ArticleJournal of orthopaedic surgery and research2025
Comparison of 2D and 3D fluoroscopy for intraoperative detection of intra-articular incongruities in distal radius fractures.
Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundInsufficient reduction of intra-articular fractures can lead to posttraumatic arthritis. An accurate intraoperative assessment of the articular surface is essential to guide surgical decision-making. This study aims to compare the sensitivity of 2D and 3D fluoroscopy for detecting intra-articular gaps and step-offs in distal radius fractures.
methodsIntra-articular distal radius fractures were induced in 6 cadaveric forearms and intra-articular incongruities (gap/step-off) of 0, 1 and 2 mm were created using 3D-printed repositioning guides. Images were acquired by 2D and 3D fluoroscopy for each step and evaluated by 3 blinded observers. Sensitivity and specificity for the detection of intra-articular incongruities were analyzed. Additionally, the inter-rater agreement for the decision to perform revision surgery and dose area product (DAP) were evaluated.
resultsThe overall sensitivity of 3D fluoroscopy for the detection of intra-articular incongruities was 90.28% compared to 55.56% for 2D fluoroscopy. Sensitivities for the detection of 2 mm incongruities were higher than for 1 mm especially in 2D fluoroscopy (1 mm: 38.89%; 2 mm: 74.72%). In 41.67% of cases with 1 mm incongruities where no revision was deemed necessary in 2D fluoroscopy, 3D imaging prompted a change in decision to perform revision. The dose area product was significantly higher for 3D fluoroscopy (41.87 cGycm
conclusionThe results suggest that 3D fluoroscopy can facilitate the detection of intra-articular incongruities in distal radius fractures and may prompt intra-operative revisions. Further clinical studies are needed to determine the effect on surgical outcomes.
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