Quantitative measures of damage to subchondral bone are associated with functional outcome following treatment of displaced acetabular fractures

Abstract

Current analysis of displaced acetabular fractures is limited in its ability to predict functional outcome. This study aimed to (1) quantify initial acetabular damage following acetabular fracture through measurement of subchondral bone density and fracture lines, and (2) evaluate associations between acetabular damage and functional outcomes following fracture. Subchondral bone intensity maps were created for 24 patients with unilateral acetabular fractures. Measures of crack length and density differences between corresponding regions in the fractured acetabuli, normalized by the unfractured side, were generated from preoperative CT images. Damage measures were compared to quality of life survey data collected for each patient at least 2 years post-injury (Musculoskeletal Functional Assessment [MFA] and Short Form-36 [SF-36], with specific focus on parameters that best describe patients' physical health). CT image quantification of initial damage to acetabular subchondral bone was associated with functional outcome post-injury. In general, damage as quantified through differences in density in the superior dome region (zones 8 and 12) and the central anterior region of the acetabulum (zone 3) were found to be the strongest significant predictors of functional outcome (adjusted R(2) = 0.3-0.45, p < 0.05). Damage to the superior dome was predictive of worse functional outcome whereas damage to the central anterior region indicated a better functional outcome. Once automated, this approach may form a basis to score acetabular fractures toward improving clinical prognoses.

Outcomes after surgical treatment of acetabular fractures: a review

“…The same authors have demonstrated that the superior acetabular region and the posterior wall have the highest bone density in the acetabulum (Fig. 3) [16]. Today, three-dimensional CT scanning greatly facilitates the surgeon’s understanding: 1) insight into the importance of the fracture relative to the critical zones of the acetabulum (the roof and the posterior wall, as discussed above), 2) visualizing fracture planes to facilitate reduction and establish orthogonal screw fixation.

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The Outcome of Bicolumnar Acetabular Fracture Treated by Single Anterior Ilioinguinal Approach

“…The peroneal division of the sciatic nerve is usually invariably injured, though less frequently the tibial division is as well. A foot drop will occur if the peroneal nerve division of the sciatic nerve is injured 23,24 . The surgical exposure and reduction of acetabular fractures may become more straightforward and practical with the improved method because it was closer to the acetabular quadrilateral plate 11,25 .…”

Intertrochanteric fracture visualization and analysis using a map projection technique

“…It can be used to develop a new classification system or sub-classifications of existed classification systems based on real fracture patterns and comminution zones [8]. Fracture prognosis prediction, hardware placement, and implant design optimization can also benefit from the use of fracture map [8][9][10]. In the past decade, the fracture heat map technique has been applied to scapular fracture [11], tibial pilon fracture [7], radial head fracture [12], and tibial plateau fracture [8], etc.…”