The accuracy of gap and step-off measurements in acetabular fracture treatment

Meesters, Anne M. L.; Duis, Kaj ten; Kraeima, Joep; Banierink, Hester; Stirler, Vincent; Wouters, P C R; Vries, J.P.P.M. de; Witjes, Max J. H.; IJpma, Frank F. A.

doi:10.1038/s41598-021-97837-9

Cited by 10 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, postoperative CT scans showed 11 cases with a step shift greater than 2 mm and 24 cases with gap shift greater than 1 cm. Meesters et al [22] measured the step and space displacement in postoperative X-ray and CT scans of patients with acetabular fractures and re-evaluated the intraoperative imaging results, and found that compared with postoperative CT, the X-ray images missed 52% of the gap and 80% of the step displacement, and intraoperative X-ray images missed approximately 70% of the residual gap and step displacement. Although previous studies have shown that CT has certain advantages in evaluating the quality of acetabular fracture reduction, due to the poor mobility of conventional CT equipment and the increased radiation dose to doctors and patients, no scholars currently use conventional CT to evaluate fracture reduction during surgery.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effect of O-arm on reduction quality and functional recovery of acetabular dome impaction fractures: a retrospective clinical study

Deng

Cong

Lei

et al. 2023

Preprint

View full text Add to dashboard Cite

Background Acetabular dome impaction fractures (ADIF) are difficult to reduce and have a high failure rate. the consistency between the acetabulum and femoral head is usually assessed under intraoperative X-ray fluoroscopy to evaluate the quality of fracture reduction.This study examines the effects of intraoperative mobile 2D/3DX imaging system (O-arm) on the reduction quality and functional recovery of Acetabular dome impaction fractures. Methods A retrospective analysis of the data of 48 patients with ADIF treated in Honghui Hospital from October 2018 to October 2021 was conducted.The patients were divided into the X-ray group and O-arm group. Residual step-off and gap displacements in the acetabular dome region were measured and the quality of fracture reduction was evaluated. Hip function was also evaluated according to the modified Merle d'Aubigné and Postel scoring system. Results There was no significant difference in preoperative general data between the two groups (P > 0.05).The residual average step displacement in the acetabular dome region was 3.48 ± 2.43mm and 1.61 ± 1.16mm(P < 0.05), and the gap displacement was 6.72 ± 3.69mm and 3.83 ± 1.67mm(P < 0.05) in the X-ray group and the O-arm group. In the X-ray group, according to the fracture reduction criteria described by Verbeek and Moed et al., 1 case was excellent, 13 cases were good, 11 cases were poor, and the rate of excellent and good was 56%; In the O-arm group, 7 cases were excellent, 12 cases were good, and 4 cases were poor, and the rate of excellent and good was 82.6% (P < 0.05). 46 patients gained follow-up, fracture healing, X-ray group at the last follow-up according to the modified Merled 'Aubigne&Postel function score: 3 cases were excellent,12 cases were good, 6 cases were middle, 3 cases were poor, the excellent and good rate of 62.5%, O-arm group: 15 cases were excellent,4 cases were good, 2 cases were middle, 1 cases were poor, the excellent and good rate was 86.4% (P < 0.05). Conclusions Application of O-arm in ADIF can have a positive impact on the improvement of fracture reduction quality and functional recovery.

show abstract

Section: Resultsmentioning

confidence: 99%

“…Several studies have shown that CT scans can provide more accurate and detailed information than radiographs in evaluating the quality of acetabular fracture reduction [4,13,21,22]. Moed et al [13] performed postoperative CT scans on 67 cases of acetabular posterior wall fractures.…”

Section: Resultsmentioning

confidence: 99%

Effect of O-arm on reduction quality and functional recovery of acetabular dome impaction fractures: a retrospective clinical study

Deng

Cong

Lei

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Furthermore, there are concerns regarding the interobserver reliability of radiographic measurements even though these measurements are still the gold standard in clinical practice 5,20 . Gap and step-off measurements in particular are prone to interobserver variability 21,22 , although measurements of tibial alignment have shown good reliability 23,24 . Nevertheless, intraobserver measurements within this study showed good reliability for all measurements.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery

