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Does Routine Postoperative Computerized Tomography After Acetabular Fracture Fixation Affect Management?

Walid A Elnahal1,2, Anthony J Ward1, Mehool R Acharya1

  • 1North Bristol NHS Trust, Bristol, United Kingdom.

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|January 29, 2019
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Routine postoperative computerized tomography (CT) scans improve accuracy in assessing acetabular fracture fixation compared to plain radiographs. CT scans are recommended for cases with inconclusive or definite malpositioning, especially when using spring plates.

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Trauma Care

Background:

  • Routine postoperative computerized tomography (CT) scans after acetabular fracture reconstruction are debated due to radiation exposure and cost.
  • CT may offer superior detail on hardware position, intra-articular fragments, and reduction quality compared to plain radiographs.

Purpose of the Study:

  • To evaluate a protocol of routine postoperative CT scans for all acetabular fractures post-fixation.
  • To assess the impact of routine CT scans on patient management and surgical decision-making.

Main Methods:

  • Reviewed 122 patients with acetabular fractures, categorizing plain radiographs and fluoroscopy findings (safe, inconclusive, definite malposition).
  • Compared radiographic assessments with postoperative CT scans for metalwork position and fracture reduction quality (Matta criteria).

Main Results:

  • CT confirmed no malposition in 94% of cases deemed 'safe' on radiographs; 6% had insignificant findings.
  • In 'inconclusive' cases (n=17), CT identified malposition in 4 patients, requiring revision in 2.
  • Significant discrepancies noted in reduction quality assessment between plain radiographs and CT (P < 0.001), with 42% of 'anatomic' reductions on X-ray deemed imperfect/poor on CT.

Conclusions:

  • Computerized tomography scans are more accurate than plain radiographs for detecting implant malposition and assessing acetabular fracture reduction quality.
  • Postoperative CT scans should be considered for fractures with inconclusive/definite malposition on radiographs, particularly with spring plate use, or for enhanced quality assurance and prognostic assessment.