Intraoperative 3D imaging in plate osteosynthesis of proximal humerus fractures

• Published in: Archives of orthopaedic and trauma surgery 2023-08, Vol.143 (8), p.4993-5000
• Main Authors: Böhringer, Alexander, Cintean, Raffael, Eickhoff, Alexander, Gebhard, Florian, Schütze, Konrad
• Format: Article
• Language: English
• Subjects: Aged; Bone Cements; Bone Plates; Cone-Beam Computed Tomography; Fracture Fixation, Internal - methods; Fractures; Humans; Humeral Fractures; Humerus; Imaging, Three-Dimensional; Medicine; Medicine & Public Health; Orthopedics; Osteoporosis; Patients; Polymethyl methacrylate; Retrospective Studies; Rotator cuff; Shoulder Fractures - diagnostic imaging; Shoulder Fractures - surgery; Surgery; Sutures; Three dimensional imaging; Tomography; Trauma; Trauma Surgery
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-023-04820-2

Introduction Proximal humerus fractures are common and often associated with osteoporosis in the elderly. Unfortunately, the complication and revision rate for joint-preserving surgical treatment using locking plate osteosynthesis is still high. Problems include insufficient fracture reduction and implant misplacement. Using conventional intraoperative two dimensional (2D) X-ray imaging control in only two planes, a completely error-free assessment is not possible. Materials and methods The feasibility of intraoperative three-dimensional (3D) imaging control for locking plate osteosynthesis with screw tip cement augmentation of proximal humerus fractures was retrospectively studied in 14 cases with an isocentric mobile C-arm image intensifier set up parasagittal to the patients. Results The intraoperative digital volume tomography (DVT) scans were feasible in all cases and showed excellent image quality. One patient showed inadequate fracture reduction in the imaging control, which then could be corrected. In another patient, a protruding head screw was detected, which could be replaced before augmentation. Cement distribution in the humeral head was consistent around the screw tips with no leakage into the joint. Conclusion This study shows that insufficient fracture reduction and implant misplacement can be easily and reliably detected by intraoperative DVT scan with an isocentric mobile C-arm set up in the usual parasagittal position to the patient.