[The clinical use of the ISO-C(3D) imaging system in calcaneus fracture surgery]. / Die klinische Wertigkeit des ISO-C(3D) bei der Osteosynthese des Fersenbeins.

We compared in a prospective study including 82 patients treated with ORIF of an intraarticular calcaneus fracture the quality of fluoroscopy, intraoperatively Iso-C(3D) and postoperative CT-scans. Therefore the posterior facet of the calcaneus (PFOC) was divided into three sectors. Joint steps and fracture gaps were detected by two independent investigators and statistically analysed. Another focus was to evaluate if the findings due to intraoperatively Iso-C(3D) assessment performed by the surgeon were correct and subsequently influenced the surgical procedure. There were no statistically differences between the Iso-C(3D)- and CT findings concerning joint steps or fracture gaps in PFOC sectors I-III. With fluoroscopy an assessment of the PFOC sectors I and II was not possible. In six cases (7.3%), intraoperative reduction was redone after performing an Iso-C(3D) scan. In ten cases, 12 malpositioned screws were replaced (12.2%/14.6%). These results suggest that intraoperative 3D Iso-C(3D) imaging provides a high diagnostic reliability. By careful assessment of the images the surgeons receive information which could lead to a change of the operative strategy.

Colour-coded duplex sonography in the diagnostic assessment of vascular complications after kidney transplantation in children.

BACKGROUND: Vascular complications are a major cause of dysfunction or transplant loss in children. Arterial or venous occlusion, transplant renal artery stenosis (TRAS) and some arteriovenous (AV) fistula require rapid detection and prompt intervention. The present study was performed to determine the accuracy of colour Doppler sonography (CDS) in the early and late phase after renal transplantation and to correlate the results with angiographic and intraoperative findings. OBJECTIVE: CDS is the preferred imaging modality with a high diagnostic accuracy for follow-up of renal transplantation in children. The indication for angiography should be established on the basis of the CDS diagnosis. MATERIALS AND METHODS: In 87 children (mean age 10.9 years, range 2-17), 423 CDS examinations were performed after renal transplantation. Angiography was performed in 17 cases; surgery was necessary in 16 patients. RESULTS: CDS correctly identified 8/8 arterial or venous occlusions and 7/7 TRAS. The only false positive diagnosis of TRAS was due to misinterpretation of an iliac artery stenosis. Six AV fistulae were diagnosed by CDS. The overall positive predictive value of CDS was 94 % in this study. CONCLUSION: CDS is a noninvasive, non-radiation producing imaging modality with a high diagnostic accuracy. It is the method of choice in the assessment of vascular complications after renal transplantation in children.