lnfluence of intraoperative 3D fluoroscopy imaging on radiographic outcome and revision rate compared to conventional fluoroscopy in intra-articular calcaneus fractures.

BACKGROUND

There is growing but so far inconclusive evidence about the value of three-dimensional (3D) fluoroscopy in calcaneal fracture care. The aim of this study was to retrospectively review our own cohort of calcaneus fractures before and after the implementation of 3D fluoroscopy and compare their outcome in terms of quality of reduction and amendments made based on the additional information gained by 3D imaging.

METHODS

Between March 2012 and October 2022, we operated on 28 calcaneal fractures in 25 patients of whom eight were treated with the aid of 3D fluoroscopy (= hybrid group). In all cases, a sinus tarsi approach (STA) and an angular stable plate were used. Intra- and postoperative scans were analyzed based on the Delphi Consensus criteria evaluating quality of reduction and radiographic outcome. Statistical analyses were performed to check for statistical significance and inter-rater reliability.

RESULTS

We found no difference between the two groups (one group treated with conventional fluoroscopy and the other with 3D fluoroscopy) in terms of quality of reduction and radiographic outcome. Nevertheless, in more than half of our patients in the hybrid group, amendments were made based on the information gained through 3D fluoroscopy. Median radiation dose and surgical time was prolonged in the hybrid group but not leading to an increased infection rate.

CONCLUSION

We found satisfactory outcomes in osteosynthesis of calcaneus fractures using the STA, regardless of whether conventional or 3D fluoroscopy was used intraoperatively. However, no significant improvement due to usage of intraoperative 3D fluoroscopy imaging in terms of restoration of the anatomy and quality of reduction could be found. Nevertheless, 3D fluoroscopy helps to avoid revision surgeries due to intra-articular placed screws and does not seem to lead to more cases of infection despite slightly prolonged operation times.