Peri-operative imaging in extremity fractures

This thesis focused on a critical evaluation of intra-operative 3D-imaging in extremity fracture surgery. Intra-operative 3D-imaging potentially enables the surgeon to improve the quality of fracture reduction and fixation of intra-articular fractures.
Epidemiologic data of extremity fractures were updated and showed a growing and ageing population and a general increase in incidence of extremity fractures between 2004 and 2012.
Furthermore, to evaluate the effectiveness of intra-operative 3D-imaging, qualification of the radiological anatomical reduction and fixation in a scoring protocol was necessary. For the wrist and ankle, group consensus amongst Dutch clinical experts was obtained following the Delphi method. For calcaneal fractures international group consensus was obtained. The scoring protocol following group consensus for calcaneal fractures showed a good inter- and intra-rater reliability.
In the literature cadaver studies showed a diagnostic accuracy comparable to CT scanning. Extra corrections were deemed necessary after 3D-imaging which would not have been recognized on 2D-imaging in clinical studies. However, in our clinical studies the use of intra-operative 3D-imaging in its current form did not result in improvement of the quality of reduction and fixation of calcaneal fractures and patient reported outcomes. The potential of this technique is worth further exploration and may be of value in other fracture types or in future developments like 3D-navigation or augmented reality.