Development of an intraoperative 3D C-arm technique for torsion control of femur fractures: a cadaver study
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TRAUMA SURGERY
Development of an intraoperative 3D C‑arm technique for torsion control of femur fractures: a cadaver study T. Stubig1 · H. Aidarous1 · A. Khalifa1 · M. Omar1 · C. Krettek1 · T. Omar Pacha1 Received: 1 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aim This study aims to test the accuracy and feasibility of a measurement of femoral torsion of a 3D C-arm system (Linea aspera method) in a cadaver setting. Materials and methods A total of 11 intact femora were used. Schanz screws were inserted in the femoral bone in a parallel manner with the help of a fixed drill sleeve. Femur bones were then fractured in a controlled manner and three different internal and external torsion angles were fixed with the help of a Goniometer. After that, a 3D scan was performed. The 3D data set was analyzed using a radiologic software (Visage 7, Visage Imaging Inc, USA). Measurements were then compared in the two methods with a dependent t test. Results Specific measurements for different angles did not show any differences between those two utilities. Conclusion Intraoperative estimation of femoral antetorsion using a 3D C-Arm system and the Linea aspera method seems to be an accurate and feasible method. Nevertheless, more studies with higher patient numbers, comparison to CT seems to be the next step and can be recommended. Keywords 3D imaging · Femur fractures · Antetorsion measurements · Rotational alignement · Intraoperative imaging
Introduction The evaluation of femoral torsion is very critical in patients with patellar instability, where a severe femoral internal torsion has been identified as a predictor, or for patients with femur fracture [1, 2] Long bone fractures are common injuries in the severely injured patients [3], with treatment typically consisting of intramedullary nailing (IMN) [1–8]. Postoperative malrotation after surgery of femur fractures above 15° is reported in up to 30% [3, 4, 7–9]. Pre- and post-operative imaging strategies include computed tomography (CT) [7], radiography, low dose bi-planar radiography, ultrasound, and magnetic resonance imaging (MRI).[7, 10]. CT and MRI are considered the gold standard for measuring femur torsion due to their speed, ease of use, and precision [1, 2]. Axial CT scans are found to lead to the T. Stubig and H. Aidarous contributed equally. * T. Stubig stuebig.timo@mh‑hannover.de 1
Trauma Department, Hannover Medical School, Carl‑Neuberg‑Str. 1, 30625 Hannover, Germany
most precise measurements for torsional differences. [2, 6, 8]. However, any evaluation for long bones’ torsion is mainly influenced by the correctness of the calculated axes, either functional or reference axes [10–12]. Intraoperative torsion control is usually performed utilizing the range of movement of both hips, the shape of the lesser trochanter or diameter difference [13]. Currently there is a rapid progression and development in the techniques of navigation and intraoperative 3D imaging over the last decades. [2, 11, 12, 14]. While these te
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