Waarde van drie dimensionele beeldvorming in de diagnose and behandeling van hielbeenfracturen

Operative treatment of displaced intra-articular calcaneal fracture (DIACF) remains controversial, but it is currently the gold standard. The main goal of surgery is to repair the anatomy of this tarsal bone and especially the posterior subtalar joint facet (PSJ), to avoid post-traumatic osteoarthritis and subtalar fusion. 3D imaging gives clear and realistic views of every bone and makes it possible to measure the distance from bone to bone and bone/joint facet orientation. Last but not least, 3D is often advocated in commenting disappointing 2D CT study results. There is some interest to use the contralateral side as reference because of the symmetry of the hindfoot in humans. Preoperative templating on RX of the uninjured contralateral calcaneus may be beneficial by reducing operative time: we will try the same by using 3D printing of the uninjured contralateral calcaneus. A custom-made application - based on freeware - was developped with the author at the Medical Imaging Research Center of Gasthuisberg University Hospital. It measures several parameters on the 3D models: distance from bone-to-bone, surfaces, and the facet orientation angle. This is done on the fractured bone before and after surgical treatment and on the uninjured contralateral calcaneus which is used as a reference. All measurements are made by using principal component analysis (PCA). The aim of this thesis is to evaluate the available measurements, their reproducibility and the correlation with clinical evaluation. This will show if 3D is an improvement in the surgical treatment of fractures and if it can be used in the education of students and trainees of traumatology.