33.
The use of intraoperative computer tomography in acetabular and
pelvic fractures
Dennis Olsson, Eckardt Henrik
Orthopaedic Bispebjerg; Trauma, Rigshospitalet
Background:
Malreduced acetabulum fractures cause severe postoperative
coxarthrosis, and intraoperative evaluation of the reduction and osteosynthesis
of acetabulum fractures is important. Two-dimensional fluoroscopy shows
only tangential views of the acetabulum roof. The new 3- dimensional
fluoroscopy could potentially revolutionize acetabular fracture surgery.
Purpose / Aim of Study:
We have used intraoperative imaging with an O-arm
to evaluate the reduction and questioned whether the intraoperative CT- like
images improve reduction after acetabulum fracture.
Materials and Methods:
We used intraoperative imaging with the O- arm in
24
patients who suffered an acetabulum fracture between October 2010 and
Mars 2012. The radiographic operative end-result was evaluated with the
Matta-score, and the functional result at 3 month postoperative was evaluated
with the score of Merle d’ Aubigné. The control group consisted of 41
consecutive acetabulum fractures operated the previous year. Chi2 tests were
used for comparison between groups.
Findings / Results:
In the O-arm group 13/24 (54,2%) had anatomic reduction
of their fracture and 2/24 (8,3%) had a poor result. In the control group 17/41
(41%)
had anatomic reduction and 12/41 (29%) had a poor result. The
differences were not significant. In complex fracture types (t-type and two-
column) the reduction with the o-arm was significantly better than in the
control group. Operation time and functional outcome was not different
between goups.
Conclusions:
Intraoperative imaging with the O-arm produces CT-like
reconstructed three- dimensional images, which fascilitates intraoperative
evaluation of reduction, and offers a possibility to correct malreduced fractures
before closing the wound. Our results showed a tendency towards better results
when the O-arm is used for intraoperative evaluation of acetabulum fractures.
