Acetabular Lateral View: Effective Fluoroscopic Imaging to Evaluate Screw Penetration Intraoperatively

Area of Science:

• Orthopedic surgery
• Surgical imaging
• Trauma care

Background:

• Screw penetration into the hip joint is a serious complication in acetabular fracture surgery.
• Standard pelvic fluoroscopic views lack sufficient safety for accurate screw insertion.
• Accurate screw placement is critical for successful acetabular fracture repair.

Purpose of the Study:

• To evaluate the accuracy of the acetabular lateral view for detecting screw placement during acetabular fracture surgery.
• To compare the diagnostic performance of standard fluoroscopic views with and without the lateral acetabular view.
• To determine if the lateral view enhances intraoperative safety and reduces complications.

Main Methods:

• A study involving 40 screws, with 20 intentionally penetrating the articular surface and 20 placed extra-articularly near it.
• Three independent surgeons evaluated 120 screw placements using standard views versus combined standard and lateral acetabular views.
• Statistical analysis included sensitivity, specificity, predictive values, intra-class correlation coefficients (ICC), and Youden index.

Main Results:

• The combination of the lateral acetabular view with standard views significantly improved sensitivity, negative predictive value, correct interpretation, and Youden index.
• The intra-class correlation coefficient (ICC) for screw placement accuracy was substantially higher when the lateral view was included.
• Standard views alone showed an ICC of 0.531, which improved with the addition of the lateral view.

Conclusions:

• The acetabular lateral view serves as a valuable complementary tool for identifying malpositioned screws during acetabular fracture surgery.
• Incorporating the lateral view enhances the accuracy of screw insertion, particularly for posterior wall fractures.
• This improved accuracy can help prevent severe complications associated with screw malplacement in the hip joint.