Efficacy of Routine Postoperative CT Scan After Open Reduction and Internal Fixation of the Acetabulum

Abstract

Objectives: The purpose of this study was to evaluate the efficacy of routine postoperative computed tomography (CT) scan after open reduction and internal fixation of acetabular fractures.

Design: Retrospective review of prospectively collected acetabulum fracture database.

Setting: Level I trauma center.

Patients/participants: A total of 606 consecutive patients underwent surgical fixation of 612 acetabular fractures. All patients were evaluated with intraoperative fluoroscopy in addition to 3 standard plain radiographs (AP pelvis and two 45 degrees oblique Judet views). Reduction and fixation were believed to be adequate and definitive before exiting the operative suite based on these imaging modalities.

Intervention: Axial postoperative CT scan of the pelvis was obtained in 563 of the patients (93%) after 569 operative cases.

Main outcome measurements: Revision acetabular surgery based on routine postoperative CT scan findings.

Results: There were no significant differences between index and revision surgery groups regarding age, gender, body mass index, fracture pattern, mechanism of injury, or surgical approach (P > 0.05). Evaluation of 563 postoperative CT scans of the pelvis resulted in revision acetabular surgery for 2.5% of patients (n = 14). There were 6 (1.1%) cases of intraarticular hardware not recognized on the intraoperative fluoroscopy or pelvic radiographs. Four patients (0.7%) had residual intraarticular osteochondral fragments deemed too large to leave in the hip joint. There were 3 cases (0.5%) of unacceptable malreduction, and 1 case (0.2%) of both malreduction and an intraarticular osteochondral fragment.

Conclusions: A small percentage of patients (2.5%) will benefit from a routine CT scan after acetabular fracture fixation.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.