Background: The purpose of this study was to analyze the applicability and advantages of the intraoperative use of a mobile isocentric C-arm with 3-dimensional imaging (SIREMOBIL ISO-C-3D) in fixation of intraarticular fractures.

Methods: Intraoperative CT-quality visualization was performed on a series of 72 closed-intraarticular fractures in 70 patients following fixation. Fracture distribution was; calcaneus (25), tibial plateau (17), tibial plafond (12), acetabulum (11), distal radius (3), ankle (3), femoral head (l). The mean patient age was 41. Intraoperative revision was performed based on the additional information Iso-C-3D provided beyond routine fluoroscopy used for fracture reduction and fixation. The primary outcome measure was revision rate after final Iso-C-3D data acquisition and prior to wound closure. Secondary objectives were to measure the additional time required for Iso-C-3D use and to determine the rate of further re-do surgeries.

Results: Eight out of 70 (11%) fracture fixations were judged by the surgeon to require intraoperative revision following Iso-C-3D imaging. In 7 cases this was due to hardware misplacement and in 1 this was for intraarticular loose fragment. Prior to leaving the operating room, the surgeon was satisfied with fracture alignment in all the procedures. The mean additional operative time using Iso-C-3D was 7.5 minutes. No patient required re-do surgery.

Conclusion: Intraoperative 3-dimensional visualization of intraarticular fractures enables the surgeon to identify inadvertent malreductions or implant malpositions which may be overlooked by routine C-arm fluoroscopy and hence eliminates the need for re-do procedures. Iso- C-3D adds little operative time and may preclude the need for preoperative and postoperative CT-scans in selected cases.