• Stefan Wirth, Ekkehard Euler, Ulrich Linsenmaier, Sandro-Michael Heining, Dorothea Kotsianos, Klaus-Jürgen Pfeifer, Wolf Mutschler, and Maximilian Reiser.
• Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany. swirth@med.uni-muenchen.de
• Comput. Aided Surg. 2004 Jan 1;9(1-2):27-38.

ObjectiveTo analyse the image quality and diagnostic effectiveness of a new C-arm-based 3D imaging method (C-arm-CT) for intraoperative evaluation of screw osteosyntheses adjacent to a peripheral joint.Materials And MethodsInsertion of screws into four cadaveric specimens simulated the surgical treatment of talus neck fractures. Ten orthopedic surgeons and 10 radiologists evaluated X-ray, C-arm fluoroscopy, C-arm-CT and CT images.ResultsThe best image quality was obtained with X-rays (p < 0.001), followed by C-arm fluoroscopy (2D) and CT, with the C-arm-CT (3D) being rated lowest (p < 0.001). The most correct diagnoses were obtained with CT and C-arm-CT (with no statistical difference between them), while C-arm-fluoroscopy was inferior (p < 0.001) and X-rays were the worst (p < 0.05).ConclusionsEven if the image quality of C-arm-CT is definitely inferior to that of CT, screw misplacements can be reliably detected using C-arm-CT. As compared to the current standard procedures (intraoperative fluoroscopy and postoperative radiography), C-arm-CT performed better. C-arm-CT is ideally suited to the intraoperative diagnosis of high-contrast inquiries like bone fragments and OS material, especially at the extremities. Coupling of the new 3D imaging to existing navigation systems is possible. C-arm-CT will support the further development and implementation of open and minimally invasive surgical procedures.

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