The Correlation between Intra-Operative 2D- and 3D Fluoroscopy with postoperative CT-scans in the Treatment of Calcaneal Fractures

Publication date: Available online 18 January 2019

Source: European Journal of Radiology

Author(s): M.S.H. Beerekamp, R.J.O. de Muinck Keizer, T. Schepers, L.F.M. Beenen, J.S.K. Luitse, N.W. Schep, D.T. Ubbink, J.C. Goslings, on behalf of the EF3X-studygroup

Abstract

Objectives

The aim of this study was to determine the correlation of the intra-operative fluoroscopic 2D- and 3D-images compared with a postoperative CT-scan, in terms of quality of reduction and fixation of calcaneal fractures.

Methods

Patients requiring open reduction and internal fixation (ORIF) of a calcaneal fracture were recruited as part of the EF3X-trial. During surgery, intra-operative images of fluoroscopic 2D- and 3D-imaging were obtained to assess the quality of the reduction and implant position. All patients received a postoperative CT-scan within one week.

The operating surgeon evaluated intra-operatively both 2D- and 3D-images according to a 23-item scoring protocol on a 3-point Likert scale. A scoring panel, consisting of three clinical experts, evaluated all images in a blinded and independent fashion. Intraclass correlation coefficients (ICC) with their 95% confidence intervals (CI) were calculated using a two-way-random model with absolute agreement.

Results

A total of 102 calcaneal fractures were included. Agreement of 3D-imaging for the quality of reduction was better than 2D-imaging, although still fair, but for fixation moderate to good. Agreement between the 2D-images and the CT-scans was poor to fair. Intra-operative 2D-imaging received the highest ratings for image quality and interpretability, followed by CT-scanning.

Conclusion

Implant position can be evaluated satisfactory with the aid of intra-operative 3D imaging. Although intra-operative 3D imaging had a better agreement with postoperative CT-scanning than 2D-imaging, there is a need to improve image quality and suppress scattering from implants to improve the additional value of intra-operative 3D imaging in calcaneal fracture reduction and fixation.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HmuwDg