The Journal of Bone and Joint Surgery (American) 85:512-522 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
Computed Tomographic Assessment of Fractures of the Posterior Wall of the Acetabulum After Operative Treatment
Berton R. Moed, MD,
Seann E. Willson Carr, MD,
Konrad I. Gruson, MD,
J. Tracy Watson, MD and
Joseph G. Craig, MD
Investigation performed at the Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan
Berton R. Moed, MD
J. Tracy Watson, MD
Department of Orthopaedic Surgery, St. Louis University School of Medicine, 3635 Vista Avenue, 7th Floor, Desloge Towers, St. Louis, MO 63110. E-mail address for B.R. Moed: bmoed{at}aol.com
Seann E. Willson Carr, MD
Department of Orthopaedic Surgery, University of Chicago Medical Center, 5841 South Maryland, MC 3079, Chicago, IL 60637
Konrad I. Gruson, MD
Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003
Joseph G. Craig, MD
Department of Radiology, Henry Ford Hospital, K-2, 2799 West Grand Boulevard, Detroit, MI 48202
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Background: The purpose of this study was to evaluate the results after operative treatment of fractures of the posterior wall of the acetabulum in relationship to the quality of the fracture reduction as assessed by postoperative two-dimensional computed tomography.
Methods: The functional results for sixty-seven patients who had open reduction and internal fixation of an unstable fracture of the posterior wall of the acetabulum and the findings of two-dimensional computed tomography performed postoperatively were analyzed. Sixty-one patients were followed for a mean of four years after the injury, and the remaining six patients who had poor early results necessitating reconstructive surgery were followed for less than two years. All patients were evaluated preoperatively and postoperatively with use of three standard plain radiographs (one anteroposterior and two Judet 45° oblique pelvic radiographs) and a two-dimensional computed tomography scan. The functional outcome for the patients was evaluated with use of a modification of the clinical grading system described by Letournel and Judet. The radiographs were graded according to the criteria described by Matta. The two-dimensional computed tomography scans were used to determine fracture gap and offset measurements.
Results: The clinical outcome was graded as excellent in thirty-one patients (46%), very good in twenty (30%), good in eight (12%), and poor in eight (12%). The final radiographic results were graded as excellent in fifty-three hips (79%), good in four (6%), fair in three (5%), and poor in seven (10%). There was a strong association between clinical outcome and final radiographic grade. Fracture reductions were graded as anatomic in sixty-five and imperfect in two, as determined with use of plain radiography. However, postoperative computed tomography revealed an incongruency (offset) of >2 mm in eleven hips and fracture gaps of  2 mm in fifty-two. Fracture gaps of 10 mm in any dimension or a total gap area of 35 mm
2 were associated with a poor result. The main risk factors for a poor result were a residual fracture gap width of 10 mm and osteonecrosis of the femoral head.
Conclusions: The degree of residual fracture displacement is detected more accurately on postoperative computed tomography scans than on plain radiographs. The accuracy of surgical reduction as assessed on postoperative computed tomography is highly predictive of the clinical outcome.
Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
B. R. Moed and J. C. McMichael
Outcomes of Posterior Wall Fractures of the Acetabulum. Surgical Technique
J. Bone Joint Surg. Am.,
March 1, 2008;
90(Supplement_2__Part_1):
87 - 107.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. R. Moed and J. C. McMichael
Outcomes of Posterior Wall Fractures of the Acetabulum
J. Bone Joint Surg. Am.,
June 1, 2007;
89(6):
1170 - 1176.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Ohashi, G. Y. El-Khoury, D. L. Bennett, J. M. Restrepo, and K. S. Berbaum
Orthopedic Hardware Complications Diagnosed with Multi-Detector Row CT
Radiology,
November 1, 2005;
237(2):
570 - 577.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. V. Giannoudis, M. R. W. Grotz, C. Papakostidis, and H. Dinopoulos
Operative treatment of displaced fractures of the acetabulum: A META-ANALYSIS
J Bone Joint Surg Br,
January 1, 2005;
87-B(1):
2 - 9.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. A. Cole
What's New in Orthopaedic Trauma
J. Bone Joint Surg. Am.,
November 1, 2003;
85(11):
2260 - 2269.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. R. Moed, P. H. Yu, and K. I. Gruson
Functional Outcomes of Acetabular Fractures
J. Bone Joint Surg. Am.,
October 1, 2003;
85(10):
1879 - 1883.
[Abstract]
[Full Text]
|
|
|
|
