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David L Helfet - One of the best experts on this subject based on the ideXlab platform.
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long term patient reported outcomes following Acetabular Fracture fixation
Injury-international Journal of The Care of The Injured, 2018Co-Authors: Jelle P Van Der List, Diederik O Verbeek, Camden M Tissue, David L HelfetAbstract:Abstract Introduction Patient reported outcome scores may be the preferred method to assess clinical results following Acetabular Fracture fixation. However, in current Acetabular Fracture research, there is a scarcity of studies using these scores and long-term follow-up is lacking. The aim of this study is to describe long-term patient reported outcomes following Acetabular Fracture surgery and to evaluate the association between reduction quality and these outcome measures. Methods Patients who received operative fixation for Acetabular Fractures (1992–2012) were sent questionnaires (short musculoskeletal functional assessment (SMFA) function index and short form (SF)-12), which was returned by 106 patients (22%) (mean age 51 years, 74% male). Mean follow-up was 11.3 years and hip survivorship 78%. Reduction quality was assessed on postoperative CT or plain pelvic radiography (PXR) (3 patients). Reductions were graded as adequate (CT: 3 mm displacement). Outcome scores between native hip versus total hip arthroplasty (THA) and adequate versus inadequate reduction groups were compared and association between reduction quality and hip survivorship was determined. Subgroup analysis was performed in older patients (≥50 years). Results Patients with native hips reported overall superior relevant outcome scores (SMFA function index (p = 0.047), mobility (p = 0.048) and SF-12 physical component (p = 0.008)) compared to THA patients. Hip survivorship was associated with adequate reductions (p = 0.019). In the native hip group, an adequate reduction was also associated with lower (better) clinical scores (exceeding the minimal clinical important difference) (MCID) specifically for SMFA function index (p = 0.117) and mobility (p = 0.022). In elderly patients, the native hip versus THA group had similar outcomes, and adequate reductions were associated with hip survivorship as well as superior clinical scores (at least exceeding the MCID) in those who retained their native hip. Conclusion At long-term follow-up, Acetabular Fracture surgery is associated with excellent patient reported outcomes. Patients who retain their native hip have overall superior relevant (SMFA and SF-12) function scores compared to those who convert to THA. Adequate reductions (on CT) were associated with both hip survivorship and superior outcome scores in patients who retain their hip.
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predictors for long term hip survivorship following Acetabular Fracture surgery importance of gap compared with step displacement
Journal of Bone and Joint Surgery American Volume, 2018Co-Authors: Diederik O Verbeek, Jelle P Van Der List, Camden M Tissue, David L HelfetAbstract:BACKGROUND: Historically, the greatest residual (gap or step) displacement is used to predict clinical outcome following Acetabular Fracture surgery. Gap and step displacement may, however, impact the outcome to different degrees. We assessed the individual relationship between gap or step displacement and hip survivorship and determined their independent association with conversion to total hip arthroplasty. METHODS: Patients who had Acetabular Fracture fixation (from 1992 through 2014), follow-up of ≥2 years (or early conversion to total hip arthroplasty), and postoperative computed tomography (CT) scans were included. Of 227 patients, 55 (24.2%) had conversion to total hip arthroplasty at a mean follow-up (and standard deviation) of 8.7 ± 5.6 years. Residual gap and step displacement were measured using a standardized CT-based method, and assessors were blinded to the outcome. Kaplan-Meier survivorship curves for the hips were plotted and compared (log-rank test) using critical cutoff values for gap and step displacement. These values were identified using receiver operating characteristic curves. Multivariate analysis was performed to identify independent variables associated with conversion to total hip arthroplasty. Subgroup analysis was performed in younger patients (<50 years old). RESULTS: The critical CT cutoff value for total hip arthroplasty conversion was 5 mm for gap and 1 mm for step displacement. Hip survivorship at 10 years was 82.0% for patients with a gap of <5 mm compared with 56.5% for a gap of ≥5 mm (p < 0.001) and 80.0% for a step of <1.0 mm versus 65.5% for a step of ≥1.0 mm (p = 0.012). A gap of ≥5 mm (hazard ratio [HR], 2.3; p = 0.012) and an age of ≥50 years (HR, 4.2; p < 0.001) were independently associated with conversion to total hip arthroplasty in all patients. In the subgroup of younger patients, only a step of ≥1 mm (HR, 6.4; p = 0.017) was an independent factor for conversion to total hip arthroplasty. CONCLUSIONS: Residual gap and step displacement as measured on CT scans are both related to long-term hip survivorship, but step displacement (1 mm) is tolerated less than gap displacement (5 mm). Of the 2 types of displacement, only a large gap displacement (≥5 mm) was independently associated with conversion to total hip arthroplasty. In younger patients who had less articular impaction with smaller residual gaps, only step displacement (≥1 mm) appeared to be associated with this outcome. