• Beerekamp M S H MSH Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands. Electronic address: m.s.beerekamp@amc.nl., de Muinck Keizer R J O RJO Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands., T Schepers, Beenen L F M LFM Department of Radiology, Amsterdam University Medical Center, Amsterdam, the Netherlands., Luitse J S K JSK Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands., N W Schep, D T Ubbink, J C Goslings, and EF3X-studygroup.
• Trauma Unit, Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands. Electronic address: m.s.beerekamp@amc.nl.
• Eur J Radiol. 2019 Mar 1; 112: 222-228.

ObjectivesThe aim of this study was to determine the correlation of the intra-operative fluoroscopic 2D- and 3D-images compared with a postoperative CT-scan, in terms of quality of reduction and fixation of calcaneal fractures.MethodsPatients requiring open reduction and internal fixation (ORIF) of a calcaneal fracture were recruited as part of the EF3X-trial. During surgery, intra-operative images of fluoroscopic 2D- and 3D-imaging were obtained to assess the quality of the reduction and implant position. All patients received a postoperative CT-scan within one week. The operating surgeon evaluated intra-operatively both 2D- and 3D-images according to a 23-item scoring protocol on a 3-point Likert scale. A scoring panel, consisting of three clinical experts, evaluated all images in a blinded and independent fashion. Intraclass correlation coefficients (ICC) with their 95% confidence intervals (CI) were calculated using a two-way-random model with absolute agreement.ResultsA total of 102 calcaneal fractures were included. Agreement of 3D-imaging for the quality of reduction was better than 2D-imaging, although still fair, but for fixation moderate to good. Agreement between the 2D-images and the CT-scans was poor to fair. Intra-operative 2D-imaging received the highest ratings for image quality and interpretability, followed by CT-scanning.ConclusionImplant position can be evaluated satisfactory with the aid of intra-operative 3D imaging. Although intra-operative 3D imaging had a better agreement with postoperative CT-scanning than 2D-imaging, there is a need to improve image quality and suppress scattering from implants to improve the additional value of intra-operative 3D imaging in calcaneal fracture reduction and fixation.Copyright © 2019 Elsevier B.V. All rights reserved.

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