Artikel
Computer-assisted Fragment Reduction of Distal Radius Fractures Depends on Surgical Planning Experience
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Autoren
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Christoph Zindel
- Universitätsklinik Balgrist, Zürich, Switzerland
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Phillip Fuernstahl
- Universitätsklinik Balgrist, Zürich, Switzerland
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Andreas Schweizer
- Universitätsklinik Balgrist, Zürich, Switzerland
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Simon Roner
- Universitätsklinik Balgrist, Zürich, Switzerland
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Preoperative planning of fracture treatment leads to a better understanding of the pathology and its management, such as e.g. the surgical approach, the intraoperative challenges and the implant choice.
Despite the advantages of 3D analysis and surgical planning in corrective osteotomies of the upper extremity, computer-assisted reduction of distal radius fractures has not been investigated so far. Current computer-based methods still rely strongly on clinical-based knowledge, which is mandatorily provided by a surgeon. Therefore, we hypothesize that the accuracy of fracture realignment is dependent on the surgical planning experience of the user.
Methods: A set of 3D bone models of distal radius fractures (n = 22) of varying complexity were presented to four readers with different surgical planning experience. The readers included a senior surgeon (SS, 23 years of experience), a resident surgeon (RS, 6y), a biomedical engineer (BE, 3y) and a medical student (MS, <1y). The objective was to perform a free-hand reduction of all fracture fragments with the use of a medical CAD planning software. To perform the final 3D displacement analysis, the fragment realignment of the SS was defined as the reference for the other three readers.
The drawback of current computer-assisted displacement analyses requiring a coordinate system was solved by a newly introduced 3D-transformation. This displacement analysis consists of only two measurement parameters for each fragment: a pure shift (3D-translation) and a pure rotation (3D-angle).
Results and Conclusions: Regarding the 3D-translation, the post-hoc analysis showed that the RS as well as the BE performed a significantly better fragment reduction compared to the MS (p =0.03). Regarding the 3D-angle, a statistical trend towards the RS as well as towards the BE was observed compared to the MS.
We conclude that computer-assisted reduction of distal radius fractures is depended on the surgical planning experience.
The hereby newly described 3D displacement analysis showed to be a promising way to describe the displacement of bone fragments. It is coordinate-system-invariant, mathematically distinct, program-independent implementable, inter-experimental comparable and surgical intuitively understandable.