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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postoperative ct is superior for Acetabular Fracture reduction assessment and reliably predicts hip survivorship
Journal of Bone and Joint Surgery American Volume, 2017Co-Authors: Diederik O Verbeek, Jelle P Van Der List, Jordan C Villa, David S Wellman, David L HelfetAbstract:BACKGROUND: Postoperative pelvic radiographs are routinely used to assess Acetabular Fracture reduction. We compared radiographs and computed tomography (CT) with regard to their ability to detect residual Fracture displacement. We also determined the association between the quality of reduction as assessed on CT and hip survivorship and identified risk factors for conversion to total hip arthroplasty (THA). METHODS: Patients were included in the study who had undergone Acetabular Fracture fixation between 1992 and 2012, who were followed for ≥2 years (or until early THA), and for whom radiographs and a pelvic CT scan were available. Residual displacement was measured on postoperative radiographs and CT and graded according to Matta's criteria (0 to 1 mm indicating anatomic reduction; 2 to 3 mm, imperfect reduction; and >3 mm, poor reduction) by observers who were blinded to patient outcome. Kaplan-Meier survivorship curves were plotted and log-rank tests were used to assess statistical differences in survivorship curves between adequate (anatomic or imperfect) and inadequate reductions on CT. Cox proportional hazard regression analysis was used to identify risk factors for conversion to THA. Two hundred and eleven patients were included. At mean of 9.0 years (standard deviation [SD], 5.6; median, 7.9; range, 0.5 to 23.3 years) postoperatively, 161 patients (76%) had retained their native hip. RESULTS: Compared with radiographs, CT showed worse reduction in 124 hips (59%), the same reduction in 79 (37%), and better reduction in 8 (4%). Of the 99 patients graded as having adequate reduction on CT, 10% underwent conversion to THA in comparison with 36% of those with inadequate reduction, and there was a significant difference between the survivorship curves (p < 0.001). Mean hip survivorship was shorter in patients ≥50 years of age (p < 0.001) and in those with an inadequate reduction on CT (p < 0.001). Independent risk factors for conversion to THA were age (hazard ratio [HR] = 4.46, 95% confidence interval [CI] = 2.07 to 9.62; p < 0.001), inadequate reduction (HR = 3.57, 95% CI = 1.71 to 7.45; p = 0.001), and posterior wall involvement (HR = 1.81, 95% CI = 1.00 to 3.26; p = 0.049). Sex, Fracture type (elementary versus associated), and year of surgery did not influence hip survivorship. CONCLUSIONS: CT is superior to radiographs for detecting residual displacement after Acetabular Fracture fixation. Hip survivorship is greater in patients with adequate (anatomic or imperfect) reduction on CT. Along with older age and posterior wall involvement, an inadequate reduction on CT is a risk factor for conversion to THA. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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total hip arthroplasty for posttraumatic arthritis after Acetabular Fracture
Journal of Arthroplasty, 2009Co-Authors: Anil S Ranawat, Jonathan Zelken, David L Helfet, Robert L BulyAbstract:Total hip arthroplasty (THA) outcomes for posttraumatic arthritis after Acetabular Fracture have yielded inferior results compared to primary nontraumatic THA. Recently, improved results have been demonstrated using cementless Acetabular reconstruction. Thirty-two patients underwent THA for posttraumatic arthritis after Acetabular Fracture; 24 were treated with open reduction internal fixation, and 8 were managed conservatively. Time from Fracture to THA was 36 months (6-227 months). Average follow-up was 4.7 years (2.0-9.7 years). Harris Hip score increased from 28 (0-56) to 82 points (20-100). Six patients required revision. Five-year survival with revision, loosening, dislocation, or infection as an end point was 79%. Survival for aseptic Acetabular loosening was 97%. Revision surgery correlated with nonanatomic restoration of the hip center and a history of infection (P < .05). Despite obvious challenges, advances in Fracture management and cementless Acetabular fixation in THA demonstrate improved results for posttraumatic arthritis following Acetabular Fracture.
