Feasibility and Safety of 3D-Navigated Trans-Sacral Bar Osteosynthesis for Fragility Fractures of the Sacrum: FIRST Clinical Experiences.

There has been an increasing number of fragility fractures of the sacrum in the recent decade. With rates of up to 28%, the complication rates after surgical treatment are still at an unacceptably high level, and new treatment strategies are urgently needed. Therefore, the purpose of this study was to evaluate the potential of 3D-navigated trans-sacral bar osteosynthesis in the surgical treatment of fragility fractures of the sacrum.

Effect of the cone-beam CT acquisition trajectory on image quality in spine surgery: experimental cadaver study.

Background: Intraoperative 3D imaging with cone-beam CT (CBCT) improves assessment of implant position and reduces complications in spine surgery. It is also used for image-guided surgical techniques, resulting in improved quality of care. However, in some cases, metal artifacts can reduce image quality and make it difficult to assess pedicle screw position and reduction.

Software-based method for automated intraoperative planning of Schoettle Point in surgical medial patellofemoral ligament reconstruction: A comparative validation study.

Background: The aim of the study was to validate a software-based planning method for the Schoettle Point and to evaluate precision and time efficiency of its live overlay on the intraoperative X-ray.

Methods: A software-based method was compared with surgeons' manual planning in an inter- and intrarater study. Subsequently, K-wire placement was performed with and without an overlay of the planning.

Analyzing the reduction quality of the distal radioulnar joint after closed K-wire transfixation in a cadaver model: is supination or neutral position superior?

Introduction: Distal radioulnar joint (DRUJ) instabilities are challenging and their optimal treatment is controversial. In special cases or when reconstruction of the stabilizing triangular fibrocartilage complex (TFCC) fails, K-wire transfixation can be performed. However, no consensus has been reached regarding the rotational position of the forearm in which this should be done.

Effect of changing the acquisition trajectory of the 3D C-arm (CBCT) on image quality in spine surgery: experimental study using an artificial bone model.

Background: Intraoperative 3D imaging using cone-beam CT (CBCT) provides improved assessment of implant position and reduction in spine surgery, is used for navigated surgical techniques, and therefore leads to improved quality of care. However, in some cases the image quality is not sufficient to correctly assess pedicle screw position and reduction, especially due to metal artifacts. The aim of this study was to investigate whether changing the acquisition trajectory of the CBCT in relation to the pedicle screw position during dorsal instrumentation of the spine can reduce metal artifacts and consequently improve image quality as well as clinical assessability on the artificial bone model.

Analysis of the cost-efficiency of the vascular impulse technology (VIT) in the perioperative management of complex ankle fractures: results of a prospective randomised controlled trial.

Introduction: Posttraumatic swelling causes a delay in surgery, a prolonged hospital stay and a higher risk of complications. Thus, soft tissue conditioning following complex ankle fractures is of central importance in their perioperative management. Since the clinical benefit of VIT usage on the clinical course has been shown, it should now be investigated whether it is also cost-efficient in doing so.

Vascular impulse technology versus elevation for reducing the swelling of upper and lower extremity joint fractures.

Soft-tissue conditioning due to posttraumatic oedema after complicated joint fractures is a central therapeutic aspect both pre- and postoperatively. On average, 6-10 days pass until the patient is suitable for surgery. This study compares the decongestant effect of vascular impulse technology (VIT) with that of conventional elevation.

Intraoperative revision rates due to three-dimensional imaging in orthopedic trauma surgery: results of a case series of 4721 patients.

Purpose: Intraoperative 3D imaging has become a valued tool in assessing the quality of reduction and implant placement in orthopedic trauma surgery. In our institution, 3D imaging is used routinely since 2001. To evaluate the intraoperative findings and consequences of this technique, intraoperative revision rates in cases with 3D imaging were analyzed.

Multi-Stage Platform for (Semi-)Automatic Planning in Reconstructive Orthopedic Surgery.

