Standard Versus Low-Dose Computed Tomography for Assessment of Acetabular Fracture Reduction

Gibbs, S. Julian; Carney, John; Erdman, Mary Kate; Telis, Alexander; Lee, Adam K.; Fleming, Mark E.; Jackson, Lee Ann; White, Eric A.; Marecek, Geoffrey S.

doi:10.1097/bot.0000000000001778

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…7,18 Instead, these authors advocate for judicious postoperative CT scan use depending on fracture complexity and postoperative radiographs. 8,18,22 The high rate of revision surgeries indicated based on the sole findings of postoperative CT scans (14.2%, 21/148) identified in this study would serve to counter the above arguments.…”

Section: Discussionmentioning

confidence: 77%

“…This study suggests that intraoperative low-dose CT scans versus intraoperative 3D fluoroscopy, while not used in this cohort of patients, are viable options that can minimize potential harm to patients and avoid revisions surgeries. Gibbs et al 22 reported that the image quality of low-dose CT scans allowed for adequate assessment of implant positioning and fracture reduction while reducing the overall radiation burden. Based on the findings of this study, the use of routine intraoperative 3D imaging, either CT or fluoroscopic, to evaluate for malreductions, loose bodies, and implant misplacement may be a prudent practice to adopt to prevent revision surgeries.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Computed Tomography (CT) Scans of Acetabular Fractures Routinely Identify Indications for Revision Surgery

Kim,

Lencioni,

Tucker

et al. 2023

Journal of Orthopaedic Trauma

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OBJECTIVES: To investigate the utility of postoperative computed tomography (CT) scans in identifying indications for revision surgery after surgical fixation of acetabular fractures. METHODS Design: Retrospective cohort study Setting: Urban level 1 trauma center Patient Selection Criteria: Patients with surgically treated acetabular fractures with surgical fixation (open reduction and internal fixation (ORIF) or percutaneous fixation) with routine postoperative CT scans Outcome Measures and Comparisons: Primary outcome - revision surgery based on postoperative imaging, including intraarticular osteochondral fragments, implant complications, and malreductions. Secondary outcome – quality of reduction on radiographs versus CT scans. RESULTS: 148 patients were included. The revision surgery rate was 15.5% (23/148); indications included malpositioned implants (6.7%, n=10), malreductions (5.4%, n=8), and intraarticular loose bodies (3.4%, n=5). Only 8.7% (2/23) of the indications for revision surgery were identified on postoperative radiographs, with the remainder being identified on CT scans. Revision surgeries were found to be associated with male gender (Proportional difference (PD): 19.6%, 95% confidence interval (CI): 3.4% to 29.4%; p=0.04) and T-type fractures (PD: 28.7%, CI: 9.0% to 48.9%; p=0.001). Revision surgery was not found to be associated with age, BMI, posterior wall fractures, concurrent pelvic ring fractures, or surgical approach. On radiographs, 51.3% (n=76/148) had anatomic reductions (<2 mm) compared to only 10.2% (n=15/148) on CT scans. Conclusions: Indications for revision acetabular ORIF surgeries and poor reductions were frequently missed on plain radiography while identified on postoperative CT scans. This suggests the use of advanced imaging such as intraoperative 3D imaging or postoperative CT scans may be beneficial. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Postoperative Computed Tomography (CT) Scans of Acetabular Fractures Routinely Identify Indications for Revision Surgery

Kim,

Lencioni,

Tucker

et al. 2023

Journal of Orthopaedic Trauma

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Standard versus low-dose computed tomography for assessment of acetabular fracture reduction using novel step and gap measurement technique

Robles

Piple

DeSanto

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose Quality of reduction is of paramount importance after acetabular fracture and is best assessed on computed tomography (CT). A recently proposed measurement technique for assessment of step and gap displacement is reproducible but has not been validated. The purpose of this study is to validate a well-established measurement technique against known displacements and to determine if it can be used with low dose CT. Methods Posterior wall acetabular fractures were created in 8 cadaveric hips and fixed at known step and gap displacements. CT was performed at multiple radiation doses for each hip. Four surgeons measured step and gap displacement for each hip at all doses, and the measurements were compared to known values. Results There were no significant differences in measurements across surgeons, and all measurements were found to have positive agreement. Measurement error < 1.5 mm was present in 58% of gap measurements and 46% of step measurements. Only for step measurements at a dose of 120 kVp did we observe a statistically significant measurement error. There was a significant difference in step measurements made by those with greater and those with fewer years in practice. Conclusion Our study suggests this technique is valid and accurate across all doses. This is important as it may reduce the amount of radiation exposure for patients with acetabular fractures.

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Routine postoperative computed tomography (CT) scans following acetabulum open reduction internal fixation (ORIF): A survey of orthopaedic traumatologists

Ricci

Thompson

Gruenberger

et al. 2023

Injury

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Standard Versus Low-Dose Computed Tomography for Assessment of Acetabular Fracture Reduction

Cited by 5 publications

References 24 publications

Postoperative Computed Tomography (CT) Scans of Acetabular Fractures Routinely Identify Indications for Revision Surgery

Postoperative Computed Tomography (CT) Scans of Acetabular Fractures Routinely Identify Indications for Revision Surgery

Standard versus low-dose computed tomography for assessment of acetabular fracture reduction using novel step and gap measurement technique

Routine postoperative computed tomography (CT) scans following acetabulum open reduction internal fixation (ORIF): A survey of orthopaedic traumatologists

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