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. 2023 May 5;13(9):1629.
doi: 10.3390/diagnostics13091629.

Both-Column Acetabular Fractures: Does Surgical Approach Vary Based on Using Virtual 3D Reconstructions?

Judith F Leemhuis  1 , Nick Assink  1   2 , Inge H F Reininga  1 , Jean-Paul P M de Vries  1 , Kaj Ten Duis  1 , Anne M L Meesters  1   2 , Frank F A IJpma  1 ; The Pelvic Fracture Consortium
Collaborators, Affiliations

Both-Column Acetabular Fractures: Does Surgical Approach Vary Based on Using Virtual 3D Reconstructions?

Judith F Leemhuis et al. Diagnostics (Basel). .

Abstract

Displacement of the anterior and posterior column complicates decision making for both-column acetabular fractures. We questioned whether pelvic surgeons agree on treatment strategy, and whether the use of virtual 3D reconstructions changes the treatment strategy of choice. A nationwide cross-sectional survey was performed in all pelvic trauma centers in the Netherlands. Twenty surgeons assessed 15 both-column fractures in 2D as well as 3D. Based on conventional imaging, surgical treatment was recommended in 89% of cases, and by adding 3D reconstructions this was 93% (p = 0.09). Surgical approach was recommended as anterior (65%), posterior (8%) or combined (27%) (poor level of agreement, κ = 0.05) based on conventional imaging. The approach changed in 37% (p = 0.006), with most changes between a combined and anterior approach (still poor level of agreement, κ = 0.13) by adding 3D reconstructions. Additionally, surgeons' level of confidence increased from good in 38% to good in 50% of cases. In conclusion, surgeons do not agree on the treatment strategy for both-column acetabular fractures. Additional information given by 3D reconstructions may change the chosen surgical approach and increase surgeons' confidence about their treatment decision. Therefore, virtual 3D reconstructions are helpful for assessing both-column fracture patterns and aid in the choice of treatment strategy.

Keywords: 3D; acetabular fracture; acetabulum; both column; surgical approach; survey; three-dimensional.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Conventional imaging provided within the surveys: (a) pelvic radiograph (AP overview), (b–d) examples of the axial, coronal, and sagittal CT slice (surgeons could scroll through every slice of the CT scan).
Figure 2
Figure 2
Virtual 3D reconstruction of a both-column acetabular fracture as provided within the surveys (surgeons could rotate and view the model in every direction). (Left): anterior view, (right): view into the acetabulum.
See this image and copyright information in PMC

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