Are Routine Postoperative Computer Tomography Scans Warranted for All Patients After Operative Fixation of Pelvic Ring Injuries?

Abstract

Objective: To evaluate the efficacy of routine postoperative computed topography (CT) scan after percutaneous fixation of unstable pelvic ring injuries. Design: Retrospective chart review. Setting: Level I Trauma Center. Patients/Participants: A total of 362 consecutive patients underwent operative fixation of unstable pelvic ring injuries during the study period. Intervention: Postoperative CT scan of the pelvis was obtained in 331 (91%) of the 362 patients treated operatively for unstable pelvic ring injuries. Main Outcome Measurements: Revision surgery based on routine postoperative CT scan. Results: Two patients (0.55%) returned to the operating room on the basis of postoperative CT scans due to malpositioned implants. There were no significant differences of age, sex, body mass index, Injury Severity Score, mechanism of injury, smoking status, or diabetes status between those who did and did not undergo revision surgery. A dysmorphic pelvis was identified in 154 (47%) patients. Both patients undergoing revision surgery were determined to have a dysmorphic pelvis while no patients with normal pelvic anatomy returned to the operating room based on postoperative CT (2/154, 1.3% vs. 0/177, 0%, P = 0.22). Conclusions: Although there remains a role for postoperative CT scans in the appropriately selected patient, in the hands of experienced orthopaedic traumatologists, patients with adequate intraoperative fluoroscopy and a nondysmorphic pelvis may not require routine postoperative three-dimensional imaging. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Routine Postoperative Computed Tomography Scans Following Posterior Pelvic Fixation of Pelvic Ring Fractures: A Survey of (OTA) Orthopaedic Traumatologists

“…The authors report a 4% revision surgery rate because of instrumentation malposition that was only found on postoperative CT scans. In comparison, Cronin et al 6 2019 report only a 0.55% revision rate (n = 2) in 332 patients based on routine postoperative CT scan following posterior pelvic fixation. It is important to note that both patients requiring revision surgery had sacral dysmorphism.…”

“…Prior authors have called for routine postoperative scans as a means to improve technique and surgical outcomes. 6 Although this may be desired by younger and less experienced surgeons, it does not come without cost. In a patient-centered practice model, unnecessary radiation and cost remain an issue.…”

“…Although many factors determine outcomes, inadequate reduction and aberrant screw placement, with extracortical, intra-articular or intraforaminal involvement, can lead to poor clinical results. 6 Assessment of reduction and instrumentation placement by a routine postoperative computed tomography (CT) has been advocated by some surgeons for all patients with posterior percutaneous pelvic fixation. 6,7 Although some patients may benefit from a postoperative pelvic CT, there is insufficient evidence to support its routine use in all patients following posterior pelvic fixation because its clinical utility has yet to be determined.…”

Nghiên Cứu Các Kích Thước Khớp Cùng Chậu Trên Phim Cắt Lớp Vi Tính Bụng Chậu Và Ứng Dụng Điều Trị Gãy Trật Khớp Cùng Chậu

“…Và điểm vào an toàn của vít cùng chậu 2 bên ở đốt xương cùng S1 là điểm ở phía trước gai chậu sau trên 1 khoảng 42,21 -63,69 mm và ở trên điểm cao nhất của khuyết hông lớn 1 khoảng 32,77 -53,75 mm. Chiều dài của vít khoảng 136,9 -174,34 mm [9], [10].…”