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magnetic resonance venography to evaluate the deep venous system of the pelvis in patients who have an Acetabular Fracture
American Academy of Orthopaedic Surgeons. Annual meeting, 1995Co-Authors: Kenneth D Montgomery, Hollis G Potter, David L HelfetAbstract:We performed a prospective, blinded study to assess and compare the values of preoperative contrast venography and magnetic resonance venography in the detection of deep venous thrombosis in the thigh and pelvis of forty-five consecutive patients who had a displaced Acetabular Fracture. The magnetic resonance venography and contrast venography were performed an average of seven days (range, one to twenty-nine days) after the injury. Twenty-four asymptomatic thrombi were identified with magnetic resonance venography in fifteen (33 per cent) of the patients. Four of the thombi were in the superficial femoral vein, nine were in the common femoral vein, one was in the external iliac vein, seven were in the internal iliac vein, and three were in the common iliac vein. Ten (42 per cent) of the twenty-four thrombi were confirmed with contrast venography ; nine of them were located in the thigh. The remaining fourteen thrombi (58 per cent) that had been noted on magnetic resonance venography could not be seen with contrast venography because they were located either in the deep pelvic veins or in the uninjured extremity. The thrombi in the internal iliac vein were identified only with magnetic resonance venography. Twelve of the fifteen patients who had thrombi had a filter placed in the inferior vena cava preoperatively. In eight of these patients, the filter was placed because of the findings of magnetic resonance venography alone. Magnetic resonance venography resulted in a change in the therapeutic management of ten (22 per cent) of the forty-five patients. There were no pulmonary emboli. We concluded that magnetic resonance venography is superior to contrast venography for the preoperative evaluation of proximal deep venous thrombosis in patients who have an Acetabular Fracture. Magnetic resonance venography is non-invasive, does not require the use of contrast medium, images the proximal aspects of both lower extremities simultaneously, and, most importantly, allows for the identification of deep venous thrombosis in the pelvis.
Daniel J Berry - One of the best experts on this subject based on the ideXlab platform.
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total hip arthroplasty after operatively treated Acetabular Fracture a concise follow up at a mean of twenty years of a previous report
Journal of Bone and Joint Surgery American Volume, 2015Co-Authors: Philipp Von Roth, Matthew P Abdel, Scott W Harmsen, Daniel J BerryAbstract:Abstract:Acetabular Fractures increase the risk of posttraumatic arthritis and thus the risk of total hip arthroplasty (THA). We previously presented the ten-year results of THA performed for posttraumatic arthritis after an Acetabular Fracture; we now present the twenty-year outcomes. The original
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uncemented Acetabular components for arthritis after Acetabular Fracture
Clinical Orthopaedics and Related Research, 2002Co-Authors: Daniel J Berry, Michael P HalasyAbstract:The purpose of the current study was to evaluate the results of uncemented Acetabular components used to treat posttraumatic arthritis after Acetabular Fracture at a minimum of 10 years. Thirty-four hips in 33 patients (mean age, 49.7 years, range, 19-78 years) were treated from 1984 to 1990 at one institution with a total hip arthroplasty using an uncemented titanium porous-coated socket. Four patients died before 10 years (all with implants intact). Nine patients had the acetabulum revised: four had the shell and liner revised (one for loosening, one for loosening and dislocation, and two for osteolysis) and five had the liner alone revised (three for polyethylene wear and two for dislocation). All patients with unrevised hip replacements who were alive and patients who were not lost to followup had no or minimal pain at final followup (range, 10-16 years); no components were radiographically loose. Uncemented sockets had a low rate of loosening in this challenging patient population, but polyethylene wear and osteolysis were problematic.