Intricate lesions of the musculoskeletal system require reconstructive orthopedic surgery to restore the correct biomechanics. Careful pre-operative planning of the surgical steps on 2D image data is an essential tool to increase the precision and safety of these operations. However, the plan’s effectiveness in the intra-operative workflow is challenged by unpredictable patient and device positioning and complex registration protocols.

Influence of unstable ankle fracture (type Weber C), osteosynthesis and syndesmotic transfixation on position of fibula in tibiofibular notch: a cadaveric study.

Purpose: The aim of the cadaveric study was to determine the effects of an unstable ankle fracture on the position of the fibula in the incisural notch and subsequently to evaluate the alterations resulting from the individual steps of a guideline-based osteosynthesis.

Methods: In a specimen model with 20 uninjured fresh-frozen lower legs with induced unstable fracture of the fibula (type Weber C), a guideline-based osteosynthesis was performed. The distances between the anterior and posterior edges of the tibia and fibula and in the center of the incisural notch, as well as the rotation angle of the fibula, were measured in the acquired 3D image data sets and were compared with the intact condition of the ankle mortise.

Influence of reduction quality on functional outcome and quality of life in the surgical treatment of tibial plateau fractures: A retrospective cohort study.

Background: Despite a substantial improvement in the operative treatment of tibial plateau fractures, the surgical procedure remains controversial and is generally challenging, as patients may develop postoperative arthritis and functional impairment of the knee joint.

Hypothesis: In the surgical treatment of tibial plateau fractures the intraoperative reposition quality has the greatest influence on the postoperative outcome, whereby misalignments of≥2mm lead to a worse result.

Patients And Methods: Forty-one patients with tibial plateau fractures were postoperatively examined.

Vascular impulse technology versus elevation for the reduction of swelling of lower extremity joint fractures: results of a prospective randomized controlled study.

Aims: Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation.

Methods: A total of 100 patients were included in this prospective, randomized, controlled monocentre study allocated to the three subgroups of dislocated ankle fracture (n = 40), pilon fracture (n = 20), and intra-articular calcaneal fracture (n = 40).

[Digital OR].

Background: Numerous processes are involved in the orthopedic and trauma surgery operating room (OR). Technical progress, particularly in the area of digitalization, is increasingly changing routine surgical procedures.

Objective: This article highlights the possibilities and also limitations regarding this matter.

Evaluation of Software-Based Metal Artifact Reduction in Intraoperative 3D Imaging of the Spine Using a Mobile Cone Beam CT.

The aim of our study was to evaluate whether software-based artifact reduction can achieve an improved image quality, using intraoperative 3D imaging in spinal surgery. A total of 49 intraoperative 3D image datasets of patients, who underwent surgery with pedicle screw placement, were retrospectively evaluated. The visibility of anatomical structures and the diameter of the pedicle screws were examined, with and without the application of the artifact reduction software.

Fracture reduction and screw position after 3D-navigated and conventional fluoroscopy-assisted percutaneous management of acetabular fractures: a retrospective comparative study.

Background: Navigational techniques in orthopaedic trauma surgery have developed over the last years leaving the question of really improving quality of treatment. Especially in marginal surgical indications, their benefit has to be evident. The aim of this study was to compare reduction and screw position following 3D-navigated and conventional percutaneous screw fixation of acetabular fractures.

Lack of Relevant Haemogram Changes During Percutaneous Radiotherapy of Localised Prostate Cancer.

Background/aim: In percutaneous radiotherapy dose-distribution and volumetric-load of normal tissue varies in different radiation-techniques. Haematotoxicity may lead to deficiencies of the immune and blood system or to secondary malignancies. Therefore, regular blood-counts are carried out during fractionated radiotherapy.

Minimally invasive surgical treatment of minimally displaced acetabular fractures does not improve pain, mobility or quality of life compared to conservative treatment: a matched-pair analysis of 50 patients.

Background: Currently available procedures for the treatment of minimally displaced acetabular fractures include conservative treatment and minimally invasive percutaneous screw fixation. Screw fixation of acetabular fractures allows patients' early full-weight bearing due to improved biomechanic stability. Can the range of motion, pain and mobility and quality of life in patients with acetabular fractures be improved by minimally invasive screw fixation, compared to conservative treatment in the long term?

