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Radiographic reconstruction of lower-extremity bone fragments: a first trial

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

The correct rotational alignment of the proximal and the distal bone fragments is an essential step in a long-bone deformity correction process. In order to plan the deformity correction, plain radiographs are conventionally used. But as three-dimensional information of the complex situation is not available, the correct amount of rotation can only be approximated. Thus, the objective of this study was to develop a system to assess the rotational relationship between the proximal and distal fragments of a long bone (tibia or femur) based on a set of two calibrated X-ray radiographs.

Methods

In order to robustly determine the rotational relationship of proximal and distal bone fragments, a statistical shape model-based 2D/3D reconstruction approach was employed. The resulting fragment models were used to determine the angle between its anatomical axes and the rotation around its particular axes. Two different studies were performed to evaluate the accuracy of the proposed system.

Results

The accuracy of the complete system was evaluated in terms of major bone axis and in-plane rotational difference. The angle between the anatomical fragment axes could be measured with an average error of 0.33\(^\circ \) ± 0.27\(^\circ \), while an average in-plane rotational error of 2.27\(^\circ \) ± 1.76\(^\circ \)  and 2.67\(^\circ \)  ± 1.80\(^\circ \)  was found for the proximal and distal fragments, respectively. The overall mean surface reconstruction error was 0.81  ± 0.59 mm when the present technique was applied to the tibia and 1.12 ± 0.87 mm when it was applied to the femur.

Conclusions

A new approach for estimating the rotational parameters of long-bone fragments has been proposed. This approach is based on two conventional radiographs and 2D/3D reconstruction technology. It is generally applicable to the alignment of any long-bone fragments and could provide an important means for achieving accurate rotational alignment.

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Abbreviations

bone:

Femur, tibia

part:

Proximal, distal

\(_\mathrm{bone}M_\mathrm{gt}\) :

Ground truth segmented surface model (specific bone, both parts)

\(^\mathrm{part}_\mathrm{bone}M_\mathrm{gt}\) :

Ground truth segmented surface model (specific bone and part)

\(^\mathrm{part}_\mathrm{bone}M_\mathrm{rec}\) :

Reconstructed surface model (specific bone and part)

P :

Set of landmarks/feature points

\(P_\mathrm{gt}\) :

Set of landmarks in ground truth CT space

\(P_\mathrm{ssm}\) :

Set of landmarks in statistical model space

\(P_\mathrm{xray}\) :

Set of landmarks in image space

\(P_\mathrm{meas}\) :

Adjusted set of reconstructed landmarks

\(_\mathrm{part}Pn_\mathrm{ssm}\) :

Landmark (n) of specific part in SSM space (\(n\,=\,1,2,3\))

\(_\mathrm{part}Pn_\mathrm{rec}\) :

Landmark (n) of specific part in reconstructed X-ray space (\(n\,=\,1,2,3\))

\(_\mathrm{part}T^\mathrm{ssm}_\mathrm{rec}\) :

Transformation of specific part from SSM- to reconstructed X-ray space

\(_\mathrm{part}F_\mathrm{gt}\) :

Nail fiducials identified in ground truth CT space for specific part

\(_\mathrm{part}F_\mathrm{rec}\) :

Triangulated nail fiducials in X-ray space for specific part

\(_\mathrm{part}T^\mathrm{ssm}_\mathrm{rec}\) :

Transformation of specific fragment from SSM to reconstructed X-ray space

\(_\mathrm{dist}T^\mathrm{intact}_\mathrm{frac}\) :

Transformation of distal fragment from intact to fractured status in CT space

\(_\mathrm{part}T^\mathrm{gt}_\mathrm{rec}\) :

Transformation of fragment from ground truth CT space to reconstructed X-ray space

\(^\mathrm{part}_\mathrm{bone}V_\mathrm{gt}\) :

Binary volume of ground truth surface model (specific bone and part)

\(^\mathrm{part}_\mathrm{bone}V_\mathrm{rec}\) :

Binary volume of reconstructed surface model (specific bone and part)

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Acknowledgments

The authors would like to thank Alper Akcöltekin, Urs Rohrer and the team from the machine shop for the valuable support in conducting this study.

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Authors and Affiliations

  1. Institute for Surgical Technology and Biomechanics (ISTB), University of Bern, Bern, Switzerland

    Steffen Schumann, Lutz-P. Nolte & Guoyan Zheng

  2. Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University of Rostock, Rostock, Germany

    Richard Bieck & Rainer Bader

  3. Department of Radiology, Inselspital, University of Bern, Bern, Switzerland

    Johannes Heverhagen

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  1. Steffen Schumann
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  2. Richard Bieck
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  3. Rainer Bader
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  4. Johannes Heverhagen
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  5. Lutz-P. Nolte
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  6. Guoyan Zheng
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Correspondence to Steffen Schumann.

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Schumann, S., Bieck, R., Bader, R. et al. Radiographic reconstruction of lower-extremity bone fragments: a first trial. Int J CARS 11, 2241–2251 (2016). https://doi.org/10.1007/s11548-016-1427-y

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  • DOI: https://doi.org/10.1007/s11548-016-1427-y

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