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Acetabular Fracture associated with cementless Acetabular component insertion a report of 13 cases
Journal of Arthroplasty, 1999Co-Authors: Peter F Sharkey, Arlen D Hanssen, William J Hozack, John J Callaghan, Daniel J Berry, David G LewallenAbstract:Abstract Acetabular Fracture during insertion of a cementless Acetabular component occurred in 13 patients. The preoperative diagnosis was osteoarthritis in 6 patients, rheumatoid arthritis in 2 patients, avascular necrosis in 3 patients, hip Fracture nonunion in 1 patient, and developmental dysplasia of the hip in 1 patient. Several different components were used; however, the acetabulum was underreamed by 1 to 3 mm in all cases. The Acetabular Fracture was identified in 9 of 13 cases intraoperatively. The Fracture was identified on postoperative radiographs for the other 4 cases. Fractures were treated by a variety of means, including the addition of augmentation screws in or around the cup, use of autograft bone at the Fracture site, modified postoperative weight-bearing status, and immobilization. In 2 cases, the socket needed to be revised after it progressively migrated and failed. One patient had cup migration, and another had a radiolucent line about the cup but was not symptomatic enough to require revision. In 3 of these 4 cases, the Fracture was not identified intraoperatively. Underreaming of the acetabulum and use of an oversized Acetabular component has been recommended to improve the initial stability of the Acetabular component during total hip arthroplasty. Impaction of an oversized component requires bone to undergo plastic deformation if the cup is to be fully seated. Theoretically, this technique provides improved component stability with enhanced osseous ingrowth into the cup. The 13 cases reported in this study demonstrate that Acetabular Fracture is a complication that may occur in association with uncemented hip arthroplasty, particularly if oversized components are used. The importance of recognizing Acetabular Fractures intraoperatively and the need to institute appropriate treatment to ensure a stable Acetabular component is emphasized. In patients with osteoporotic bone, line-to-line reaming with use of a cementless Acetabular component or insertion of a cemented socket may be considered to avoid this significant complication.
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total hip arthroplasty after operative treatment of an Acetabular Fracture
Journal of Bone and Joint Surgery American Volume, 1998Co-Authors: Martin Weber, Daniel J Berry, William S HarmsenAbstract:Sixty-six primary total hip arthroplasties were performed to treat post-traumatic osteoarthrosis that had developed following an Acetabular Fracture and subsequent open reduction and internal fixation. The mean age of the patients at the time of the total hip arthroplasty was fifty-two years (range, nineteen to eighty years). The arthroplasty was performed with cement in forty-four hips and without cement in twenty hips; in the remaining two hips, the Acetabular component was inserted without cement and the femoral component was inserted with cement (a so-called hybrid procedure). Scarring from a previous procedure, retained hardware, heterotopic bone, and residual osseous deformity and deficiency made the procedure more complex than routine total hip arthroplasty in most patients. However, only one of the sixty-six procedures was associated with an operative complication. Three patients were lost to follow-up. The remaining sixty-three patients were followed for a mean of 9.6 years (range, two to twenty years). The mean duration of follow-up was 14.9 years for the Acetabular components inserted with cement, 11.6 years for the femoral components inserted with cement, 4.6 years for the femoral components inserted without cement, and 3.9 years for the Acetabular components inserted without cement. The mean Harris hip score improved from 49 points preoperatively to 93 points at the latest follow-up evaluation for the forty-six patients who did not have a revision procedure after the index arthroplasty. Seventeen patients had a revision; sixteen revisions were performed because of aseptic loosening of one or both components (nine Acetabular and eleven femoral components). Mechanical failure (radiographic loosening or revision due to aseptic loosening) occurred in twenty-five hips. As determined with use of the Kaplan-Meier method, the ten-year survival rate, with revision due to aseptic loosening as the end point, was 78 per cent (95 per cent confidence interval, 66 to 92 per cent) for the prosthesis as a whole (that is, no revision of either component), 87 per cent (95 per cent confidence interval, 76 to 99 per cent) for the Acetabular component, and 84 per cent (95 per cent confidence interval, 72 to 97 per cent) for the femoral component. An age of less than fifty years (p = 0.02), a weight of eighty kilograms or more (p = 0.047), and large residual combined segmental and cavitary deficiencies in the Acetabular bone (p < 0.0001) were significant risk factors for revision because of aseptic loosening. At the ten-year follow-up, none of the twenty-two Acetabular components that had been inserted without cement had been revised or demonstrated radiographic loosening. The ten-year rate of failure due to aseptic loosening was higher than that in many reported series of total hip arthroplasties performed for other indications; this was probably partly because of the young mean age of the patients, the high number of patients who had Charnley class-A involvement, and the predominantly male cohort.
Diederik O Verbeek - One of the best experts on this subject based on the ideXlab platform.