Methods: Patients treated for a minimally displaced acetabular fracture, either conservatively or by closed reduction percutaneous screw fixation, in the period from 2001 to 2013 were included in this retrospective study.

First experiences with intraoperative CT in navigated sacroiliac (SI) instrumentation: An analysis of 25 cases and comparison with conventional intraoperative 2D and 3D imaging.

Background: Intraoperative imaging is regularly used for intraoperative reduction control and evaluation of the implant position in trauma surgery. 2D imaging is limited, especially in complex anatomical regions such as the pelvis. The introduction of mobile 3D C-arms (CBCT: cone-beam computed tomography) has significantly improved intraoperative assessment.

Validation of radiological reduction criteria with intraoperative cone beam CT in unstable syndesmotic injuries.

Purpose: Acute unstable syndesmotic lesions are regularly treated with closed or open reduction and fixation with either a positioning screw or tight rope. Conventional fluoroscopy is limited to identify a malreduction of the ankle mortise. The aim of the study was to validate the reduction criteria of intraoperative cone beam CT in unstable syndesmotic injuries by analyzing the clinical outcome.

Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study.

Background: The aim of the study was to evaluate the impact of reduction quality, using intraoperative 3D imaging, on quality of life and functional outcome in the operative treatment of tibial plafond fractures.

Methods: A group of patients with tibial plafond fractures was re-examined. The operative treatment was performed between September 2001 and October 2011.

Comparison of three different reduction methods of the ankle mortise in unstable syndesmotic injuries.

In order to achieve a clinically satisfying result and to prevent posttraumatic osteoarthritis in the treatment of unstable syndesmotic injuries, anatomically correct reduction is crucial. The objective of the study was to investigate three different reduction methods of the ankle mortise in unstable syndesmotic injuries. In a specimen model with 38 uninjured fresh-frozen lower legs, a complete syndesmotic dissection was performed.

Distal radioulnar joint instability with three different injury patterns assessed by three-dimensional C-arm scans: a cadaveric study.

The aim of this study was to establish a radiographic method for detecting distal radioulnar joint instability intraoperatively. We created three successive instabilities in 12 intact Thiel-fixed upper limb specimens: lesion of the triangular fibrocartilage complex, Galeazzi injury and Essex-Lopresti injury. We made three-dimensional scans of the wrists in pronation and supination with a mobile C-arm.

Computer-assisted intra-operative verification of surgical outcome for the treatment of syndesmotic injuries through contralateral side comparison.

Purpose: Fracture reduction and fixation of syndesmotic injuries is a common procedure in trauma surgery. An intra-operative evaluation of the surgical outcome is challenging due to high inter-individual anatomical variation. A comparison to the contralateral uninjured ankle would be highly beneficial but would also incur additional radiation and time consumption.

Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases.

Introduction: The aim of this study was to evaluate the intraoperative revision rate and reasons for revision following 3D imaging in the management of dislocated articular tibial plateau fractures based on a large patient sample.

Methods: This retrospective cohort study included all patients who underwent open reduction and internal fixation due type B or C tibial plateau fracture according to the AO/OTA classification between August 2001 and December 2017 using intraoperative cone beam CT (3D imaging) for the analysis of fracture reduction and implant placement. The findings of the 3D scan were categorized regarding the amount and type of revision.

Influence of ankle joint position on angles and distances of the ankle mortise using intraoperative cone beam CT: A cadaveric study.

Background: The precise anatomical reduction of the ankle mortise is crucial for the clinical outcome in unstable syndesmotic injuries. Intraoperative cone beam computed tomography (CT), in addition to two-dimensional fluoroscopy, provides detailed information about the reduction and implant placement. The aim of this study was to analyze the influence of the joint position on the fibula position in the incisural notch and to determine the inter- and intraindividual anatomical differences in the intact ankle joints.