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International Journal of Computer Assisted Radiology and Surgery
Published in: International Journal of Computer Assisted Radiology and Surgery 12/2019

07-08-2019 | Original Article

Computer-assisted intra-operative verification of surgical outcome for the treatment of syndesmotic injuries through contralateral side comparison

Authors: Sarina Thomas, Fabian Isensee, Simon Kohl, Maxim Privalov, Nils Beisemann, Benedict Swartman, Holger Keil, Sven Y. Vetter, Jochen Franke, Paul A. Grützner, Lena Maier-Hein, Marco Nolden, Klaus Maier-Hein

Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 12/2019

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Abstract

Purpose:

Fracture reduction and fixation of syndesmotic injuries is a common procedure in trauma surgery. An intra-operative evaluation of the surgical outcome is challenging due to high inter-individual anatomical variation. A comparison to the contralateral uninjured ankle would be highly beneficial but would also incur additional radiation and time consumption. In this work, we pioneer automatic contralateral side comparison while avoiding an additional 3D scan.

Methods:

We reconstruct an accurate 3D surface of the uninjured ankle joint from three low-dose 2D fluoroscopic projections. Through CNN complemented 3D shape model segmentation, we create a reference model of the injured ankle while addressing the issues of metal artifacts and initialization. Following 2D–3D multiple bone reconstruction, a final reference contour can be created and matched to the uninjured ankle for contralateral side comparison without any user interaction.

Results:

The accuracy and robustness of individual workflow steps were assessed using 81 C-arm datasets, with 2D and 3D images available for injured and uninjured ankles. Furthermore, the entire workflow was tested on eleven clinical cases. These experiments showed an overall average Hausdorff distance of \(2.4\pm 1.1\) mm measured at clinical evaluation level.

Conclusion:

Reference contours of the contralateral side reconstructed from three projection images can assist surgeons in optimizing reduction results, reducing the duration of radiation exposure and potentially improving postoperative outcomes in the long term.
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Metadata
Title
Computer-assisted intra-operative verification of surgical outcome for the treatment of syndesmotic injuries through contralateral side comparison
Authors
Sarina Thomas
Fabian Isensee
Simon Kohl
Maxim Privalov
Nils Beisemann
Benedict Swartman
Holger Keil
Sven Y. Vetter
Jochen Franke
Paul A. Grützner
Lena Maier-Hein
Marco Nolden
Klaus Maier-Hein
Publication date
07-08-2019
Publisher
Springer International Publishing
Published in
International Journal of Computer Assisted Radiology and Surgery / Issue 12/2019
Print ISSN: 1861-6410
Electronic ISSN: 1861-6429
DOI
https://doi.org/10.1007/s11548-019-02043-8

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