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The Heidari Publications
94 publications · 23 years of research · click or drag a page corner to turn
Royal College
British Orthopaedic
AO Trauma
Churchill
Limb Recon
Specialist Reg.
Jeyaseelan L, Malagelada F, Parker L, Panagopoulos A, Heidari N, Vris A.
Intraoperative two-dimensional (2D) fluoroscopy is the standard imaging modality available to orthopaedic surgeons worldwide. It is well-accepted, however, multiplanar 3-dimensional (3D) CT scanning is superior to 2D imaging for visualising joint surfaces and is now a fundamental feature of the pre-operative planning of intra-articular fractures. We present two cases in which the use of 3D intraoperative imaging and the O-arm (Medtronic) led to immediate intraoperative revision to optimise fixation and articular congruity. During the trial period at our major trauma centre, intra-operative imaging was used in the lower limb trauma setting. Each patient was followed-up for 12 months post-operation and was finally assessed with x-rays and the AOFAS score. In both cases, either fracture reduction or implant position observed with 2D fluoroscopy was revised following a 3D intra-operative scan. No postoperative complications were noted and the healing process was uneventful.
What did we look at?
Whether a 3D scanner brought into the operating theatre — the O-arm — could change what surgeons did during foot and ankle fracture surgery, compared to relying on the standard flat (2D) x-ray images that have been used for decades. We describe two patients in detail and review the wider published evidence.
Why did we look at it?
Routine theatre x-rays show only one plane at a time. Foot and ankle fractures often involve curved joint surfaces that are hard to assess from these images alone — meaning small misalignments can be missed and only become apparent on a CT scan after the patient has woken up. By that point a second operation is needed to correct them. A scanner that can take a 3D image during surgery could let the surgeon spot and correct these errors before closing.
What did we find?
In both cases, the O-arm scan revealed a problem the standard 2D images had missed — either the fracture had not been fully reduced, or the position of the implant needed adjusting. The surgeon was able to revise the fixation in the same operation. Both patients then healed without complication and had good functional scores at one year.
What does this mean for patients?
For complex foot and ankle fractures involving the joint surface, intra-operative 3D imaging is a useful tool that may avoid second operations to correct subtle errors. The technology is not yet routine in every hospital and adds time and cost. As 3D scanners become more available, surgeons may increasingly choose them for these difficult fracture patterns.
The Open Orthopaedics Journal 2019. doi:10.2174/1874325001913010189