Acetabular fracture diagnosis according to Letournel classification is difficult and depends greatly on the experience of the reader. The described set of 3D images yields better accuracy and renders the diagnosis more repeatable and faster. We recommend the use of these images in classifying acetabular fractures.

Background:Accurate classification of acetabular fractures remains difficult. To aid in the classification of acetabular fractures and to aid in teaching, our department developed a diagnostic algorithm that involves the use of 1 standardized 3-dimensional reconstruction of a computed tomography (CT) scan (an exopelvic view without the femoral head) with 8 anatomical landmarks. The algorithm was integrated into a smartphone application (app). The main objective of this study was to test the efficacy of this algorithm and smartphone app.Methods:Fourteen reviewers (3 experts, 3 fellows, 3 residents, and 5 novice reviewers) evaluated a set of 35 CT scans of acetabular fractures in 2 phases. During the first phase, the scans (including axial 2-dimensional views and 3-dimensional (3D) multiplanar reconstruction views) were assessed by each reviewer twice, with an interval of 4 weeks between the readings to decrease recall bias. During that phase, the reviewers were provided with a diagram of the Letournel classification system with no guidelines for interpretation. During the second phase, performed 4 weeks after the first phase, 1 standardized 3D reconstruction (an exopelvic view without the femoral head) was reviewed twice, with an interval of 4 weeks between the readings. During that phase, the reviewers used the smartphone app. The primary outcome was the accuracy of classification. Interobserver reliability, reading time, and time needed for accurate classification were noted.Results:The accuracy of fracture classification was 64.5% when the standard method of analysis was used and 83.4% when the app was used (p < 0.001). Improvement was noted in all groups, with the expert group showing the least improvement (88.6% to 97.2%, p = 0.04) and the novice group showing the most improvement (42.0% to 75.5%, p < 0.001). Furthermore, use of the app greatly increased the accuracy of classification of complex fractures. The average reading time was 71.8 minutes when the standard method was used and 37.4 minutes when the app was used. The interobserver reliability improved in all groups to an excellent reliability (interclass correlation coefficient [ICC] > 0.79).Conclusions:The Letournel classification system is difficult to understand and to learn but remains the only system guiding the surgical strategy for acetabular fractures. The impact of diagnostic algorithms is debatable. The most important finding of the present study is the high accuracy for inexperienced groups when the app was used. Another important finding is the high reliability of this method for the diagnosis of complex acetabular fractures.

Posterior wall with transverse acetabular fractures represents the most common type of acetabular fractures and is generally associated with poorer outcomes. This is caused by improper visualization of the fragments leading to imperfect reductions. Navigation in pelvic and acetabular trauma is reserved nowadays to non-displaced or mildly displaced fractures. To add to that, perioperative control of reduction is difficult using the conventional X-ray. The described 3D imaging method allowed proper reduction control. On the other hand, screw navigation of acetabular screws enabled better control of screw position as well as screw placement in otherwise inaccessible zones. In conclusion, peroperative 3D imaging and screw navigation optimize fracture reduction promoting better radiological and functional results.

Tuberculous spondylodiscitis usually affects the dorso-lumbar spine, and its cervical location is a rare condition that can mimic other diseases and consequently cause treatment delays. We report a case of tuberculous spondylodiscitis of the lower cervical spine discovered under unusual circumstances in a patient with severe polytrauma involving a cranio-cerebral trauma, a non-displaced fracture of the two laminæ and the spinous process of the C6 vertebrae as well as fibular and tibial shaft fractures. The patient underwent static tibial nailing, and a collar with occipital and chin supports was applied. At 2-month follow-up, the patient presented with severe neck pain without neurologic deficits. Plain and dynamic cervical radiographs showed a stable C6-C7 subluxation and C7 superior endplate collapse. The CT scan also outlined prevertebral soft tissue swelling. The MRI showed a C6-C7 spondylodiscitis associated with a prevertebral abscess with am 8-cm major axis. The diagnosis of C6-C7 Pott's disease was confirmed by a CT-guided biopsy. The patient received 12 months of antituberculous chemotherapy, after which the paravertebral abscess completely disappeared, and the patient has had no functional sequelae. The diagnosis of cervical spine tuberculosis is difficult and requires a high level of attention. Delays in establishing the diagnosis and starting the appropriate treatment result in severe complications such as spinal cord compression and spinal deformity, which are difficult to manage.

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