[Intraoperative 3D C-arm imaging. State of the art]

Mobile C-arms with the option of 3D imaging like the Iso-C(3D) allow for intraoperative 3D visualization of anatomical areas with complex three-dimensional structures like articular surfaces. In an 8-year period we performed 1,841 intraoperative control scans following osteosynthesis. Among these patients we registered the number of intraoperative adjustments of fracture reduction and implant position in correlation to the area of surgery. The majority of intraoperative examinations in 1,841 patients was performed in fractures of the calcaneus (20.5%) and the upper ankle joint (13.2%). Altogether we improved the reduction or the implant position intraoperatively in 21.5%. The majority of intraoperative revisions was seen in osteosynthesis of the calcaneus (40.3%), the upper ankle joint (30.9%) and fractures of the distal tibia (29%). The rate of revisions over the time was very stable. Intraoperative need for revision of reduction or implant position is not a rare phenomenon in our experience. Intraoperative 3D imaging is a valid tool to recognize and adjust suboptimal reduction or implant positioning. Intraoperative 3D imaging can improve the quality of osteosynthesis especially in fractures of joints and complex anatomical areas.