This multicenter prospective randomized controlled trial aimed to study in patients with intra-articular fractures of the calcaneus, the clinical effect of additional intraoperative 3D fluoroscopy on postoperative quality of reduction and fixation, and patient-reported outcome when compared to conventional 2D (2-dimensional) fluoroscopy.
3D (Three-dimensional) fluoroscopy is thought to be
beneficial in the ORIF (open reduction and internal fixation) of calcaneal
fractures. This study depicted that in the treatment of intra-articular
calcaneal fractures, the use of intraoperative 3D fluoroscopy prolongs the
operative procedures without improving the quality of reduction and
fixation.
This multicenter prospective randomized controlled
trial aimed to study in patients with intra-articular fractures of the
calcaneus, the clinical effect of additional intraoperative 3D fluoroscopy on
postoperative quality of reduction and fixation, and patient-reported outcome
when compared to conventional 2D (2-dimensional) fluoroscopy.
During the operative treatment of calcaneal fracture, the patients were randomized to 3D or 2D fluoroscopy. The study included a total of 102 calcaneal fractures in 100 patients. A total of 50 fractures were randomly assigned to the 3D group and 52 to the 2D group. The primary outcome was the difference in the quality of fracture reduction and implant position on postoperative CT (computed tomography).
The secondary outcomes were intraoperative corrections (before wound closure), complications, and revision surgery (after wound closure). Post surgically, the function and patient-reported outcomes were assessed and included a range of motion, FAOS (Foot and Ankle Outcome Score), AOFAS (American Orthopaedic Foot & Ankle Society) score, SF-36 (Short-Form 36) questionnaires, and Kellgren-Lawrence posttraumatic osteoarthritis classification.
A statistically significant difference was
witnessed in the duration of surgery between the groups as depicted in Table 1:
|
2D Group |
3D Group |
Duration of surgery |
125 min |
147 min |
Table 1: Duration
of surgery between 2D and 3D groups
After 3D fluoroscopy, 57 intraoperative
corrections were conducted in 28 patients (56%). The postoperative CT scan
revealed an indication for additional revision of reduction or implant position
in 69% of the 3D group vs 60% in the 2D group as depicted in Table 2:
|
2D Group |
3D Group |
Need for additional revision of reduction
or implant position in patients (%) |
69.00% |
60.00% |
Table 2: Percentage of patients requiring
additional revision of reduction or implant position
The use of intraoperative 3D fluoroscopy was
found to increase the duration of surgical procedure but it do not have any
associations with the improvement of fixation and quality of reduction. It was
also not found to have any impact on patient related outcomes.
Foot & Ankle International
Intraoperative Effect of 2D vs 3D Fluoroscopy on Quality of Reduction and Patient-Related Outcome in Calcaneal Fracture Surgery
Jens A. Halm et al.
Comments (0)