Preoperative Evaluation for Pelvic Discontinuity Using a New Reformatted Computed Tomography Scan Protocol

Area of Science:

• Orthopedic Surgery
• Radiology
• Medical Imaging

Background:

• Pelvic discontinuity identification is vital for revision hip arthroplasty preoperative planning.
• Standard computed tomography (CT) reconstructions have limitations in detecting all pelvic discontinuities.
• A novel technique using 45° oblique CT reformations is proposed to enhance detection.

Purpose of the Study:

• To evaluate the diagnostic advantage of 45° oblique CT reformations over standard CT reconstructions for pelvic discontinuity.
• To assess the sensitivity of the new technique in identifying pelvic discontinuity preoperatively.

Main Methods:

• Retrospective review of 22 patients with intraoperative pelvic discontinuity findings and preoperative CT scans.
• Diagnosis of pelvic discontinuity defined as a continuous fracture line across anterior and posterior columns.
• Comparison of sensitivity between standard CT reconstructions and 45° oblique CT reformations.

Main Results:

• Standard CT reconstructions demonstrated 73% sensitivity for pelvic discontinuity.
• The addition of 45° oblique CT reformations increased sensitivity to 91%.

Conclusions:

• 45° oblique CT views (iliac and obturator oblique) offer high sensitivity for suspected pelvic discontinuity.
• This technique aids preoperative planning and potential modification of reconstructive strategies in revision hip arthroplasty.
• The novel CT reformation technique improves detection when plain films are inconclusive.