INTRAOPERATIVE CONTROL OF OSTEOSYNTHESIS USING ISO-C-3D IMAGE INTENSIFIER. ONE YEAR OF UTILISATION.

Abstract

Introduction: Preoperative use of tomodensitometry is a common practice when assessing fractures with intraarticular involvement, helping to determine the most appropriate surgical approach according to the lesions observed. To date, during the surgical procedure itself, radiographical or fluoroscopic controls still largely rely on two dimensions X rays. We assessed the possible benefits of intraoperative tridimensional reconstructions using mobile isocentric fluoroscopy (iso-C-3D) after one year of use.

Material and Methods: All the procedures where intra-operative tridimensional fluoroscopy was used were assessed prospectively for one year. The type of osteosynthesis as well as specific modalities of installation and therapeutic measures driven from analysis of the images were analyzed.

Results: During the first year of use, intraoperative tridimensional reconstruction had been carried out in 48 procedures in 47 patients. The region involved was calcaneus 13 times, thoracolumbar spine 12 times, acetabulum 11 times, tibial condyles 9 times, axis 2 times and pelvis one time. Installation was the same than usually performed in the cases of calcaneus and axis osteosynthesis. For the other localisations, obtention of good quality images was facilitated through the use of a carbon table for spine and osteosynthesis of the tibial condyles, and through the use of a carbon traction table for acetabular or pelvic fractures. Intraoperative tridimensional reconstruction allowed to check for freedom of the vertebral canal after reduction and osteosynthesis of the spine. in the cases of fracture of the calcaneus, reduction of one thalamic fragment was improved in one case and one intraarticular screw could be changed in another case. In the case of acetabular surgery, one screw stabilizing the posterior wall was found intraarticular on tridimensional reconstruction and could be changed before closure.

Discussion: Intraoperative tridimensional reconstruction, during its first year of use, allowed to avoid 3 early reinterventions (for 2 calcaneus and one acetabulum). Accurate interpretation of standard plain X ray in these two localizations is difficult because of the spherical shape of the hip joint and because good quality imaging, especially the retrotibial view, is hardly obtained intraoperatively in fractures of the cacaneus. When using tridemensional reconstructions, acquisition of good quality images has to be anticipated during the installation of the patient, limiting any interfereces with metallic supports to a minimum.

Conclusion: the results obtained over the first year of use of intraoperative tridimensional reconstructions with the ISO-C-3D encouraged the authors to generalize its use when performing osteosynthesis of the acetabulum or calcaneus as well as percutaneus osteosynthesis of articular fractures.