Evaluation of Computed Tomography for Determining the Diagnosis of Acetabular Fractures
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Journal of orthopaedic trauma
(Impact Factor: 1.8).
05/2010; 24(5):284-90. DOI: 10.1097/BOT.0b013e3181c83bc0
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.
Available from: Leo Joskowicz
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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.
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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.
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ABSTRACT: Management of complex acetabular fractures in the geriatric patient requires a better understanding of a different spectrum and frequency of fracture patterns, surgical techniques, and even treatment principles than in younger patients. Although joint replacement plays a role in certain elderly patients with acetabular fractures, open reduction internal fixation is the preferred treatment strategy, and must be executed even when combined with arthroplasty.Patient baseline functional status must be considered in choosing treatment goals, as well as their frailty and comorbidities. There are typical injury characteristics that must be recognized which require treatment-specific strategies. Lengthy reconstructions in this fragile patient population are to be avoided, and therefore single nonextensile approaches limiting blood loss are most appropriate, considering that the patient's physiological reserve is lesser than younger counterparts.Although obtaining an anatomic reduction of the acetabulum is of paramount importance in the physiologically young who can withstand greater demands of surgery and who will require greater functional demands, the physiologically old patient requires stability to allow mobility and a surgery to mitigate their surgical risks.
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