CT of Preoperative and Postoperative Acetabular Fractures Revisited

Jaskolka, Diana; Primio, Gina A. Di; Sheikh, Adnan; Schweitzer, Mark E.

doi:10.1097/rct.0b013e3182ab384a

Cited by 20 publications

(11 citation statements)

References 22 publications

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“…Controversy exists about routine use of postoperative CT scans, because of the costs, radiation exposure and limited clinical consequences. [12,13] Nevertheless, routine postoperative CT scans have been used in large studies for assessing postoperative reduction, determining patient’s prognosis, and the evaluation of the surgical techniques. [9] There is no difference in radiation exposure between 3DCT and 2DCT fracture assessment, because both measurement techniques are based on the same CT data.…”

Section: Discussionmentioning

confidence: 99%

Introduction of a three-dimensional computed tomography measurement method for acetabular fractures

et al. 2019

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Introduction Acetabular fractures consist of complex fracture patterns whereby bone fragments are displaced in different directions. Two-dimensional computed tomography (2DCT) gap and step-off measurements tend to underestimate the multidirectional features of these fractures. The aim was to develop a three-dimensional computed tomography (3DCT) measurement method for acetabular fractures and validate whether this method will provide an observer independent fracture characterization. Materials and methods Sixty patients, operated for an acetabular fracture between 2007 and 2018, were included. The displacement was measured on the pre- and postoperative CT scans. Pre- and postoperative CT-based 3D models were made for each patient. Multiple 3D measurements, namely the 3D step-off, gap and the total gap area were introduced to quantify the preoperative and postoperative displacement. The Wilcoxon signed rank analysis was used to compare the 2DCT and 3DCT measurements. Results The preoperative displacement was significantly underestimated by 2DCT measurements in comparison with 3DCT measurements (2D vs. 3D; step-off 8 vs. 16 mm with P < 0.001; gap 19 vs. 21 mm with P = 0.001). The same applies to the postoperative residual displacement (2D vs. 3D; step-off 0 vs. 6 mm; gap 3 vs. 8 mm; P < 0.001). The total gap area, defined as the surface area between all fracture lines in the 3D model, was measured for each patient, resulting in a median value of 722 mm 2 preoperatively and 168 mm 2 postoperatively, with excellent inter- and intra-rater reliability. Conclusion 2DCT measurements tend to underestimate the initial and residual displacement in complex acetabular fractures. A 3DCT analysis of these injuries was developed to overcome this and should be used in addition to the Judet/Letournel and AO/OTA classification systems, in order to provide an observer independent quantifiable fracture description and accurate assessment of the fracture reduction.

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Section: Discussionmentioning

confidence: 99%

Introduction of a three-dimensional computed tomography measurement method for acetabular fractures

et al. 2019

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“…Some studies show poor correlation between the degree of articular reduction as seen on postoperative CR and clinical outcome (13,21). Jaskolka et al shows that as much as 44% of patients with acetabular fractures has significant findings on conventional CT, signifying either imperfect fracture reduction, intra-articular fragments, or hardware complications, less than half of these findings are visualized with CR (7). The advantage with CT when assessing hardware positioning and fracture reduction is well described regarding acetabular fractures (7) (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Assessment of acetabular joint congruency with both CR and LDCT in this study was based on criteria described by Matta, which were developed for CR (13). Recent studies have proposed revised criteria for significant findings in postoperative CT (7). A review article by Dodd et al concluded that there is a lack of reproducible description methods when dealing with radiographic criteria for assessing displacement of acetabular fractures, the one described by Matta et al being used in the majority of studies (13,29).…”

Section: Discussionmentioning

confidence: 99%

Low-dose CT of postoperative pelvic fractures: a comparison with radiography

et al. 2018

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“…Jaskolka et al demonstrated that 44% of patients had significant post-operative CT findings defined as imperfect alignment, 2 or more intra articular fragments, or hardware complications. Out of those with significant post-operative findings, 92% were complex acetabular fractures defined as anything more than a simple Letournel/Judet posterior wall or anterior column fracture [7]. Furthermore, this case would have been an excellent opportunity for intraoperative cone beam tomography imaging and could have possibly avoided a return trip to the OR to remove the intra-articular loose bodies.…”

Section: Discussionmentioning

confidence: 99%

Repeat posterior wall acetabular fracture-dislocation: High-energy trauma as a ‘second hit phenomenon’

Dunlap

Voskuil

Cincere

et al. 2019

Trauma Case Reports

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Acetabular fractures are injuries that require significant force transmission, especially when associated with a femoral head dislocation. The mechanism of injury is typically in the setting of a high-speed motor vehicle collision. In a similar manner, this is an injury that is highly demanding for the orthopaedic trauma surgeon to treat as well. We present a patient who sustained an initial posterior wall acetabular fracture with an associated posterior dislocation. This was treated surgically with open reduction, internal fixation without complication. The patient subsequently sustained a second posterior wall acetabular fracture with dislocation fifteen years later through the plated and healed previous fracture. Both injuries were sustained in high-speed motor vehicle collisions, so it is difficult to presume the patient was predisposed for the repeat injury. At any rate, the repeat injury makes the surgical management significantly more challenging. In complicated acetabular fractures like these, a post or intra-operative CT scan can be of utility to determine quality of reduction as well as assessing for retained bony fragments. Our patient underwent a post-operative CT scan with the finding of intra-articular bony fragments that subsequently required arthroscopic removal. Given the rare nature of this complicated injury occurring twice in a patient, it is difficult to make evidence-based comments on long-term prognosis and functional outcomes. This unique case and the applied treatment will serve as a guide for future similar cases.

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CT of Preoperative and Postoperative Acetabular Fractures Revisited

Abstract: Although reoperation rate is low after fixation of AFs, CT is required to identify those requiring reintervention. However, postoperative CT should be used judicially, only in patients presenting with complex acetabular fractures.

Cited by 20 publications

References 22 publications

Introduction of a three-dimensional computed tomography measurement method for acetabular fractures

Introduction of a three-dimensional computed tomography measurement method for acetabular fractures

Low-dose CT of postoperative pelvic fractures: a comparison with radiography

Repeat posterior wall acetabular fracture-dislocation: High-energy trauma as a ‘second hit phenomenon’

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