Gardner Samantha R, Haase Douglas R, Gattu Nikhil, Warner Stephen J, Routt Milton L Chip, Kellam Patrick, Eastman Jonathan G
Department of Orthopaedic Surgery, McGovern Medical School, UT Health Houston, Houston, TX.
Department of Orthopaedic Surgery, University of Missouri, Columbus, MO; and.
J Orthop Trauma. 2025 Apr 1;39(4):167-173. doi: 10.1097/BOT.0000000000002954.
To report the frequency of patients with pre-reduction and postreduction computed tomography (CT) scans associated with acetabular fracture-dislocations and the change in position of associated intra-articular fragments occurring with joint reduction.
Retrospective case series.
Regional Level 1 trauma center.
Patients who sustained Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association 62A1 and 62B1 posterior wall or transverse posterior wall acetabular fracture-dislocations with pre-reduction and postreduction CT imaging from February 2020 to July 2023.
Intra-articular fragments were identified, and change in position (fossa to cranial, intra-articular to extra-articular, etc.) was noted from pre-reduction to postreduction scans. Operative reports and postoperative CT scans were reviewed to determine the frequency of fragment retrieval.
One hundred nineteen (30.2%) of 394 patients meeting fracture pattern inclusion criteria received a CT scan before hip reduction. Of the 394 patients, 100 (25.9%) had pre-reduction and postreduction CT scans and were studied [average age of 35.5 years (range 16-87 years), 59 male patients]. Forty-five (45%) of 100 patients had pre-reduction CT imaging demonstrating the presence of intra-articular fragment(s). Thirty (66.7%) of 45 patients with a pre-reduction intra-articular fragment had an intra-articular fragment location change during the reduction. Of the 55 patients who did not have an intra-articular fragment on pre-reduction imaging, 28 (50.9%) had at least 1 intra-articular fragment on the postreduction CT. Complete fragment retrieval was performed in 71.4% of patients.
The study demonstrated that 30.2% of patients with posterior wall and transverse posterior wall acetabular fracture-dislocations received a CT scan before hip reduction. It was common to find intra-articular fragments on the postreduction CT in patients who did not have them on the pre-reduction CT. Obtaining and scrutinizing the postreduction CT scan provided accurate knowledge of the location of all osseous fragments associated with the fracture-dislocations, which facilitated thorough preoperative planning, intraoperative implementation, and hopeful long-term patient outcomes.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
报告髋臼骨折脱位患者复位前和复位后计算机断层扫描（CT）的频率，以及关节复位时相关关节内碎片位置的变化。
回顾性病例系列研究。
一级区域创伤中心。
2020年2月至2023年7月期间，因Arbeitsgemeinschaft fur Osteosynthesefragen/骨科创伤协会62A1和62B1型后壁或后壁横行髋臼骨折脱位而接受复位前和复位后CT成像的患者。
识别关节内碎片，并记录从复位前到复位后扫描时碎片位置的变化（从髋臼窝到髋臼顶、从关节内到关节外等）。查阅手术报告和术后CT扫描结果，以确定碎片取出的频率。
394例符合骨折类型纳入标准的患者中，119例（30.2%）在髋关节复位前接受了CT扫描。在这394例患者中，100例（25.9%）进行了复位前和复位后CT扫描并纳入研究[平均年龄35.5岁（范围16 - 87岁），男性患者59例]。100例患者中有45例（45%）复位前CT成像显示存在关节内碎片。45例复位前有关节内碎片的患者中，30例（66.7%）在复位过程中关节内碎片位置发生了变化。55例复位前成像无关节内碎片的患者中，28例（50.9%）复位后CT显示至少有1个关节内碎片。71.4%的患者进行了完整的碎片取出。
该研究表明，30.2%的后壁和后壁横行髋臼骨折脱位患者在髋关节复位前接受了CT扫描。复位前CT无关节内碎片的患者，复位后CT发现关节内碎片很常见。获取并仔细检查复位后CT扫描能够准确了解与骨折脱位相关的所有骨碎片的位置，这有助于进行全面的术前规划、术中实施，并有望改善患者的长期预后。
预后性IV级。有关证据级别的完整描述，请参阅作者须知。
