Eight years' experience with intraoperative three-dimensional imaging. A critical review

Mobile C-arms with three-dimensional (3D) imaging, such as the Iso-C3D, allow for intraoperative 3D visualization of anatomic areas having complex 3D structures, such as articular surfaces. Over an 8-year period we performed 1,841 intraoperative control scans following osteosynthesis. For these patients we registered the number of intraoperative adjustments of fracture reduction and implant position in correlation to the area of surgery. Most intraoperative examinations in these patients were done for fractures of the calcaneus (20.5%) or the upper ankle joint (13.2%). We intraoperatively improved the reduction or implant position in 21.5% of the patients altogether. The majority of intraop-erative revisions were done in cases of osteosynthesis of the calcaneus (40.3%), injuries of the upper ankle joint (30.9%), or fractures of the distal tibia (29%). The revision rate over time was very stable. The intraoperative need to revise a reduction or implant position is not rare in our experience, and intraoperative 3D imaging is a valid tool to recognize and adjust suboptimal reduction or implant positioning.