Usefulness of intraoperative three-dimensional imaging in fracture surgery: a prospective study

Since its introduction, intraoperative three-dimensional (3D) imaging has enabled the analysis of articular fractures and implant positions during fracture surgery. The purpose of this study was to evaluate the usefulness of intraoperative 3D imaging in locating anatomic structures, correcting errors, and preventing revision surgery.

Between March 2010 and November 2012, intraoperative 3D imaging was used during surgery for 109 fractures in 101 patients. Fluoroscopy was performed with the Iso-C3D (Siemens, Erlangen, Germany). We recorded the number of intraoperative revisions for adjustment of fracture reduction and correction of implant position for these fractures.

Cases comprised intra-articular fractures (55%), disruptions of the posterior pelvic ring (33%), and syndesmotic injury (12%). The intraoperative revision rate was 9.2% (10/109). When considered by fracture site, the revision rate was highest for syndesmotic injury (23.1%), followed by iliosacral fixation (8.3%) and intra-articular fractures (6.6 %). We changed the implant position in six cases, corrected the articular reduction in one case, and revised the malreduction of syndesmosis in three cases. No postoperative infection occurred in any of these cases.

Intraoperative 3D imaging is useful for correcting errors and may prevent a second operation. Three-dimensional imaging may be especially helpful in intra-articular fractures, iliosacral screw fixation, and syndesmotic injury.