Volume rendering of three-dimensional fluoroscopic images for percutaneous scaphoid fixation: an in vitro study

Percutaneous fixation of scaphoid fractures offers potential advantages to cast treatment but can be difficult to perform with conventional two-dimensional imaging. This study aimed to evaluate the use of a novel navigation technique using volume-rendered images derived from intraoperative cone-beam computed tomography imaging, without the need for typical patient-based registration. Randomized in vitro trials in which a guidewire was inserted into a scaphoid model were conducted to compare volumetric navigation to conventional fluoroscopic C-arm (n = 24). Central wire placement, surface breach, procedure time, drilling attempts, and radiation exposure were compared between groups. Compared to conventional percutaneous insertion, navigation achieved equal or significantly better placement of the guidewire with fewer drilling attempts and less radiation exposure. On average, navigation took 74 s longer to perform than the conventional method, which was statistically significant but clinically irrelevant. This evaluation suggests that the technology is promising and may have many clinical benefits including improved fixation placement, fewer complications, and less radiation exposure. The intraoperative workflow is more efficient and eliminates the need for preoperative computed tomography, image segmentation, and patient-based registration typical of traditional navigated procedures.