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  • 1
    Online Resource
    Online Resource
    Initial and Residual 3D Fracture Displacement Is Predictive for Patient-Reported Functional Outcome at Mid-Term Follow-Up in Surgically Treated Tibial Plateau Fractures
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 18 ( 2023-09-19), p. 6055-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 18 ( 2023-09-19), p. 6055-
    Abstract: Background: Conventional measures of fracture displacement have low interobserver reliability. This study introduced a novel 3D method to measure tibial plateau fracture displacement and its impact on functional outcome. Methods: A multicentre study was conducted on patients who had tibial plateau fracture surgery between 2003 and 2018. Eligible patients had a preoperative CT scan (slice thickness ≤ 1 mm) and received a Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A total of 362 patients responded (57%), and assessment of initial and residual fracture displacement was performed via measurement using the 3D gap area (mm2). Patients were divided into four groups based on the 3D gap area size. Differences in functional outcome between these groups were assessed using analysis of variance (ANOVA). Multiple linear regression was used to determine the association between fracture displacement and patient-reported outcome. Results: Functional outcome appeared significantly worse when initial or residual fracture displacement increased. Multivariate linear regression showed that initial 3D gap area (per 100 mm2) was significantly negatively associated with all KOOS subscales: symptoms (−0.9, p 〈 0.001), pain (−0.0, p 〈 0.001), ADL (−0.8, p = 0.002), sport (−1.4, p 〈 0.001), and QoL (−1.1, p 〈 0.001). In addition, residual gap area was significantly negatively associated with the subscales symptoms (−2.2, p = 0.011), ADL (−2.2, p = 0.014), sport (−2.6, p = 0.033), and QoL (−2.4, p = 0.023). Conclusion: A novel 3D measurement method was applied to quantify initial and residual displacement. This is the first study which can reliably classify the degree of displacement and indicates that increasing displacement results in poorer patient-reported functional outcomes.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12186055
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662592-1
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  • 2
    Online Resource
    Online Resource
    Quantitative Three-Dimensional Measurements of Acetabular Fracture Displacement Could Be Predictive for Native Hip Survivorship
    MDPI AG ; 2022
    In:  Journal of Personalized Medicine Vol. 12, No. 9 ( 2022-09-06), p. 1464-
    Details
    In: Journal of Personalized Medicine, MDPI AG, Vol. 12, No. 9 ( 2022-09-06), p. 1464-
    Abstract: This study aims to develop a three-dimensional (3D) measurement for acetabular fracture displacement, determine the inter- and intra-observer variability, and correlate the measurement with clinical outcome. Three-dimensional models were created for 100 patients surgically treated for acetabular fractures. The ‘3D gap area’, the 3D surface between all the fracture fragments, was developed. The association between the 3D gap area and the risk of conversion to a total hip arthroplasty (THA) was determined by an ROC curve and a Cox regression analysis. The 3D gap area had an excellent inter-observer and intra-observer reliability. The preoperative median 3D gap area for patients without and with a THA was 1731 mm2 versus 2237 mm2. The median postoperative 3D gap area was 640 mm2 versus 845 mm2. The area under the curve was 0.63. The Cox regression analysis showed that a preoperative 3D gap area 〉 2103 mm2 and a postoperative 3D gap area 〉 1058 mm2 were independently associated with a 3.0 versus 2.4 times higher risk of conversion to a THA. A 3D assessment of acetabular fractures is feasible, reproducible, and correlates with clinical outcome. Three-dimensional measurements could be added to the current classification systems to quantify the level of fracture displacement and to assess operative results.
    Type of Medium: Online Resource
    ISSN: 2075-4426
    URL: Article
    DOI: 10.3390/jpm12091464
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662248-8
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  • 3
    Online Resource
    Online Resource
    Both-Column Acetabular Fractures: Does Surgical Approach Vary Based on Using Virtual 3D Reconstructions?
    MDPI AG ; 2023
    In:  Diagnostics Vol. 13, No. 9 ( 2023-05-05), p. 1629-
    Details
    In: Diagnostics, MDPI AG, Vol. 13, No. 9 ( 2023-05-05), p. 1629-
    Abstract: Displacement of the anterior and posterior column complicates decision making for both-column acetabular fractures. We questioned whether pelvic surgeons agree on treatment strategy, and whether the use of virtual 3D reconstructions changes the treatment strategy of choice. A nationwide cross-sectional survey was performed in all pelvic trauma centers in the Netherlands. Twenty surgeons assessed 15 both-column fractures in 2D as well as 3D. Based on conventional imaging, surgical treatment was recommended in 89% of cases, and by adding 3D reconstructions this was 93% (p = 0.09). Surgical approach was recommended as anterior (65%), posterior (8%) or combined (27%) (poor level of agreement, κ = 0.05) based on conventional imaging. The approach changed in 37% (p = 0.006), with most changes between a combined and anterior approach (still poor level of agreement, κ = 0.13) by adding 3D reconstructions. Additionally, surgeons’ level of confidence increased from good in 38% to good in 50% of cases. In conclusion, surgeons do not agree on the treatment strategy for both-column acetabular fractures. Additional information given by 3D reconstructions may change the chosen surgical approach and increase surgeons’ confidence about their treatment decision. Therefore, virtual 3D reconstructions are helpful for assessing both-column fracture patterns and aid in the choice of treatment strategy.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics13091629
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662336-5
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  • 4
    Online Resource
    Online Resource
    Accuracy of Patient-Specific Drilling Guides in Acetabular Fracture Surgery: A Human Cadaver Study
    MDPI AG ; 2021
    In:  Journal of Personalized Medicine Vol. 11, No. 8 ( 2021-08-03), p. 763-
    Details
    In: Journal of Personalized Medicine, MDPI AG, Vol. 11, No. 8 ( 2021-08-03), p. 763-
    Abstract: Due to the complex anatomical shape of the pelvis, screw placement can be challenging in acetabular fracture surgery. This study aims to assess the accuracy of screw placement using patient-specific surgical drilling guides applied to pre-contoured conventional implants in acetabular fracture surgery. CT scans were made of four human cadavers to create 3D models of each (unfractured) pelvis. Implants were pre-contoured on 3D printed pelvic models and optically scanned. Following virtual preoperative planning, surgical drilling guides were designed to fit on top of the implant and were 3D printed. The differences between the pre-planned and actual screw directions (degrees) and screw entry points (mm) were assessed from the pre- and postoperative CT-scans. The median difference between the planned and actual screw direction was 5.9° (IQR: 4–8°) for the in-plate screws and 7.6° (IQR: 6–10°) for the infra-acetabular and column screws. The median entry point differences were 3.6 (IQR: 2–5) mm for the in-plate screws and 2.6 (IQR: 2–3) mm for the infra-acetabular and column screws. No screws penetrated into the hip joint or caused soft tissue injuries. Three-dimensional preoperative planning in combination with surgical guides that envelope pre-contoured conventional implants result in accurate screw placement during acetabular fracture surgery.
    Type of Medium: Online Resource
    ISSN: 2075-4426
    URL: Article
    DOI: 10.3390/jpm11080763
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662248-8
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