Abstract
BackgroundIn acetabular fractures, the assessment of reduction and implant placement has limitations in conventional 2D intraoperative imaging. 3D imaging offers the opportunity to acquire CT-like images and thus to improve the results. However, clinical experience shows that even 3D imaging has limitations, especially regarding artifacts when implants are placed. The purpose of this study was to assess the difference between intraoperative 3D imaging and postoperative CT regarding reduction and implant placement.MethodsTwenty consecutive cases of acetabular fractures were selected with a complete set of intraoperative 3D imaging and postoperative CT data. The largest detectable step and the largest detectable gap were measured in all three standard planes. These values were compared between the 3D data sets and CT data sets. Additionally, possible correlations between the possible confounders age and BMI and the difference between 3D and CT values were tested.ResultsThe mean difference of largest visible step between the 3D imaging and CT scan was 2.0 ± 1.8 mm (0.0–5.8, p = 0.02) in the axial, 1.3 ± 1.4 mm (0.0–3.7, p = 0.15) in the sagittal and 1.9 ± 2.4 mm (0.0–7.4, p = 0.22) in the coronal views. The mean difference of largest visible gap between the 3D imaging and CT scan was 3.1 ± 3.6 mm (0.0–14.1, p = 0.03) in the axial, 4.6 ± 2.7 mm (1.2–8.7, p = 0.001) in the sagittal and 3.5 ± 4.0 mm (0.0–15.4, p = 0.06) in the coronal views. A positive correlation between the age and the difference in gap measurements in the sagittal view was shown (rho = 0.556, p = 0.011).ConclusionsIntraoperative 3D imaging is a valuable adjunct in assessing reduction and implant placement in acetabular fractures but has limitations due to artifacts caused by implant material. This can lead to missed malreduction and impairment of clinical outcome, so postoperative CT should be considered in these cases.
Highlights
In acetabular fractures, the assessment of reduction and implant placement has limitations in conventional 2D intraoperative imaging. 3D imaging offers the opportunity to acquire Computed tomography (CT)-like images and to improve the results
Anonymized image sets from patients that were operated on the acetabulum and received an intraoperative 3D as well as a postoperative CT scan before ambulation was included in this study
The postoperative CT scans were performed by the radiological department with a clinical 32-slice CT scanner (Aquilion 32, Toshiba, Japan)
Summary
The assessment of reduction and implant placement has limitations in conventional 2D intraoperative imaging. 3D imaging offers the opportunity to acquire CT-like images and to improve the results. The assessment of reduction and implant placement has limitations in conventional 2D intraoperative imaging. Clinical experience shows that even 3D imaging has limitations, especially regarding artifacts when implants are placed. The purpose of this study was to assess the difference between intraoperative 3D imaging and postoperative CT regarding reduction and implant placement. The acetabulum is the pelvic part of the hip joint, being formed by the ischium, ilium, and the pubis. It is a central part of the musculoskeletal system and needs to bear heavy forces due to the large range of motion of the hip joint and weight supply during walking and running.
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