Fractures of the thoracolumbar junction are the most common vertebral fractures and can require surgical treatment. Several studies have shown that the accuracy of pedicle screw placement can be improved by the use of 3D-navigation. Still only few studies have focused on the use of navigation in traumatic spine injuries. The aim of this study was to compare the screw placement accuracy and radiation exposure for 3D-navigated and fluoroscopy-guided percutaneous pedicle screw placement in traumatic fractures of the thoracolumbar junction. In this single-center study 25 patients undergoing 3D-navigated percutaneous pedicle screw placement for traumatic fractures of the thoracolumbar junction (T12-L2) were compared to a control group of 25 patients using fluoroscopy. Screw accuracy was determined in postoperative CT-scans using the Gertzbein-Robbins classification system. Additionally, duration of surgery, dose area product, fluoroscopy time and intraoperative complications were compared between the groups. The accuracy of 3D-navigated percutaneous pedicle screw placement was 92.66 % while an accuracy of 88.08 % was achieved using standard fluoroscopy (p = 0.19). The fluoroscopy time was significantly less in the navigation group compared to the control group (p = 0.0002). There were no significant differences in radiation exposure, duration of surgery or intraoperative complications between the groups. The results suggest that 3D-navigation facilitates higher accuracy in percutaneous pedicle screw placement of traumatic fractures of the thoracolumbar junction, although limitations should be considered. In this study 3D-navigation did not increase fluoroscopy time, while radiation exposure and surgery time were comparable.

Cervical pedicle screw (CPS) placement is a technically demanding procedure with a high risk of neurovascular injuries in case of screw misplacement. In contrast to the thoracolumbar spine, there is limited data on percutaneous pedicle screw placement in the cervical spine. This study aims to compare the accuracy, blood loss and duration of surgery for open and percutaneous CPS placement for traumatic injuries of the subaxial cervical spine. In this retrospective single-center study, 22 patients undergoing percutaneous CPS placement were compared to a control group of 18 patients treated with open CPS placement. The screw position was analyzed in postoperative CT scans using the Neo and Bredow classifications. Additionally, intraoperative radiation exposure, duration of surgery, and blood loss were evaluated. The overall accuracy (perforation 0.99). None of the misplaced screws resulted in neurovascular injuries. One patient in the control group underwent revision surgery due to screw misplacement. The mean duration of surgery and intraoperative blood loss were lower in percutaneous compared to open procedures. There was no significant difference in intraoperative radiation exposure between the two groups. The results suggest that percutaneous CPS placement in the subaxial spine is feasible with similar accuracy compared to open CPS placement. Further studies are needed to evaluate long-term clinical outcomes.

Background: Intraoperative C‐arm imaging is essential in orthopaedic and trauma surgery, particularly with the increasing use of minimally invasive techniques. Conventional repositioning is performed by non‐scrubbed staff, while robotic imaging systems are mainly limited to hybrid operating rooms. This study presents the first clinical experience with a fully motorised, self‐driving mobile 3D‐C‐arm. Methods: In this prospective, single‐center study, 300 procedures were analyzed using device log data and perioperative parameters to assess imaging workflow and system performance. Results: Of 300 procedures, 279 were included. Mean procedure time was 104.7 ± 57.4 min, with a C‐arm operation time of 31.9 ± 29.1 min, corresponding to a C‐arm operation ratio (COR) of 35.2%. Automated positioning accounted for 30.7% of movements, and 37.9% of images were acquired from stored positions. Conclusion: The system enabled sterile‐field control and demonstrated potential to support intraoperative imaging workflow. Further comparative studies are required to evaluate its clinical impact.

