Three-dimensional evaluations of preoperative planning reproducibility for the osteosynthesis of distal radius fractures

Abstract

Background: Three-dimensional preoperative planning was applied for the osteosynthesis of distal radius fractures. The objective of this study was to evaluate the reproducibility of three-dimensional preoperative planning for the osteosynthesis of distal radius fractures with three-dimensional reference points.

Methods: Sixty-three wrists of 63 distal radius fracture patients who underwent osteosynthesis with three-dimensional preoperative planning were evaluated. After taking preoperative CT scans of the injured wrists, 3D images of the distal radius were created. Fracture reduction, implants choices, and placements simulation were performed based on the 3D images. One month after the surgery, postoperative CT images were taken. The reproducibility was evaluated with preoperative plan and postoperative 3D images. The images were compared with the three-dimensional coordinates of radial styloid process, volar and dorsal edges of sigmoid notch, and the barycentric coordinates of the three reference points. The reproducibility of the preoperative plan was evaluated by the distance of the coordinates between the plan and postoperative images for the reference points. The reproducibility of radial inclination and volar tilt on three-dimensional images were evaluated by intra-class correlation coefficient (ICC).

Results: The distances between the preoperative plan and the postoperative reduction for each reference point were (1) 2.1±1.3 mm, (2) 1.9±1.2 mm, and (3) 1.9±1.2 mm, respectively. The distance between the preoperative plan and postoperative reduction for the barycentric coordinate was 1.3±0.8 mm. ICCs were 0.54 and 0.54 for the volar tilt and radial inclination, respectively (P<0.01).

Conclusions: Three-dimensional preoperative planning for the osteosynthesis of distal radius fracture was reproducible with an error of about 2 mm for each reference point and the correlations of reduction shapes were moderate. The analysis method and reference points may be helpful to understand the accuracy of reductions for the three-dimensional preoperative planning in the osteosynthesis of distal radius fractures.

Trial registration: Registered as NCT02909647 at ClinicalTrials.gov.

Keywords: Computed tomography; Computer-assisted orthopedic surgery; Distal radius fracture; Osteosynthesis; Preoperative plan; Three dimensions.

Conflict of interest statement

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Figures

Fig. 1

An example of the preoperative planning process. a Reduction simulation in the axial view, b reduction simulation in the sagittal view, c implant choices and placement

Fig. 2

Axial view of 3D image. a Preoperative plan, b postoperative image. Three reference points, (1) radial styloid process, (2) sigmoid notch volar edge, and (3) sigmoid notch dorsal edge, were marked on the image. The barycentric coordinates of the plane connecting the three reference points were measured

Fig. 3

Sagittal and coronal views of a 3D image. a Sagittal view, b coronal view

Fig. 4

Results of coordinates for three reference points in the axial plane. a Results of coordinates for the preoperative plan image. b Results of coordinates for the postoperative reduction image. The orange dots indicate radial styloid process: reference point (1). The gray dots indicate sigmoid notch volar edge: reference point (2). The blue dots indicate sigmoid notch dorsal edge: reference point (3)

Fig. 5

Results of coordinates for three reference points in the sagittal plane. a Results of coordinates for the preoperative plan image. b Results of coordinates for the postoperative reduction image. The orange dots indicate radial styloid process: reference point (1). The gray dots indicate sigmoid notch volar edge: reference point (2). The blue dots indicate sigmoid notch dorsal edge: reference point (3)

Fig. 6

Results for the barycentric coordinates in the axial plane. a Results of coordinates for the preoperative plan image. b Results of coordinates for the postoperative reduction image

Fig. 7

Results of correlations for the volar tilt and radial inclination. a Results of volar tilt correlations between the preoperative plan and postoperative reduction. b Results of radial inclination correlations between the preoperative plan and postoperative reduction