SLR - June 2015 - James A. Averett
Reference: Franke J, Wendl K, Suda AJ, Giese T, Grutzner PA, von Recum J. Intraoperative three-dimensional imaging in the treatment of calcaneal fractures. J Bone Joint Surg Am. 2014 May 7;96(9):e72.Scientific Literature Review
Reviewed By: James A. Averett, DPM
Residency Program: Southern Arizona VA Healthcare System
Podiatric Relevance: Displaced intra-articular calcaneal fractures are often treated surgically by open reduction and internal fixation by foot and ankle surgeons. Standard of care calls for the use of intraoperative fluoroscopy during surgery and is frequently used to evaluate reduction of the subtalar joint. These fractures often go onto revisional surgery or arthrodesis with less than satisfactory reduction. The information gathered from this article keys on the percentage of patients in which intra-operative three-dimensional imaging leads to intra-operative revision and whether the avoidance of an intra-articular step or gap influences the clinical outcome.
Methods: In this retrospective chart review from August 2001 – June 2009, 377 consecutive, operatively treated calcaneal fractures were identified. The findings of intraoperative 3D scans using either (SIREMOBIL Iso-C scanner or ARCADIS Orbic 3D scanner), were analyzed for the rate of and the reason for intraoperative revision. Clinically, all patients with Sanders type-II & III fractures were included. Noting on 3D scan when the shape of the calcaneus was successfully restored, the fractures where then divided into two separate groups according to the outcome of reduction for all joint surfaces (step-off or gap of <2mm or >2mm). American Orthopaedic Foot & Ankle Society (AOFAS) score determined clinical outcomes.
Results: Three hundred and seventy-seven calcaneal fractures were analyzed and intraoperative revision was performed in 152 fractures (40.3 percent). Nineteen and six-tenths percent of the patients had additional fracture reduction and seventy-seven fractures were followed clinically. Post-operative AOFAS scores indicated that postoperative joint surface continuity had a significant influence on clinical outcomes. This same relationship was also noted between the joint surface congruence and the degree of osteoarthritis development.
Conclusions: Intra-operative three-dimensional imaging can identify intra-articular incongruence and implants that are not detected by fluoroscopy alone. Clinical outcomes can be improved by utilizing three-dimensional imaging, resulting in better joint surface reconstructions and reduction in post-traumatic osteoarthritis.