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Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: a systematic review.

Abstract：

OBJECTIVES:The aim of this systematic review was to compare the diagnostic accuracy, subjective image quality and clinical consequences of 3D-fluoroscopy with standard imaging modalities (2D-fluoroscopy, X-ray or CT) during reduction and fixation of intra-articular upper and lower extremity fractures. METHODS:A systematic literature search was performed in MEDLINE, EMBASE and the Cochrane library. In total 673 articles were identified (up to March 2012). The 19 included studies described patients/cadavers with intra-articular upper/lower extremity fractures and compared 3D-fluoroscopy to standard imaging. The study was performed in accordance with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines. Diagnostic accuracy was defined by the quality of fracture reduction or implant position and, if possible, expressed as sensitivity and specificity; subjective image quality was determined by the quality of depiction of bone or implants; clinical consequences were defined as corrections in reduction or implant position following 3D-fluoroscopy. RESULTS:Ten cadaver- and nine clinical studies were included. A meta-analysis was not possible, because studies used different scoring protocols to express diagnostic accuracy and reported incomplete data. Based on the individual studies, diagnostic accuracy of 3D-fluoroscopy was better than 2D-fluoroscopy and X-ray, but similar to CT-scanning. Subjective image quality of 3D-fluoroscopy was inferior compared to all other imaging modalities. In 11-40% of the operations additional corrections were performed after 3D-fluoroscopy, while the necessity for these corrections were not recognized based on 2D-fluoroscopic images. CONCLUSIONS:Although subjective image quality is rated inferior compared to other imaging modalities, intra-operative use of 3D-fluoroscopy is a helpful diagnostic tool for improving the quality of reduction and implant position in intra-articular fractures.

journal_name

Eur J Radiol

journal_title

European journal of radiology

authors

Beerekamp MS,Sulkers GS,Ubbink DT,Maas M,Schep NW,Goslings JC

doi

10.1016/j.ejrad.2012.06.021

subject

Has Abstract

pub_date

2012-12-01 00:00:00

pages

4019-28

issue

eissn

0720-048X

issn

1872-7727

pii

S0720-048X(12)00288-4

journal_volume

pub_type

杂志文章,meta分析,评审

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Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: a systematic review.