Abstract
Purpose
Acetabular fractures are associated to an increased risk of subsequent hip osteoarthritis. The only available score for post-operative reduction assessment in acetabular fractures (Matta’s score) is x-ray based. CT-scan was shown superior to X-rays in post-operative reduction assessment. We aim to describe a CT-scan-based post-operative reduction score in acetabular fractures and evaluate its accuracy and reproducibility.
Methods
This is a retrospective study that includes 138 patients who underwent surgery for an acetabular fracture in our tertiary referral centre with a mean follow-up of 104.39±42.2 months. The post-operative CT-scan was reviewed and residual displacement (maximum gap and step) measured by three independent observers. The association between the occurrence of THA and the CT-scan measurements was evaluated. This led to a new prognostic score. The interobserver reliability and accuracy of this score were calculated.
Results
Interobserver reproducibility for the residual maximal gap was 0.82 (95% CI [0.70–0.89]) and 0.61 (95% CI [0.52–0.70]) for the residual maximal step displacement measurements. We created a score from a logistic regression model, attributing 1 point for every 1 mm of residual maximal step displacement and 1 point for every 2 mm of residual maximal gap displacement. The interobserver reproducibility of this score was 0.78 (95% CI [0.71–0.84]), and its AUC was 0.79 (95% CI [0.69–0.88]).
Conclusion
This is the first CT-scan-based score for the assessment of residual displacement of a surgically treated acetabular fracture. It shows good interobserver reproducibility and accuracy in predicting the risk for secondary THA. It should be regularly used per-operatively (if per-operative 3D imaging is available) and post-operatively to predict the prognosis.
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Data and material are available.
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Elias Melhem participated in data collection, designing the work, and drafting of the manuscript. Maroun Rizkallah participated in data collection, work design, and approving the final manuscript. Hichem Abid participated in statistical analysis and reviewing the manuscript. Pierre Emmanuel Moreau participated in drafting manuscript and analysing collected data. Peter Upex participated in drafting manuscript and analysing collected data. Mourad Zaraa participated in drafting manuscript and analysing collected data. Mansour Sadeqi participated in data collection and statistic analysis. Pomme Jouffroy participated in designing the work, drafting the manuscript, and reviewing the final manuscript. Guillaume Riouallon is the main conceptor of the study and participated in drafting the manuscript.
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Melhem, E., Rizkallah, M., Abid, H. et al. The Saint-Joseph Acetabular score: a reproducible and accurate prediction of the outcome of open reduction and internal fixation of acetabular fractures. International Orthopaedics (SICOT) 47, 2977–2984 (2023). https://doi.org/10.1007/s00264-023-05913-8
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DOI: https://doi.org/10.1007/s00264-023-05913-8