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Abstract
A few events represent progress in the development of orthopaedic surgery. Imagery,
and especially imagery by Roentgen rays, brought up modern orthopaedic surgery about
one hundred years ago. So-called conventional radiography also brought with it disadvantages
and pitfalls and misinterpretations mostly due to the ‘shadow’ technique of imaging
by planar projection of three-dimensional structures. Surgical handling of the locomotor
system is basically subject to the physical rules of statics and dynamics. Such handling
may (and should today) be preceded by preoperative evaluation and planning using technology
which operates within three-dimensional space. Such technologies have been developed
recently in the form of computerized radiographic tomography (CT) and computerized
nuclear magnetic imaging (MRI). The path to the practical application of these techniques
in orthopaedic surgery requires specialized software, the use of which is described
here. Such software introduces virtual reality in the interpretation of pathology
and simulation of corrective means by osteotomy. Surgical handling in orthopaedic
surgery, similar to aircraft navigation, thus gains in reliability and precision and
loses some of its adventurous aspect. Using virtual reality in simulating re-orientating
osteotomies can also lead to misinterpretation, for example, due to underestimating
the role of the soft tissues. Soft tissues can be represented in static views but
must be excluded when using intra-operative navigation. The rationale of using three-dimensional
imagery has clear limits which have to be respected. Direct visualization of the hard
tissue (bone) is mandatory in correction osteotomies even when using interactive image
control because of the unknown behaviour of soft tissue under strain. Endoscopic techniques
are useful tools, complementing 3-D imaging and image interaction.
Keywords
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© 1997 Published by Elsevier Inc.