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What is the value of 3D virtual reality in understanding Acetabular Fractures
European Journal of Orthopaedic Surgery and Traumatology, 2019Co-Authors: L. Brouwers, Albert F. Pull Ter Gunne, Mariska A.c. De Jongh, Thomas J.j. Maal, Rinaldo D. Vreeken, Frank H. W. M. Van Der Heijden, Luke P. H. Leenen, Willem R. Spanjersberg, Sven H. Van Helden, Diederik O VerbeekAbstract:Background Acetabular Fractures are difficult to classify owing to the complex three-dimensional (3D) anatomy of the pelvis. 3D printing helps to understand and reliably classify Acetabular Fracture types. 3D-virtual reality (VR) may have comparable benefits. Our hypothesis is that 3D-VR is equivalent to 3D printing in understanding Acetabular Fracture patterns.
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long term patient reported outcomes following Acetabular Fracture fixation
Injury-international Journal of The Care of The Injured, 2018Co-Authors: Jelle P Van Der List, Diederik O Verbeek, Camden M Tissue, David L HelfetAbstract:Abstract Introduction Patient reported outcome scores may be the preferred method to assess clinical results following Acetabular Fracture fixation. However, in current Acetabular Fracture research, there is a scarcity of studies using these scores and long-term follow-up is lacking. The aim of this study is to describe long-term patient reported outcomes following Acetabular Fracture surgery and to evaluate the association between reduction quality and these outcome measures. Methods Patients who received operative fixation for Acetabular Fractures (1992–2012) were sent questionnaires (short musculoskeletal functional assessment (SMFA) function index and short form (SF)-12), which was returned by 106 patients (22%) (mean age 51 years, 74% male). Mean follow-up was 11.3 years and hip survivorship 78%. Reduction quality was assessed on postoperative CT or plain pelvic radiography (PXR) (3 patients). Reductions were graded as adequate (CT: 3 mm displacement). Outcome scores between native hip versus total hip arthroplasty (THA) and adequate versus inadequate reduction groups were compared and association between reduction quality and hip survivorship was determined. Subgroup analysis was performed in older patients (≥50 years). Results Patients with native hips reported overall superior relevant outcome scores (SMFA function index (p = 0.047), mobility (p = 0.048) and SF-12 physical component (p = 0.008)) compared to THA patients. Hip survivorship was associated with adequate reductions (p = 0.019). In the native hip group, an adequate reduction was also associated with lower (better) clinical scores (exceeding the minimal clinical important difference) (MCID) specifically for SMFA function index (p = 0.117) and mobility (p = 0.022). In elderly patients, the native hip versus THA group had similar outcomes, and adequate reductions were associated with hip survivorship as well as superior clinical scores (at least exceeding the MCID) in those who retained their native hip. Conclusion At long-term follow-up, Acetabular Fracture surgery is associated with excellent patient reported outcomes. Patients who retain their native hip have overall superior relevant (SMFA and SF-12) function scores compared to those who convert to THA. Adequate reductions (on CT) were associated with both hip survivorship and superior outcome scores in patients who retain their hip.
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predictors for long term hip survivorship following Acetabular Fracture surgery importance of gap compared with step displacement
Journal of Bone and Joint Surgery American Volume, 2018Co-Authors: Diederik O Verbeek, Jelle P Van Der List, Camden M Tissue, David L HelfetAbstract:BACKGROUND: Historically, the greatest residual (gap or step) displacement is used to predict clinical outcome following Acetabular Fracture surgery. Gap and step displacement may, however, impact the outcome to different degrees. We assessed the individual relationship between gap or step displacement and hip survivorship and determined their independent association with conversion to total hip arthroplasty. METHODS: Patients who had Acetabular Fracture fixation (from 1992 through 2014), follow-up of ≥2 years (or early conversion to total hip arthroplasty), and postoperative computed tomography (CT) scans were included. Of 227 patients, 55 (24.2%) had conversion to total hip arthroplasty at a mean follow-up (and standard deviation) of 8.7 ± 5.6 years. Residual gap and step displacement were measured using a standardized CT-based method, and assessors were blinded to the outcome. Kaplan-Meier survivorship curves for the hips were plotted and compared (log-rank test) using critical cutoff values for gap and step displacement. These values were identified using receiver operating characteristic curves. Multivariate analysis was performed to identify independent variables associated with conversion to total hip arthroplasty. Subgroup