Summary

The intraoperative open insertion of arthroscope (Fracturoscopy) permitted a significantly improved visualization of fracture surface and fragment displacement as compared to fluoroscopy. A fast, cost-effective and space saving alternativ to fracturoscopy is the fracturosmartoscopy (Smart phone assisted open reduction control of the joint in tibial plateau fracture).

Abstract

Anatomical articular surface reconstruction of complex tibial head fractures is a major challenge. It was schown that intraoperative open fracturoscopy permitted as significantly improved visualization of fracture fragment displacement, specifically in the postero-latero-central region of the tibial plateau, which are difficult to visualize macroscopically and fluoroscopically and can avoid the need for extended approach. As compared to fluoroscopy fracturoscopy is recommended for fractures involving the postero-latero-central region of the tibial plateau. The intraoperative, open insertion of an arthroscope to visualize the articular surface still a good tool to analyze the anatomic accuracy of fracture reduction but it needs a complete arthroscopic setting and that takes up a lot of space and time.
The fracturosmartoscopy allows the surgeon to perform a fast and space saving direkt visualization of the joint surface during the operative phase of care. The SMART SCOPE comprises a telescope with quick-release coupling and a matching smartphone case. The case acts as a holder for the smartphone and establishes an optimal connection between the SMART SCOPE and the smartphone camera. Thanks to the quick release coupling a standard arthroscope sheath can be connected to the smart scope.
In our case series of 10 patients, 4 patients with tibial plateau fracture AO 41B and 6 patients with AO41C was an open fracture reduction with SMART SCOPE (fracturosmatoscopy) guidance performed. In 4 of 10 Patients fracturoscopy showed perstistent fracture depression (> 2mm) with the need for intraoperaive correction.
The fracturosmartoscopy can provides a fast, cost-effective and space saving alternative to intraoperative fracturoscopy and/or intraoperative CT-scan. Smart Scope assisted reduction control may also be suitbale for quick inspection of other joints during the operative phase of surgery.