Postoperative CT Is Superior for Acetabular Fracture Reduction Assessment and Reliably Predicts Hip Survivorship

Journal of Bone and Joint Surgery - Tập 99 Số 20 - Trang 1745-1752 - 2017
Diederik O. Verbeek1, Jelle P. van der List1, Jordan C. Villa1, David S. Wellman1, David L. Helfet1
1Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY

Tóm tắt

Background: Postoperative pelvic radiographs are routinely used to assess acetabular fracture reduction. We compared radiographs and computed tomography (CT) with regard to their ability to detect residual fracture displacement. We also determined the association between the quality of reduction as assessed on CT and hip survivorship and identified risk factors for conversion to total hip arthroplasty (THA). Methods: Patients were included in the study who had undergone acetabular fracture fixation between 1992 and 2012, who were followed for ≥2 years (or until early THA), and for whom radiographs and a pelvic CT scan were available. Residual displacement was measured on postoperative radiographs and CT and graded according to Matta’s criteria (0 to 1 mm indicating anatomic reduction; 2 to 3 mm, imperfect reduction; and >3 mm, poor reduction) by observers who were blinded to patient outcome. Kaplan-Meier survivorship curves were plotted and log-rank tests were used to assess statistical differences in survivorship curves between adequate (anatomic or imperfect) and inadequate reductions on CT. Cox proportional hazard regression analysis was used to identify risk factors for conversion to THA. Two hundred and eleven patients were included. At mean of 9.0 years (standard deviation [SD], 5.6; median, 7.9; range, 0.5 to 23.3 years) postoperatively, 161 patients (76%) had retained their native hip. Results: Compared with radiographs, CT showed worse reduction in 124 hips (59%), the same reduction in 79 (37%), and better reduction in 8 (4%). Of the 99 patients graded as having adequate reduction on CT, 10% underwent conversion to THA in comparison with 36% of those with inadequate reduction, and there was a significant difference between the survivorship curves (p < 0.001). Mean hip survivorship was shorter in patients ≥50 years of age (p < 0.001) and in those with an inadequate reduction on CT (p < 0.001). Independent risk factors for conversion to THA were age (hazard ratio [HR] = 4.46, 95% confidence interval [CI] = 2.07 to 9.62; p < 0.001), inadequate reduction (HR = 3.57, 95% CI = 1.71 to 7.45; p = 0.001), and posterior wall involvement (HR = 1.81, 95% CI = 1.00 to 3.26; p = 0.049). Sex, fracture type (elementary versus associated), and year of surgery did not influence hip survivorship. Conclusions: CT is superior to radiographs for detecting residual displacement after acetabular fracture fixation. Hip survivorship is greater in patients with adequate (anatomic or imperfect) reduction on CT. Along with older age and posterior wall involvement, an inadequate reduction on CT is a risk factor for conversion to THA. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Từ khóa


Tài liệu tham khảo

Matta, 1996, Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within 3 weeks after the injury, J Bone Joint Surg Am., 78, 1632, 10.2106/00004623-199611000-00002

Tannast, 2012, 2 to 20-year survivorship of the hip in 810 patients with operatively treated acetabular fractures, J Bone Joint Surg Am., 94, 1559, 10.2106/JBJS.K.00444

Briffa, 2011, Outcomes of acetabular fracture fixation with 10 years’ follow-up, J Bone Joint Surg Br., 93, 229, 10.1302/0301-620X.93B2.24056

Moed, 2003, Computed tomographic assessment of fractures of the posterior wall of the acetabulum after operative treatment, J Bone Joint Surg Am., 85, 512, 10.2106/00004623-200303000-00018

Moed, 2002, Results of operative treatment of fractures of the posterior wall of the acetabulum, J Bone Joint Surg Am., 84, 752, 10.2106/00004623-200205000-00008

Borrelli, 2005, Postoperative radiographic assessment of acetabular fractures: a comparison of plain radiographs and CT scans, J Orthop Trauma., 19, 299

Dailey, 2016, Achieving anatomic acetabular fracture reduction-when is the best time to operate?, J Orthop Trauma., 30, 426, 10.1097/BOT.0000000000000576

Mayo, 1994, Open reduction and internal fixation of fractures of the acetabulum. Results in 163 fractures, Clin Orthop Relat Res., 305, 31, 10.1097/00003086-199408000-00005

Carroll, 2010, Treatment of acetabular fractures in an older population, J Orthop Trauma., 24, 637, 10.1097/BOT.0b013e3181ceb685

Helfet, 1992, Stabilization of acetabular fractures in elderly patients, J Bone Joint Surg Am., 74, 753, 10.2106/00004623-199274050-00015

Jeffcoat, 2012, Operative treatment of acetabular fractures in an older population through a limited ilioinguinal approach, J Orthop Trauma., 26, 284, 10.1097/BOT.0b013e31821e10a2

Dodd, 2016, Radiographic measurement of displacement in acetabular fractures: a systematic review of the literature, J Orthop Trauma., 30, 285

Olson, 1993, The computerized tomography subchondral arc: a new method of assessing acetabular articular continuity after fracture (a preliminary report), J Orthop Trauma., 7, 402, 10.1097/00005131-199310000-00002

Giannoudis, 2005, Operative treatment of displaced fractures of the acetabulum. A meta-analysis, J Bone Joint Surg Br., 87, 2, 10.1302/0301-620X.87B1.15605

Archdeacon, 2015, Efficacy of routine postoperative CT scan after open reduction and internal fixation of the acetabulum, J Orthop Trauma., 29, 354, 10.1097/BOT.0000000000000332

O’Shea, 2006, The usefulness of computed tomography following open reduction and internal fixation of acetabular fractures, J Orthop Surg (Hong Kong)., 14, 127, 10.1177/230949900601400204

Ochs, 2010, Changes in the treatment of acetabular fractures over 15 years: analysis of 1,266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU), Injury., 41, 839, 10.1016/j.injury.2010.04.010

Thông tin
Thông tin xuất bản

Journal of Bone and Joint Surgery

Tập 99 Số 20

1745-1752

Thông tin tác giả