analysis was performed in younger patients (<50 years old). RESULTS: The critical CT cutoff value for total hip arthroplasty conversion was 5 mm for gap and 1 mm for step displacement. Hip survivorship at 10 years was 82.0% for patients with a gap of <5 mm compared with 56.5% for a gap of ≥5 mm (p < 0.001) and 80.0% for a step of <1.0 mm versus 65.5% for a step of ≥1.0 mm (p = 0.012). A gap of ≥5 mm (hazard ratio [HR], 2.3; p = 0.012) and an age of ≥50 years (HR, 4.2; p < 0.001) were independently associated with conversion to total hip arthroplasty in all patients. In the subgroup of younger patients, only a step of ≥1 mm (HR, 6.4; p = 0.017) was an independent factor for conversion to total hip arthroplasty. CONCLUSIONS: Residual gap and step displacement as measured on CT scans are both related to long-term hip survivorship, but step displacement (1 mm) is tolerated less than gap displacement (5 mm). Of the 2 types of displacement, only a large gap displacement (≥5 mm) was independently associated with conversion to total hip arthroplasty. In younger patients who had less articular impaction with smaller residual gaps, only step displacement (≥1 mm) appeared to be associated with this outcome. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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postoperative ct is superior for Acetabular Fracture reduction assessment and reliably predicts hip survivorship
Journal of Bone and Joint Surgery American Volume, 2017Co-Authors: Diederik O Verbeek, Jelle P Van Der List, Jordan C Villa, David S Wellman, David L HelfetAbstract:BACKGROUND: Postoperative pelvic radiographs are routinely used to assess Acetabular Fracture reduction. We compared radiographs and computed tomography (CT) with regard to their ability to detect residual Fracture displacement. We also determined the association between the quality of reduction as assessed on CT and hip survivorship and identified risk factors for conversion to total hip arthroplasty (THA). METHODS: Patients were included in the study who had undergone Acetabular Fracture fixation between 1992 and 2012, who were followed for ≥2 years (or until early THA), and for whom radiographs and a pelvic CT scan were available. Residual displacement was measured on postoperative radiographs and CT and graded according to Matta's criteria (0 to 1 mm indicating anatomic reduction; 2 to 3 mm, imperfect reduction; and >3 mm, poor reduction) by observers who were blinded to patient outcome. Kaplan-Meier survivorship curves were plotted and log-rank tests were used to assess statistical differences in survivorship curves between adequate (anatomic or imperfect) and inadequate reductions on CT. Cox proportional hazard regression analysis was used to identify risk factors for conversion to THA. Two hundred and eleven patients were included. At mean of 9.0 years (standard deviation [SD], 5.6; median, 7.9; range, 0.5 to 23.3 years) postoperatively, 161 patients (76%) had retained their native hip. RESULTS: Compared with radiographs, CT showed worse reduction in 124 hips (59%), the same reduction in 79 (37%), and better reduction in 8 (4%). Of the 99 patients graded as having adequate reduction on CT, 10% underwent conversion to THA in comparison with 36% of those with inadequate reduction, and there was a significant difference between the survivorship curves (p < 0.001). Mean hip survivorship was shorter in patients ≥50 years of age (p < 0.001) and in those with an inadequate reduction on CT (p < 0.001). Independent risk factors for conversion to THA were age (hazard ratio [HR] = 4.46, 95% confidence interval [CI] = 2.07 to 9.62; p < 0.001), inadequate reduction (HR = 3.57, 95% CI = 1.71 to 7.45; p = 0.001), and posterior wall involvement (HR = 1.81, 95% CI = 1.00 to 3.26; p = 0.049). Sex, Fracture type (elementary versus associated), and year of surgery did not influence hip survivorship. CONCLUSIONS: CT is superior to radiographs for detecting residual displacement after Acetabular Fracture fixation. Hip survivorship is greater in patients with adequate (anatomic or imperfect) reduction on CT. Along with older age and posterior wall involvement, an inadequate reduction on CT is a risk factor for conversion to THA. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Yue Shen - One of the best experts on this subject based on the ideXlab platform.
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augmented reality patient specific reconstruction plate design for pelvic and Acetabular Fracture surgery
Computer Assisted Radiology and Surgery, 2013Co-Authors: Fangyang Shen, Bailiang Chen, Yue Qi, Yue ShenAbstract:Purpose The objective of this work is to develop a preoperative reconstruction plate design system for unilateral pelvic and Acetabular Fracture reduction and internal fixation surgery, using computer graphics and augmented reality (AR) techniques, in order to respect the patient-specific morphology and to reduce surgical invasiveness, as well as to simplify the surgical procedure.
