IMPACT OF INTRAOPERATIVE 3D FLUOROSCOPY SCAN IN THE SURGICAL TREATMENT OF CALCANEAL FRACTURES

Abstract

The operative therapy of intraarticular fractures of the calcaneus is nowadays established surgical standard. Aim is an accurate reduction with reconstruction of the Boehler’s angle, the length and the subtalar joint. 3D-fluoroscopy with the Siremobil Iso-C 3D? mobile C-arm radiography system is a valuable assistance for the accurate reconstruction of the anatomical structures. Remaining incongruities can be recognized and corrected intraoperatively. The achieved reduction can be safely fixed by the advantages of a locked implant In the period of 10/2002 until 10/2004 we operated 59 patients with intraarticular fractures of the calcaneus by means of anatomical reduction and locked plate (Calcaneus TiFix, Litos, Germany) under control of 3D-fluoroscopy. After routine CT diagnostics, fractures were classified according to Sanders: 18 fractures were type II, 33 fractures type III and 9 were classified type IV.

Results: Surgical treatment of the fractures took place according on average after an interval of 8.5 days (7 to 11). A 3D-fluoroscopy was performed after reduction and temporary fixation of the fracture. There was no technical fault of the device. Median theatre time was 72 minutes (53–112 minutes) including 3-D-fluoroscopy. In 22 cases a remaining incongruity of > 1 mm could be seen on intraoperative 3-D-fluoroscopy. In these cases a reduction was performed again. The Boehler’s angle could be raised on average by 18° (11° to 22°), shortening of the hindfoot could be improved on average by 13 picture millimetres (9 to 17mm). Bone graft was not required in any case. At 6 months follow up, all patients had returned to work, or if unemployed, where judged fit to work by their GP. Three patients changed their position. 25 Patients were completely pain free at follow-up. In all cases the achieved reduction could be fixed by the implant until full weight bearing was reached.

Conclusion: The use of 3D Fluoroscopy had a real impact in the treatment of calcaneal fractures. If this short term advantage influences the long term result has to be shown in further follow up.