We assessed whether, in contrast to reports in the literature, computed tomographic (CT) scans improve the ability to classify acetabular fractures in comparison with plain radiographs.
Level I trauma center.
Seventy-five patients with 75 acetabular fractures treated between June 2005 and May 2006.
Four different image sets for each patient were evaluated: image set A, Judet view plain radiographs plus axial view CT scans; image set B, Judet view plain radiographs alone; image set C, three-dimensional CT reconstructions; and image set D, CT-simulated anteroposterior and Judet views of the pelvis. The 300 image sets were viewed in random order by four orthopaedic trauma fellowship-trained surgeons who independently recorded a diagnosis. A gold standard diagnosis was determined by group consensus.
Agreement among four imaging methods was evaluated by using kappa statistics for multiple raters and nominal data.
Comparing the gold standard diagnosis with the four image sets, Judet view plain radiographs had a worse kappa value than CT scans (P < 0.05). The adjusted kappa values for all three image sets that included CT scans averaged greater than 0.62, showing substantial agreement, whereas the image set with plain radiographs alone (image set B) had a lower kappa value of only 0.48 (P < 0.05).
In contrast to previous reports in the literature, the accuracy of plain radiographs alone was less than the accuracy of CT scans in terms of diagnosis. The interobserver reliability was also worse for plain radiographs alone.
[Show abstract][Hide abstract] ABSTRACT: The most commonly used imaging device for assessment of fracture reduction is the two-dimensional X-ray fluoroscope. Two recently introduced 3D fluoroscopic devices, the Siremobil ISO-C3D (Siemens) and the C-InSight (Mazor Surgical Technologies), enable the surgeon to obtain spatial information for the assessment of articular reduction and hardware placement. The purpose of this study was to assess the reliability and accuracy of these two 3D fluoroscopic systems in measuring articular reduction in a cadaveric tibial plateau fracture.
Six cadaveric knee specimens were osteotomized at the lateral tibial plateau and fixed with a maximal articular step-off of 0, 1, 2.5, 5 and 7.5 mm. Each specimen was scanned 10 times with two 3D fluoroscopes, the Siremobil ISO-C3D and the C-InSight. The resulting images were reformatted and interpreted for articular displacements at four different locations at the plateau level and were compared with high-resolution CT scans by an independent observer.
For the non-displaced fracture, no displacement (mean < 0.1 mm) was observed in either modality. The mean scanning time for the ISO-C3D was 2 min, while each C-InSight scan took 20 s. The readings at four different points along the malreduced fractures were similar for most measurements with either of the two modalities. The C-InSight readings were less accurate than those of the ISO-C3D, relative to the CT scan, but most errors were within clinically acceptable limits (< 2 mm) and used less radiation.
Intraoperative 3D fluoroscopes can detect clinically significant intra-articular step-off with acceptable measurement errors, using newer devices that enable the use of a conventional C-arm and reduced radiation.
International Journal of Computer Assisted Radiology and Surgery 02/2011; 6(5):685-92. DOI:10.1007/s11548-011-0548-6 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the radiographic and computed tomographic reduction qualities after acetabular fracture repair in obese and nonobese patients.
University medical center.
Two hundred forty-two patients were treated with open reduction internal fixation for displaced acetabular fractures. The nonobese group (Group 1) consisted of 149 patients and the obese group (Group 2) had 93 patients. A nonmorbidly obese group (Group 3 = 221 patients) and a morbidly obese group (Group 4 = 21 patients) were also created from the same patient population.
Operative repair of acetabular fractures.
Reductions on postoperative radiographs were classified as anatomic with less than 1 mm, imperfect with 2 to 3 mm, and poor with greater than 3 mm of residual displacement. On postoperative computed tomographic scans, reductions were considered nonanatomic with persistent gap or step displacements greater than or equal to 2 mm.
Anatomic radiographic reductions were achieved in 72% of the nonobese patients, 70% of the obese patients, 72% of the nonmorbidly obese patients, and 61% of the morbidly obese patients. (P = 0.379) On postoperative computed tomographic scans, an acceptable reduction was obtained in 47% of the nonobese patients, 44% of the obese patients, 47% of the nonmorbidly obese patients, and 31% of the morbidly obese patients. (P = 0.232).
Anatomic or satisfactory reductions can be similarly achieved in all classes of nonmorbidly obese patients who have sustained displaced acetabular fractures. In the morbidly obese, anatomic reductions may be more difficult to obtain.
[Show abstract][Hide abstract] ABSTRACT: Acetabular fractures in the elderly individuals are increasing in prevalence. Although there is evidence in the literature that acetabular fractures in elderly patients sustained as a result of low-energy mechanisms can be well treated by nonoperative management, open reduction and internal fixation, or even acute arthroplasty, almost no literature exists that may appropriately guide the treatment of elderly acetabular fractures that occur as a result of high-energy mechanisms. In spite of this lack of evidence, specific principles for providing the best care in adult trauma patients may reasonably be adopted. These principles include aggressive resuscitation and medical optimization; surgical care that focuses on a patient's survival but does not sacrifice skeletal stability; and early mobilization. Best practices that guide the care of hip fracture patients, such as a team approach to care, the use of protocols to guide treatment, and the timing of surgery to occur as soon as is safely possible also should be employed to guide care in patients who have sustained acetabular fractures. Opportunity exists to better study these higher energy fractures and to, thereby, affect outcomes in patients who have sustained them.
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