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Intraoperative Imaging in Pelvic Surgery.

Holger Keil1, Sara Aytac1, Paul Alfred Grützner1

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Summary

Pelvic fractures, including acetabular injuries, require careful surgical planning. Advanced imaging techniques like intraoperative CT and navigation improve surgical outcomes for complex pelvic and acetabular fractures.

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Medical Imaging

Background:

  • Pelvic fractures encompass a spectrum of injuries, from minor to life-threatening, including pelvic ring and acetabular fractures.
  • Surgical intervention for pelvic ring injuries is determined by injury type, patient condition, and specific demands.
  • Acetabular fractures with intraarticular step-off >2mm typically necessitate open reduction and osteosynthesis.

Purpose of the Study:

  • To review current imaging modalities for pelvic and acetabular fractures.
  • To highlight the evolution from 2D imaging to advanced 3D intraoperative techniques.
  • To discuss the benefits and limitations of intraoperative imaging in managing pelvic fractures.

Main Methods:

  • Preoperative CT scans are standard for surgical planning of pelvic and acetabular fractures.
  • Intraoperative 2D imaging includes anteroposterior, inlet, outlet, and iliac oblique views.
  • Emerging intraoperative 3D imaging and radiation-free navigation offer enhanced visualization and precision.

Main Results:

  • 2D imaging can be limited by anatomical superimposition and artifacts.
  • Intraoperative 3D imaging provides CT-like views but can be affected by implant artifacts.
  • Intraoperative CT and navigation show promise in overcoming artifact issues and improving minimally invasive procedures.

Conclusions:

  • Accurate preoperative and intraoperative imaging is crucial for successful pelvic and acetabular fracture management.
  • Advanced imaging techniques, including intraoperative 3D CT and navigation, enhance surgical precision and patient outcomes.
  • Continued development in imaging technology is vital for optimizing treatment of complex pelvic injuries.