MR imaging of acetabular fractures: value in detecting femoral head injury, intraarticular fragments, and sciatic nerve injury.

OBJECTIVE

The purpose of this prospective study was to compare the value of MR imaging in the detection of injuries associated with acute acetabular fractures (femoral head fracture, free fragments within the hip joint, and injury to the sciatic nerve) with the value of preoperative CT examinations, intraoperative inspection, intraoperative somatosensory evoked potentials (SEP), and clinical neurologic examinations.

SUBJECTS AND METHODS

Coronal fat suppressed long TR/TE and unenhanced and contrast-enhanced T1-weighted MR images were obtained preoperatively in 37 patients with acetabular fractures. The sciatic nerve was assessed for injury and the femoral head was assessed for fracture, dislocation, and contusion. MR results were compared with CT findings for acetabular fractures and fractures of the femoral head. The appearance of the sciatic nerve on MR images was correlated with intraoperative changes in SEP and results of the clinical neurologic examination.

RESULTS

Although MR images showed acetabular fractures, intraarticular fragments were often obscured. Fragments were readily apparent on CT scans. MR images showed fracture of the femoral head in 10 (27%) of 37 cases. Nine of these fractures also were seen on CT scans. MR images showed subchondral contusion of the femoral head in 24 (65%) of 37 cases. The same areas appeared normal on CT scans. MR images of the sciatic nerve obtained after injection of contrast material showed intraneural or perineural enhancement in all patients with either changes in baseline SEP (n = 19) or preoperative neurologic deficit (n = 10). Although baseline changes in SEP were more common with intraneural enhancement, the difference in the prevalence of neurologic deficits was not significant. The preoperative enhancement pattern alone could not be used to predict a neurologic deficit.

CONCLUSIONS

MR imaging of acetabular fractures can be used to detect subclinical injury of the sciatic nerve and occult injuries of the femoral head not readily apparent on CT scans. However, intraarticular fragments may be obscured.