Assink

Moumni

Kraeima

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: Radiographic measurements of initial displacement of tibial plateau fractures and of postoperative reduction are used to determine treatment strategy and prognosis. We assessed the association between radiographic measurements and the risk of conversion to total knee arthroplasty (TKA) at the time of follow-up. Methods: A total of 862 patients surgically treated for tibial plateau fractures between 2003 and 2018 were eligible for this multicenter cross-sectional study. Patients were approached for follow-up, and 477 (55%) responded. The initial gap and step-off were measured on the preoperative computed tomography (CT) scans of the responders. Condylar widening, residual incongruity, and coronal and sagittal alignment were measured on postoperative radiographs. Critical cutoff values for gap and step-off were determined using receiver operating characteristic curves. Postoperative reduction measurements were categorized as adequate or inadequate on the basis of cutoff values in international guidelines. Multivariable analysis was performed to assess the association between each radiographic measurement and conversion to TKA. Results: Sixty-seven (14%) of the patients had conversion to TKA after a mean follow-up of 6.5 ± 4.1 years. Assessment of the preoperative CT scans revealed that a gap of >8.5 mm (hazard ratio [HR] = 2.6, p < 0.001) and step-off of >6.0 mm (HR = 3.0, p < 0.001) were independently associated with conversion to TKA. Assessment of the postoperative radiographs demonstrated that residual incongruity of 2 to 4 mm was not associated with increased risk of TKA compared with adequate fracture reduction of <2 mm (HR = 0.6, p = 0.176). Articular incongruity of >4 mm resulted in increased risk of TKA. Coronal (HR = 1.6, p = 0.05) and sagittal malalignment (HR = 3.7 p < 0.001) of the tibia were strongly associated with conversion to TKA. Conclusions: Substantial preoperative fracture displacement was a strong predictor of conversion to TKA. Postoperative gaps or step-offs of >4 mm as well as inadequate alignment of the tibia were strongly associated with an increased risk of TKA. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

“…Meesters et al 1 analyzed incongruity in acetabular fractures and concluded that 52% of gaps and 80% of step-offs visible using computed tomography were missed on radiographs. In addition, radiographs underestimated the size of the detected gaps or step-offs by a factor of 2.…”

Section: Commentarymentioning

confidence: 99%

Fourteen Percent of Complex Tibial Plateau Fractures Need a TKA

Schmeling

2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Assink et al. report the results of a retrospective multicenter review of surgically treated tibial plateau fractures to identify preoperative and postoperative radiographic findings associated with patients going on to have a total knee arthroplasty (TKA). They identified 1,035 patients treated over a period of a decade and a half, of whom 173 (17%) were excluded, and only 477 (55%) of the remaining 862 patients responded. Preoperative parameters included the radiographically assessed gap and step-off. Postoperative radiographic assessment included condylar widening, articular incongruity, coronal alignment (medial proximal tibial angle [MPTA]), and sagittal alignment (posterior proximal tibial angle [PPTA]). Postoperative reduction was considered adequate if both the gap and step-off (articular congruence) were <2 mm, MPTA was 87°± 5°, PPTA was 9°± 5°, and condylar widening was 0 to 5 mm.Sixty-seven (14%) of the 477 patients who responded went on to have a TKA during a mean follow-up of 6.5 years. A preoperative gap of >8.5 mm (hazard ratio [HR] = 2.6) and a preoperative step-off of >6 mm (HR = 3.0) were independently associated with the patient requiring a TKA.Postoperative condylar widening was not independently associated with patients requiring a TKA. Postoperative MPTA and PPTA outside the defined adequate range were associated with the patient requiring a TKA (HR = 1.6 and 3.7, respectively). Articular congruence (gap and step-off) of >4 mm was also associated with the patient requiring a TKA (HR = 2).The authors concluded that preoperative displacement of the articular surface, a postoperative gap (>8.5 mm), and a postoperative step-off (>6 mm) indicated an increased risk of TKA. This implies that failure to correct the coronal and sagittal alignment or articular congruence to within a defined interval results in an increased risk of TKA. Condylar widening, on the other hand, did not influence the risk of TKA. These conclusions could be important when counseling patients about possible outcomes after their injury. However, the reader should consider the following.The authors do not separate gap and step-off in the postoperative results. They use the term "adequate articular congruence" to mean that both gap and step-off are <2 mm. Inadequate articular congruence occurs if either or both the gap and the step-off are >4 mm. Previous literature would suggest that a gap is tolerated better than a step-off. A gap and step-off of 3 mm each could have an unrecognized impact. The impact of articular incongruity in combination with abnormal alignment was not assessed, nor were the impacts of preoperative incongruity combined with postoperative incongruity or malalignment.Meesters et al. 1 analyzed incongruity in acetabular fractures and concluded that 52% of gaps and 80% of step-offs visible using computed tomography were missed on radiographs. In addition, radiographs underestimated the size of the detected gaps or stepoffs by a factor of 2. Approximately 70% of residual gaps and step-offs were similarly not det...

show abstract

The accuracy of gap and step-off measurements in acetabular fracture treatment

Cited by 10 publications

References 22 publications

Effect of O-arm on reduction quality and functional recovery of acetabular dome impaction fractures: a retrospective clinical study

Effect of O-arm on reduction quality and functional recovery of acetabular dome impaction fractures: a retrospective clinical study

Radiographic Predictors of Conversion to Total Knee Arthroplasty After Tibial Plateau Fracture Surgery

Fourteen Percent of Complex Tibial Plateau Fractures Need a TKA

Contact Info

Product

Resources

About