Intraoperative virtual implant planning for volar plate osteosynthesis of distal radius fractures

• Published in: Der Unfallchirurg Vol. 119; no. 1; pp. 36 - 42
• Main Authors: Franke, J, Vetter, S Y, Reising, K, Herrmann, S, Südkamp, N P, Grützner, P A, von Recum, J
• Format: Journal Article
• Language: German
• Published: Germany 01-01-2016
• Subjects: Adult; Aged; Aged, 80 and over; Bone Plates; Fluoroscopy - methods; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Imaging, Three-Dimensional - methods; Intraoperative Care - methods; Male; Middle Aged; Prosthesis Fitting - methods; Radius Fractures - diagnostic imaging; Radius Fractures - surgery; Surgery, Computer-Assisted - methods; Treatment Outcome; User-Computer Interface; Wrist Injuries - diagnostic imaging; Wrist Injuries - surgery; Young Adult; Matching; Intraoperative fluoroscopy time; Operating time; Screw misplacement; Intraoperative 3D imaging
• ISSN: 1433-044X
• DOI: 10.1007/s00113-014-2715-z

Digital planning of implants is in most cases conducted prior to surgery. The virtual implant planning system (VIPS) is an application developed for mobile C-arms, which assists the virtual planning of screws close to the joint line during surgery for treatment of distal radius fractures with volar plate osteosynthesis. The aim of this prospective randomized study was to acquire initial clinical experiences and to compare the VIPS method with the conventional technique.
The study included 10 patients for primary testing and 30 patients with distal radius fractures of types A3, C1 and C2, divided in 2 groups. In the VIPS group, after placement of the plate and fracture reduction, a virtual 3D model of the plate was matched with the image of the plate from the fluoroscopic acquisition. Next, the length and position of the screws close to the joint line were planned on the virtual plate. The control group was treated with the same implant in the conventional way. Data were collected regarding screw replacement, fluoroscopy and operating room (OR) times.
The VIPS group included six A3, one C1 and eight C2 fractures, while the control group consisted of six A3 and nine C2 fractures. Three screws were replaced in the VIPS group and two in the control group (p = 0.24). The mean intraoperative fluoroscopy time of the VIPS group amounted to 2.58 ± 1.38 min, whereas it was 2.12 ± 0.73 min in the control group (p = 0.26). The mean OR time in the VIPS group was 53.3 ± 34.5 minutes and 42.3 ± 8.8 min (p = 0.23) in the control group.
The VIPS enables a precise positioning of screws close to joint line in the treatment of distal radius fractures; however, for routine use, further development of the system is necessary.