Authors of section

Authors

Alexander Schramm, Marc Metzger, Nils Gellrich, Bradley Strong

General Editor

Daniel Buchbinder

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CAS: Intraoperative imaging in closed treatment

1. Introduction

Indiations

Whenever an intraoperative CT scanner is available, an intraoperative scan should be obtained for intraoperative evaluation of the reduction.

When using computer assisted surgery, the reduction (and fixation if necessary) is performed according to standard procedures as described in the AO Surgery Reference. It should be considered an adjunct to surgical treatment.

Computer assisted surgery in treating fractures allows intraoperative visualization of the reduction using intraoperative imaging combined with image fusion of preoperative and intraoperative CT scans.

With this technique, insufficient fracture reduction can be can be identified and corrected, eliminating the need for secondary procedures which may be necessary if only postoperative imaging is performed.

Intraoperative imaging requires an additional 10-15 min.

2. Preoperative imaging

The preoperative CT scan shows a displaced isolated zygomatic arch fracture of the left side.

isolated zygomatic arch fracture

3. Intraoperative assessment of reduction

To verify that the zygomatic arch has been properly reduced, CT scans can be performed intraoperatively.

computer assisted surgery gunshot injury virtual planning and intraoperative navigation

The intraoperative CT scan shows anatomic reduction of the bony fragments.

computer assisted surgery zygomatic arch intraoperative imaging closed reduction

Virtual planning software allows automatic image fusion of preoperative (blue) and intraoperative (gold) CT scans. This allows for a better visualization of the achieved reduction.

computer assisted surgery zygomatic arch intraoperative imaging closed reduction

In the example shown here, the intraoperative imaging shows an incomplete reduction of the right zygomatic arch.

computer assisted surgery zygomatic arch intraoperative imaging closed reduction

Without additional morbidity, the reduction of the zygomatic arch could be completed during the same operative session and verified with a second intraoperative scan.

computer assisted surgery zygomatic arch intraoperative imaging closed reduction