Computer-assisted preoperative planning via digital telemedicine for the treatment of periarticular fractures of the extremities: a multicenter cohort study

Background: Accurate preoperative planning is essential for the treatment of complex fractures, but the proportion of patients who have access to this service remains low. Therefore, the purpose was to evaluate the association of computer-assisted preoperative planning via digital telemedicine with the risk of postoperative in-hospital complications for periarticular fractures of the extremities. Methods: A multicenter retrospective cohort study was performed from January 2010 to December 2019. A total of 11 192 patients (≥18 years) with periarticular fractures of the extremities (proximal humerus, distal humerus, distal radius, intertrochanteric, distal femur, tibial plateau, distal tibia, and trimalleolar) were identified and divided into 2 cohorts: 7130 (63.7%) patients received conventional preoperative planning and 4062 (36.3%) patients received computer-assisted preoperative planning via telemedicine. Propensity score matching for 23 baseline characteristics yielded 4050 patient pairs. Primary outcome was in-hospital complications (surgical site infection, urinary tract infection, pneumonia, sepsis, thromboembolic event, stroke, and myocardial infarction). Results: Among 11 192 unadjusted patients, the mean (SD) age was 60.2 (12.3) years, and 7052 (63.0%) were female. After propensity score matching (total 8100 patients, 4050 patients in each group), patients with computer-assisted preoperative planning via telemedicine had the lower in-hospital complications (7.9% [318/4050 patients] vs.10.9% [442/4050 patients]; hazard ratio, 0.72 [95% CI, 0.59 to 0.89]; P = 0.002) compared with those with conventional method. Conclusion: For patients undergoing complex periarticular fractures of the extremities, the use of computer-assisted preoperative planning via digital telemedicine was associated with lower incidence of in-hospital complications compared with the use of conventional method.