Intra-Operative 3-Dimensional Imaging (O-arm) in Foot and Ankle Trauma Surgery: Report of 2 Cases and Review of the Literature

Abstract

Background: 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. Objective: We present two cases in which the use of 3D intraoperative imaging and the O-arm® (Medtronic, Minneapolis, USA) led to immediate intraoperative revision to optimise fixation and articular congruity. A review of the current literature is also provided. Methods: During the trial period of the O-arm at our major trauma centre, intra-operative imaging was used in the lower limb trauma setting. The O-arm was used intra-operatively in a comminuted pilon fracture and a displaced talus fracture. We recorded all the intra-operative events, including quality of reduction, implant positioning and operation time. Each patient was followed-up for 12 months post-operation and was finally assessed with x-rays and the AOFAS score. Results: In both the cases, either fracture reduction or the implant position/usage that was observed with 2D fluoroscopy was revised following a 3D intra-operative scan. No postoperative complications were noted and the healing process was uneventful. X-rays at the final follow-up were excellent and acceptable for the talus and pilon fracture, respectively, with corresponding clinical results and AOFAS score. Conclusion: Although frequently used in spinal surgery, to the best of our knowledge, the use of intra-operative 3D techniques in lower limb trauma is sparse and sporadically reported. We present our cases in which the most current innovative imaging techniques influenced intra-operative outcomes without compromising patient safety. We feel that this is a real example of how innovation can positively influence patient care.