Purpose of the study: Computed tomography is recommended for the preoperative work-up of joint fractures as it allows an optimisation of the access as a function of the injury. During the operation, 2D radiographic or fluoroscopic controls are still widely used. After one year’s experience, we evaluated the potential pertinence of using 3D reconstructions intraoperatively with a mobile isocentric fluoroscope (iso-C-3D).

Material and methods: All operations for which the amplifier was used were collected prospectively. The type of fixation as well as the details of the installation and measures taken intraoperatively were noted.

Results: At one year, intraoperative 3D reconstructions were made during 48 operations in 47 patients: fracture of the calcaneum (n=13), thoracolumbar spin (n=12), acetabulum (n=11), tibial condyles (n=9), odontoid (n=2), pelvis (n=1). The installation was habitual for the calcaneum and odontoid fractures. For the other localizations, use of a carbon plateau table facilitated good quality imaging for spinal and tibial condyle fractures; a carbon orthopaedic table was useful for acetabulum and pelvis fractures. With the intraoperative 3D reconstruction the surgeon was able to check the freedom of the canal after reduction and fixation. For the calcaneum fractures, reduction of the thalamic fragment was revised in one patient; in another, an intra-articular screw was replaced. One intra-articular screw stabilizing the posterior wall was also changed during an acetabulum fixation.

Discussion: During our first year of use, 3D reconstruction intraoperatively has allowed us to avoid three early reoperations (for two calcaneums and one acetabulum). Classical 2D imaging of these two localizations is difficult to interpret because of the spherical form of the hip joint and, for the calcaneum, the difficulty in obtaining quality retrotibial images. Quality images requires specific installation, limiting interference with metallic supports.

Conclusion: The results we have obtained in our first year of use of the ISO-C-3D amplifier has led us to generalise its use for percutaneous fixation procedures involving the acetabulum and the calcaneum.

Purpose of the study: We report a prospective consecutive series of femoral fractures on prosthesis. The goal was to evaluate mid-term outcome of treatment with a locking plate.

Material and methods: From June 2002 to December 2007, we treated 35 patients (1 bilateral), 28 female and 7 male, with a fracture around their total hip arthroplasty (n=21), total knee arthroplasty n=7), unicompartmental knee prosthesis (n=1), between a THA and a TKA (n=2), or between a trochanteric osteosynthesis and a TKA (n=5). Mean age was 76 years (39–93). For the majority, osteosynthesis was achieved via a mini-invasive incision, using a locking plat (Synthes^®) bridging the implant in situ. The rehabilitation protocol consisted in immediate weight-bearing for most of the cases.

Results: At revision, one patient was lost to follow-up, one was an early failure, and seven patients had died, including four which were retained for the analysis because data was available for 24, 40, 43 and 67 months respectively. The analysis thus included 30 patients with 31 fractures and mean 26 months follow-up (range 6 – 67 months). The following results were obtained for the initial series: mini-invasive surgery (n=26), access to fracture focus (n=10), total postoperative weight bearing (n=20), partial weight bearing at 20 kg (n=3), no weight-bearing for six weeks (n=13). Complications were: infection (n=2), general (n=2), disassembly (n=3, one femoral stem replacement and two revision ostheosynthesis). Bone healing was obtained in all cases except one. There was a misalignment > 5 in five cases. At review, there was no implant loosening.

Discussion: This work shows that locking compression plates inserted via a mini-invasive approach followed by weight-bearing is a feasible option. This technique combines the principles of closed osteosynthesis with preservation of the haematoma and stability of osteosynthesis material. The rehabilitation protocol was developed in consideration of the nature of the material. The locked plate acts like an internal fixator, allowing increased implant stability. Screw hold appeared to be sufficient to allow early weight-bearing.

Conclusion: Use of locking compression plates for femoral fractures on osteosynthesis implants is effective. The stability of the assembly allow, despite the age of the patients, early weight-bearing and walking, with a stable outcome over time.

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.