Evaluating the Appropriate Surgical Approach in Complex Acetabular Fractures (T, Transverse and Both Columns) using 3D Computed Tomography (CT) method

Abstract

Acetabular fractures consist of complex fracture patterns whereby bone fragments are displaced in different directions. Acetabulum surgery is one of the controversial fields in traumatic orthopedic surgeries. A detailed study of pelvic anatomy is not possible without the use of new imaging techniques, including three-dimensional (3D) CT scan. It is necessary to choose correct imaging in order to select the most correct surgical approach. Therefore, the use of new technologies in trauma orthopedics can be very effective in helping surgeons and planning surgery. Purpose: The purpose of this study is to evaluate the appropriate surgical approach in complex Acetabular fractures (T, transverse, and both columns) using a 3D-CT scan. Methods: This cross-sectional study was conducted on 50 trauma patients with a mean age of 35 ± 7 years who referred to Shohada Hospital of Tabriz University of Medical Sciences. Patients’ radiographic including; radiographs of the Anteroposterior pelvis, oblique iliac, and oblique abductor were performed. Also, 3D-CT scan with reconstruction was done for the patients before the operation. After surgery, control radiography of patients were performed from all patients. Based on the quality of fracture fixation in postoperative control radiographies, the degree of anatomical fixation was examined and this was considered as a criterion to determine the appropriateness of the selected approach. Results: The preoperative displacement was significantly underestimated by radiographic measurements (7 mm) in comparison with 3D-CT measurements (15 mm) (p < 0.05). The same applies to the postoperative residual displacement (2 mm radiograph and 5 mm CT scan; P < 0.05). The total gap area, defined as the surface area between all fracture lines in the 3D model, was measured for each patient, resulting in a median value of 655 mm2 preoperatively and > 155 mm2 postoperatively, with excellent reliability. There was moderate correlation between 2D and 3D measurements (0.3 & 0.4, respectively).