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General Orthopaedics

INTRA-OPERATIVE CT-LIKE 3D IMAGING USING A MOTORISED IMAGE INTENSIFIER IN PAEDIATRIC HIP SURGERY

British Orthopaedic Association (BOA) 2006



Abstract

Background

Paediatric pelvic corrective surgery for developmentally dysplastic hips requires that the acetabular roof is angulated to improve stability and reduce morbidity. Accurate bony positioning is vital in a weight-bearing joint as is appropriate placement of metalwork without intrusion into the joint. This can often be difficult to visualise using conventional image intensifier equipment in a 2D plane.

Methods

The ARCADIS Orbic 3D image intensifier produces CT-quality multi-axial images which can be manipulated intra-operatively to give immediate feedback of positioning of internal fixation. The reported radiation dose is 1/5 and 1/30 of a standard spiral CT in high and low quality modes, respectively.

Results

We present 15 elective cases of paediatric pelvic osteotomy and fixation of SUFE, with use of the ARCADIS Orbic 3D image intensifier. Images were taken intra-operatively in order to confirm satisfactory fracture reduction and appropriate positioning of fixation devices avoiding joint spaces. This was achieved by 3D reconstruction and review of the surgical field in theatre. In all of the cases appropriate bony placement and position of fixation devices was demonstrated in the multi-axial images and 3D reconstruction.

Conclusions

The use of 3D image intensification is a novelty in the UK. Our results suggest that the 3D image intensifier is a valuable aid in the field of paediatric surgery. Accurate positioning of internal fixation devices can be confidently confirmed ‘on-table’. The radiation dose is also significantly less than a standard spiral CT.