Background/Objectives: Dorsal screw protrusion or intra-articular screw penetration at the distal radius can cause extensor tendon injuries or articular surface damage. Despite the use of various views, the detection of screw misplacement remains limited in 2D fluoroscopy. This study compares the sensitivity of 2D and 3D fluoroscopy for detecting screw misplacement at the distal radius. Methods: Volar locking plates were placed in six cadaveric forearms, and dorsal or intra-articular screw misplacement was induced. For each screw position, images were acquired by 2D and 3D fluoroscopy and assessed by three blinded observers. Sensitivity and specificity, inter-rater agreement, and observer confidence were evaluated. The dose area product (DAP) was measured separately for 2D and 3D fluoroscopy. Results: Three-dimensional fluoroscopy showed higher sensitivities for detecting dorsal (97.22%) and intra-articular (95.83%) screw misplacements than two-dimensional fluoroscopy. In 2D fluoroscopy, sensitivity for detecting dorsal screw protrusions improved from 63.89 to 75.00–77.78% with the inclusion of tangential views. For intra-articular penetrations, sensitivity in 2D fluoroscopy increased from 79.17 to 83.33% with the addition of oblique views. Observer confidence was higher in 3D fluoroscopy. DAP was significantly higher in 3D (42.4 ± 0.4 cGycm²) compared to 2D fluoroscopy (14.2 ± 3.7 cGycm²) (p < 0.0001). Conclusions: Compared to 2D fluoroscopy, 3D fluoroscopy improves the detection of screw misplacement at the distal radius. However, its routine use is constrained by increased radiation exposure and limited availability. If 3D fluoroscopy is not accessible, the addition of dorsal tangential and oblique views may improve the sensitivity of 2D fluoroscopy.

Background/Objectives: Fractures of the distal humerus and olecranon often require surgical intervention due to their complexity and intra-articular fracture pattern. Precise implant positioning and articular surface reconstruction are crucial for optimal outcomes. Intraoperative 3D imaging offers advantages over 2D fluoroscopy by providing enhanced visualization of fracture reduction and implant alignment. However, limited space in the prone position restricts the use of standard 3D imaging with complete orbital rotation. This cadaver study investigates the feasibility and intra-articular screw detection performance of intraoperative 3D tomosynthesis with reduced orbital rotation at the elbow. Methods: In this cadaver study, six distal humeri and six olecranons were examined using an isocentric 3D C-arm with a complete 200° acquisition. The disarticulated upper extremities were positioned to reproduce the prone surgical setup. Reduced-angle datasets ranging from 200° to 100° were reconstructed retrospectively from the complete acquisition, with and without metal artifact reduction (MAR). Double-plate osteosynthesis was applied to the distal humerus, while an anatomic olecranon plate was used for fixation on the olecranon. To evaluate detection capabilities, screw positions were deliberately modified to include both correct placements and intra-articular malpositions. Image quality (5-point Likert scale) and certainty of intra-articular screw assessment were evaluated by three blinded raters; sensitivity and specificity were calculated relative to the complete 200° imaging-based reference condition. Results: Image quality, sensitivity, and specificity decreased with reduced orbital rotation. MAR significantly improved image quality and specificity, but not sensitivity. At an orbital rotation of 160°, MAR-reconstructed tomosynthesis achieved acceptable image quality (3.36 ± 0.53), high sensitivity (94.9%), and high specificity (93.9%) for detecting intra-articular screws. Conclusions: Intraoperative tomosynthesis with MAR provides acceptable image quality and high performance for intra-articular screw detection at the elbow under the present experimental conditions. This approach may support intraoperative assessment in prone-position elbow surgery when full orbital rotation is not feasible. Clinical studies are needed to confirm its value in routine practice.

Different flat-panel detector technologies are available for intraoperative fluoroscopy. This study compared orthopedic and trauma surgeons’ preference and subjective image quality among mobile C-arm systems equipped with amorphous silicon (a-Si), complementary metal oxide semiconductor (CMOS) or indium gallium zinc oxide (IGZO) detectors. Fluoroscopic imaging was performed on four human specimens at four anatomic locations at pulse rates of 1/s and 10/s in low- and high-dose settings using three C-arm systems. Subjective image quality was rated by two observers on 5-point Likert scales. Pairwise forced-choice comparisons of images with identical acquisition parameters were analyzed using a Bradley–Terry model. Across all images, CMOS- and IGZO-based systems were preferred over the a-Si-based system in 91.8% and 90.4% of comparisons, respectively (ORs 9.53 and 11.20; both p < 0.001). No significant overall preference was observed between the IGZO- and CMOS-equipped systems. Subjective image quality ratings were significantly higher for CMOS- and IGZO-based systems compared with the a-Si-based system, particularly for overall image quality and perceived noise, while no consistent differences in image quality were found between CMOS- and IGZO-based systems. Overall, the CMOS- and IGZO-based systems evaluated in this study were preferred over the a-Si-based system and achieved superior subjective image quality ratings.