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:

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:

Table 2: Percentage of patients requiring additional revision of reduction or implant position

 At 2 years, there was no difference in the number of revision surgery, complications, FAOS, AOFAS score, SF-36 score, or post-traumatic OA.

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.