Both-Column Acetabular Fractures: Does Surgical Approach Vary Based on Using Virtual 3D Reconstructions?

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Medical imaging

Background:

• Both-column acetabular fractures present complex challenges for treatment planning.
• Displacement of anterior and posterior columns complicates surgical decision-making.

Purpose of the Study:

• To assess agreement among pelvic surgeons regarding treatment strategies for both-column acetabular fractures.
• To evaluate the impact of virtual 3D reconstructions on treatment strategy selection and surgeon confidence.

Main Methods:

• A nationwide cross-sectional survey was conducted across Dutch pelvic trauma centers.
• Twenty surgeons assessed 15 both-column acetabular fractures using both 2D conventional imaging and 3D virtual reconstructions.
• Inter-surgeon agreement was analyzed using kappa statistics (κ).

Main Results:

• Surgical treatment was recommended in 89% of cases with conventional imaging, increasing to 93% with 3D reconstructions (p=0.09).
• Initial agreement on surgical approach (anterior, posterior, combined) was poor (κ=0.05).
• The addition of 3D reconstructions led to a significant change in recommended surgical approach in 37% of cases (p=0.006), with continued poor agreement (κ=0.13).
• Surgeon confidence increased from 38% to 50% when using 3D reconstructions.

Conclusions:

• There is a lack of consensus among surgeons on the optimal treatment strategy for both-column acetabular fractures.
• Virtual 3D reconstructions can alter the preferred surgical approach and enhance surgeon confidence.
• 3D reconstructions are valuable tools for evaluating fracture patterns and guiding treatment decisions in complex acetabular fractures.