Utility of an image fusion system for 3D preoperative planning and fluoroscopy in the osteosynthesis of distal radius fractures

Yuichi Yoshii, Yasukazu Totoki, Satoshi Sashida, Shinsuke Sakai, Tomoo Ishii, Yuichi Yoshii, Yasukazu Totoki, Satoshi Sashida, Shinsuke Sakai, Tomoo Ishii

Abstract

Background: Recently, computerized virtual surgery planning has been increasingly applied in various orthopedic procedures. In this study, we developed an image fusion system for 3D preoperative planning and fluoroscopy for the osteosynthesis. To assess the utility of image fusion system, we evaluated the reproducibility of preoperative planning in the osteosynthesis of distal radius fractures with using the image fusion system, and compared with the reproducibility of the patients without using the image fusion system.

Methods: Forty-two wrists of 42 distal radius fracture patients who underwent osteosynthesis using volar locking plates were evaluated. The patients were divided into two groups. Image fusion group utilized three-dimensional (3D) preoperative planning and image fusion system. Control group utilized only 3D preoperative planning. In both groups, 3D preoperative planning was performed in order to determine reduction, placement, and choice of implants. In the image fusion group, the outline of planned image was displayed on a monitor overlapping with fluoroscopy images during surgery. Reductions were evaluated by volar tilt and radial inclination of 3D images. Plate positions were evaluated with distance to joint surface, plate center axis position, and inclination relative to the radius axis. Screw choices were recorded for the plan and actual choices for each screw hole. Differences in the parameters between pre- and postoperative images were evaluated. Differences in reduction shape, plate positions, and screw choices were compared between groups.

Results: The differences in the distance from plate to joint surface were significantly smaller in the image fusion group compared to the control group (P < 0.01). The differences in the distal screw choices were significantly smaller in the image fusion group compared to the control group (P < 0.01).

Conclusions: The image fusion system was useful to reproduce the planned plate position and distal screw choices in the osteosynthesis of distal radius fractures.

Trial registration: ClinicalTrials.gov, NCT03764501.

Keywords: Computed tomography; Distal radius fracture; Fluoroscopy; Image fusion; Osteosynthesis; Preoperative plan.

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. The image fusion system described in this study has been developed through a collaborative study between Tokyo Medical University Ibaraki Medical Center and LEXI Co., Ltd. One of the authors (SS) is a paid employee at LEXI Co., Ltd. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Image fusion system. a 3D preoperative planning image. b Contour extraction of 3D image. c Examples of fusion images. Fusion images were created by overlapping the outline of the 3D preoperative plan and the fluoroscopic image
Fig. 2
Fig. 2
Evaluation of plate positions. A: distance from the plate to the joint surface. D1, D2: distance from the plate center to the radial edge of the distal radius. R1, R2: transverse diameter of the radius
Fig. 3
Fig. 3
Results for reduction accuracy. a Difference in the volar tilt. b Difference in the radial inclination. Red bar shows the results for the image fusion group, and blue bar those for the control group
Fig. 4
Fig. 4
Results for plate positions. a Difference in the distance from the plate to the joint surface. There was a significant difference between the image fusion group and the control group (*P < 0.01). b Difference in plate center positions. c Difference in plate axis inclinations. Red bar shows the results for the image fusion group, and the blue bar shows those for the control group
Fig. 5
Fig. 5
Results for screw choices. a Difference in the distal screw choices. There was a significant difference between the image fusion group and the control group (*P < 0.01). b Difference in the proximal screw choices. Red bar shows the results for the image fusion group, and the blue bar shows those for the control group

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Source: PubMed

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