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Augmented reality patient-specific reconstruction plate design for pelvic and Acetabular Fracture surgery
International Journal of Computer Assisted Radiology and Surgery, 2013Co-Authors: Fangyang Shen, Bailiang Chen, Qingshan Guo, Yue Qi, Yue ShenAbstract:PURPOSE: The objective of this work is to develop a preoperative reconstruction plate design system for unilateral pelvic and Acetabular Fracture reduction and internal fixation surgery, using computer graphics and augmented reality (AR) techniques, in order to respect the patient-specific morphology and to reduce surgical invasiveness, as well as to simplify the surgical procedure.\n\nMATERIALS AND METHODS: Our AR-aided implant design and contouring system is composed of two subsystems: a semi-automatic 3D virtual Fracture reduction system to establish the patient-specific anatomical model and a preoperative templating system to create the virtual and real surgical implants. Preoperative 3D CT data are taken as input. The virtual Fracture reduction system exploits the symmetric nature of the skeletal system to build a "repaired" pelvis model, on which reconstruction plates are planned interactively. A lightweight AR environment is set up to allow surgeons to match the actual implants to the digital ones intuitively. The effectiveness of this system is qualitatively demonstrated with 6 clinical cases. Its reliability was assessed based on the inter-observer reproducibility of the resulting virtual implants.\n\nRESULTS: The implants designed with the proposed system were successfully applied to all cases through minimally invasive surgeries. After the treatments, no further complications were reported. The inter-observer variability of the virtual implant geometry is 0.63 mm on average with a standard deviation of 0.49 mm. The time required for implant creation with our system is 10 min on average.\n\nCONCLUSION: It is feasible to apply the proposed AR-aided design system for noninvasive implant contouring for unilateral Fracture reduction and internal fixation surgery. It also enables a patient-specific surgical planning procedure with potentially improved efficiency.
Fangyang Shen - One of the best experts on this subject based on the ideXlab platform.
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augmented reality patient specific reconstruction plate design for pelvic and Acetabular Fracture surgery
Computer Assisted Radiology and Surgery, 2013Co-Authors: Fangyang Shen, Bailiang Chen, Yue Qi, Yue ShenAbstract:Purpose The objective of this work is to develop a preoperative reconstruction plate design system for unilateral pelvic and Acetabular Fracture reduction and internal fixation surgery, using computer graphics and augmented reality (AR) techniques, in order to respect the patient-specific morphology and to reduce surgical invasiveness, as well as to simplify the surgical procedure.
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Augmented reality patient-specific reconstruction plate design for pelvic and Acetabular Fracture surgery
International Journal of Computer Assisted Radiology and Surgery, 2013Co-Authors: Fangyang Shen, Bailiang Chen, Qingshan Guo, Yue Qi, Yue ShenAbstract:PURPOSE: The objective of this work is to develop a preoperative reconstruction plate design system for unilateral pelvic and Acetabular Fracture reduction and internal fixation surgery, using computer graphics and augmented reality (AR) techniques, in order to respect the patient-specific morphology and to reduce surgical invasiveness, as well as to simplify the surgical procedure.\n\nMATERIALS AND METHODS: Our AR-aided implant design and contouring system is composed of two subsystems: a semi-automatic 3D virtual Fracture reduction system to establish the patient-specific anatomical model and a preoperative templating system to create the virtual and real surgical implants. Preoperative 3D CT data are taken as input. The virtual Fracture reduction system exploits the symmetric nature of the skeletal system to build a "repaired" pelvis model, on which reconstruction plates are planned interactively. A lightweight AR environment is set up to allow surgeons to match the actual implants to the digital ones intuitively. The effectiveness of this system is qualitatively demonstrated with 6 clinical cases. Its reliability was assessed based on the inter-observer reproducibility of the resulting virtual implants.\n\nRESULTS: The implants designed with the proposed system were successfully applied to all cases through minimally invasive surgeries. After the treatments, no further complications were reported. The inter-observer variability of the virtual implant geometry is 0.63 mm on average with a standard deviation of 0.49 mm. The time required for implant creation with our system is 10 min on average.\n\nCONCLUSION: It is feasible to apply the proposed AR-aided design system for noninvasive implant contouring for unilateral Fracture reduction and internal fixation surgery. It also enables a patient-specific surgical planning procedure with potentially improved efficiency.
