Value of 3-D CT in Classifying Acetabular Fractures During Orthopedic Residency Training

Garrett, Jeffrey S.; Halvorson, Jason J.; Carroll, Eben A.; Webb, Lawrence X.

doi:10.3928/01477447-20120426-12

Cited by 47 publications

(55 citation statements)

References 9 publications

(9 reference statements)

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“…Letournel's original classification system was based on plain radiographs, and there is debate whether addition of CT scans improves reliability of his classification system [4,7,15,23]. Accurate and consistent classification of acetabular fractures is essential for surgical planning.…”

Section: Validationmentioning

confidence: 99%

Classifications in Brief: Letournel Classification for Acetabular Fractures

Alton

Gee

2014

Clinical Orthopaedics &Amp; Related Research

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Section: Validationmentioning

confidence: 99%

Classifications in Brief: Letournel Classification for Acetabular Fractures

Alton

Gee

2014

Clinical Orthopaedics &Amp; Related Research

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“…However, clinical studies already suggest this new technology as a promising and useful option in the future [1][2][3][4][5][6][7][9][10][11][12][13]. Benefits of 3D models include reduced surgical time, decreased amount of blood loss, risk of infections and exposure to ionizing radiations.…”

Section: Discussionmentioning

confidence: 99%

Traumatological Application of 3D Model in Complex Acetabular Fractures

Battiato¹

2017

Trauma Cases Rev

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Three-dimensional reconstruction (3D) and rapid prototyping (RPT), starting from computed tomographic (CT) examinations, is a promising technology in traumatology. It facilitates the planning and surgical results of complex fractures. Here, we used it in a complex bilateral acetabulum fracture for the assessment of the injury type and for improving knowledge of the fracture fragments. The patient was a forty-five-year-old male, with no accompanying fractures. The solid model allowed an accurate preoperative and intraoperative planning. The 3D printed model improved the understanding of anatomy of the fractures, in order to facilitate the surgical approach and the creation of dedicated pre-shaped plates. The use of the 3D model reduced surgical time, intraoperative soft tissues damage and blood loss as well as the risk of infections. Fluoro scoping imaging was also minimized. This case highlights the importance of 3D model in the management of complex fractures. Keywords Trauma, Innovations in traumatology, Rapid prototyping, PelvisWe show our experience with 3D printing on two complex fractures of both acetabula present on the same patient (fracture patterns: two columns on the left and a T-shaped on the right). Surgery was performed in a single operative session with the continued comparison of the sterilized 3D model. The 3D-printed model allowed a faster and accurate understanding of the morphology of the fracture and a more accuratepreoperative planning. In this case, surgeons simulated the operative planning (i.e. fracture reduction, screw measurement, and plate positioning). This simulation allowed the modelling of plates before surgery, thus reducing both the operating time and fluoroscopic imaging. Case ReportIn July 2015 a forty-five-year-old male patient presented to our trauma centre for a complex bilateral acetabular fracture (Figure 1) after a car accident. The patient did not present accompanying fractures or bleedings and was hemodynamically stable. At the time of presentation, CT scans were taken with conventional 16-detector CT scanners with slice thickness of 0.625 mm. The DICOM imaging files were converted in the software Mimics (Metarialise, Leuven, Belgium) by acquisition of three 2D plans (axial, coronal, sagittal) and one 3D view. 2D CT slices have a white/black appearance referring to the density of the material. Mimics is able to isolate a particular type of material starting from a selected colour (this type of process is called thresholding). Once the material has been selected, it can be transformed into a 3D image, then the file can

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“…Regarding 3D images, one study showed that at all levels of training among orthopedic surgeons, there were benefits for the use of 3D images over that of axial CT images, with the greatest benefit among junior residents (55). Another study showed that although the use of 3D images did not significantly increase accuracy for radiologists, it did increase accuracy for orthopedic surgeons (56).…”

Section: Imaging Acetabular Fracturesmentioning

confidence: 99%

“…Although it may take a few extra minutes to construct the 3D model, we believe there are substantial benefits of higher confidence and greater accuracy (55,56). Once the 3D reconstruction is created, it should be oriented in the standard position, with the acetabulum en face and the acetabular notch directed inferiorly.…”

Section: How To Practically Classify An Acetabular Fracturementioning

confidence: 99%

Acetabular Fractures: What Radiologists Should Know and How 3D CT Can Aid Classification

Scheinfeld¹,

Dym²,

Spektor³

et al. 2015

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Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures. The elementary fractures are anterior wall, posterior wall, anterior column, posterior column, and transverse. The associated fractures are all combinations or partial combinations of the elementary fractures and include transverse with posterior wall, T-shaped, associated both column, anterior column or wall with posterior hemitransverse, and posterior column with posterior wall. The most unique fracture is the associated both column fracture, which completely dissociates the acetabular articular surface from the sciatic buttress. Accurate categorization of acetabular fractures is challenging because of the complex three-dimensional (3D) anatomy of the pelvis, the rarity of certain acetabular fracture variants, and confusing nomenclature. Comparing a 3D image of the fractured acetabulum with a standard diagram containing the 10 Judet and Letournel categories of acetabular fracture and using a flowchart algorithm are effective ways of arriving at the correct fracture classification. Online supplemental material is available for this article.

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Value of 3-D CT in Classifying Acetabular Fractures During Orthopedic Residency Training

Cited by 47 publications

References 9 publications

Classifications in Brief: Letournel Classification for Acetabular Fractures

Classifications in Brief: Letournel Classification for Acetabular Fractures

Traumatological Application of 3D Model in Complex Acetabular Fractures

Acetabular Fractures: What Radiologists Should Know and How 3D CT Can Aid Classification

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