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Effect of external fixation rod coupling in computed tomography.

Peña-Solórzano, CA; Dimmock, M; Albrecht, DW; Paganin, DM; Bassed, RB; Klein, M; Harris, PC

Effect of external fixation rod coupling in computed tomography. Thumbnail


CA Peña-Solórzano

DW Albrecht

DM Paganin

RB Bassed

M Klein

PC Harris


External fixation is a common tool in the treatment of complex fractures, correction of limb deformity, and salvage arthrodesis. These devices typically incorporate radio-opaque metal rods/struts connected at varying distances and orientations between rings. Whilst the predominant imaging modality is plain film radiology, computed tomography (CT) may be performed in order for the surgeon to make a more confident clinical decision (e.g. timing of frame removal, assessment of degree of arthrodesis). We used a fractured sheep leg to systematically assess CT imaging performance with a Discovery CT750 HD CT scanner (GE Healthcare) to show how rod coupling in both traditional Ilizarov and hexapod frames distorts images. We also investigated the role of dual-energy CT (DECT) and metal artefact reduction software (MARS) on the visualisation of the fractured leg. Whilst mechanical reasons predominantly dictate the rod/strut configurations when building a circular frame, rod coupling in CT can be minimised. Firstly, ideally, all or all but one rod can be removed during imaging resulting in no rod coupling. If this is not possible, strategies for configuring the rods to minimise the effect of the rod coupling on the region of interest are demonstrated, e.g., in the case of a four-rod construct, switching the two anterior rods to a more central single one will achieve this goal without particularly jeopardising mechanical strength for a short period. It is also shown that the addition of DECT and MARS results in a reduction of artefacts, but also affects tissue and bone differentiation.

Acceptance Date Sep 11, 2018
Publication Date Nov 30, 2018
Journal Strategies in Trauma and Limb Reconstruction
Print ISSN 1828-8936
Publisher Springer Verlag
Pages 137 - 149
Publisher URL


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