46.
7.
FarshadMHessFNagyLSchweizerA. Corrective osteotomy of distal radial deformities: a new method of guided locking fixed screw positioning. J Hand Surg Eur. 2013, 38: 29–34.
8.
GavaskarASMuthukumarSChowdaryN. Fragment-specific fixation for complex intra-articular fractures of the distal radius: results of a prospective single-centre trial. J Hand Surg Eur. 2012, 37: 765–71.
9.
HüfnerTStübigTGöslingTKendoffDGeerlingJKrettekC. Cost-benefit analysis of intraoperative 3D imaging. Unfallchirurg. 2007, 110: 14–21.
10.
KotsianosDWirthSFischerT. 3D imaging with an isocentric mobile C-arm comparison of image quality with spiral CT. Eur Radiol. 2004, 14: 1590–5.
11.
LinsenmaierURockCEulerE. Three-dimensional CT with a modified C-arm image intensifier: feasibility. Radiology. 2002, 224: 286–92.
12.
MeierRKfuriMJrGeerlingJHufnerTKrimmerHKrettekC. Intraoperative three-dimensional imaging with an isocentric C-arm at the wrist. Handchir Mikrochir Plast Chir. 2005, 37: 256–9.
13.
OrbayJ. Volar plate fixation of distal radius fractures. Hand Clin. 2005, 21: 347–54.
14.
ParkDHGoldieBS. Volar plating for distal radius fractures – do not trust the image intensifier when judging distal subchondral screw length. Tech Hand Up Extrem Surg. 2012, 16: 169–72.
15.
RichterMGeerlingJZechSGoeslingTKrettekC. Intraoperative three-dimensional imaging with a motorized C-arm (SIREMOBIL ISO-C-3D) in foot and ankle trauma care: a preliminary report. J Orthop Trauma. 2005, 19: 259–66.
16.
RichterMZechS. Intraoperative 3-dimensional imaging in foot and ankle trauma-experience with a second-generation device (ARCADIS-3D). J Orthop Trauma. 2009, 23: 213–20.
17.
RiddickAPHickeyBWhiteSP. Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation. J Hand Surg Eur. 2012, 37: 407–11.
18.
RockCKotsianosDLinsenmaierU. Studies on image quality, high contrast resolution and dose for the axial skeleton and limbs with a new, dedicated CT system (ISO-C-3D). Rofo. 2002, 174: 170–6.
19.
RübbertAFeilRStengelD. The clinical use of the ISO-C(3D) imaging system in calcaneus fracture surgery. Unfallchirurg. 2006, 109: 112–8.
20.
SügünTSKarabayNGürbüzYOzaksarKTorosTKayalarM. Screw prominences related to palmar locking plating of distal radius. J Hand Surg Eur. 2011, 36: 320–4.
21.
TakemotoRCGageMJRybakLWalshMEgolKA. Articular cartilage skiving: the concept defined. J Hand Surg Eur. 2011, 36: 364–9.
22.
von RecumJWendlKGrütznerPAVockBKorberJWentzensenA. Distal fractures of the radius. Intraoperative application of modern imaging techniques. Trauma Berufskrankh. 2007, 9: 38–41.
23.
WendlKVockBvon RecumJGrütznerPAWentzensenA. Eight years’ experience with intraoperative three-dimensional imaging. A critical review. Trauma Berufskrankh. 2009, 11: 177–82.
24.
WichMSprangerNEkkenkampA. Intraoperative imaging with the ISO C(3D). Chirurg. 2004, 75: 982–7.
25.
WirthSEulerEKotsianos-HermleD. Comparison of C-arm CT and standard imaging in osteosyntheses of fractured distal radius specimens. Unfallchirurg. 2007, 110: 41–8.
