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Imaging of the acetabulum in the era of multidetector computed tomography

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Abstract

Acetabular fractures are often complex injuries and the result of high-energy trauma with associated injuries. Understanding and classification of these rare injuries using radiography can be difficult and are much facilitated by the addition of computed tomography (CT). The purpose of this paper is to briefly review some of the underlying physical principles and technical factors for multidetector CT (MDCT) and to describe its use and imaging findings in the evaluation of acetabular fractures. Using MDCT with two-dimensional multiplanar reformatted (MPR) images and three-dimensional volume rendered images, the supplemental oblique radiographic Judet views can be omitted. MDCT is now an indispensable tool in preoperative imaging of acetabular fractures and also in postoperative imaging in complicated cases. Not only is MDCT excellent for a general overview but also for detailed imaging of fracture extent, joint congruency, step-offs or gaps in the joint surface, and entrapped osteochondral fragments.

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References

  1. Dakin GJ, Eberhardt AW, Alonso JE, Stannard JP, Mann KA (1999) Acetabular fracture patterns: associations with motor vehicle crash information. J Trauma 47:1063–1071

    Article  PubMed  CAS  Google Scholar 

  2. Ohashi K, El-Khoury GY, Abu-Zahra KW, Berbaum KS (2006) Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary? Radiology 241:386–391

    Article  PubMed  Google Scholar 

  3. Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Jt Surg Am 46:1615–1646

    CAS  Google Scholar 

  4. Dalrymple NC, Prasad SR, Freckleton MW, Chintapalli KN (2005) Informatics in radiology (infoRAD): introduction to the language of three-dimensional imaging with multidetector CT. Radiographics 25:1409–1428

    Article  PubMed  Google Scholar 

  5. Geijer M, El-Khoury GY (2006) MDCT in the evaluation of skeletal trauma: principles, protocols, and clinical applications. Emerg Radiol 13:7–18

    Article  PubMed  Google Scholar 

  6. Mahesh M (2002) Search for isotropic resolution in CT from conventional through multiple-row detector. Radiographics 22:949–962

    PubMed  Google Scholar 

  7. Burk DLJ, Mears DC, Kennedy WH, Cooperstein LA, Herbert DL (1985) Threedimensional computed tomography of acetabular fractures. Radiology 155:183–186

    PubMed  Google Scholar 

  8. Pozzi Mucelli RS, Muner G, Pozzi Mucelli F, Pozzi Mucelli M, Marotti F, Dalla Palma L (1986) Three-dimensional computed tomography of the acetabulum. Eur J Radiol 6:168–177

    PubMed  CAS  Google Scholar 

  9. Scott WW Jr, Magid D, Fishman EK, Riley LH Jr, Brooker AF Jr, Johnson CA (1987) Three-dimensional imaging of acetabular trauma. J Orthop Trauma 1:227–232

    PubMed  Google Scholar 

  10. Haveri M, Junila J, Suramo I, Lähde S (1998) Multiplanar and 3D CT of acetabular fractures. Acta Radiol 39:257–264

    Article  PubMed  CAS  Google Scholar 

  11. Mettler FAJ, Wiest PW, Locken JA, Kelsey CA (2000) CT scanning: patterns of use and dose. J Radiol Prot 20:353–359

    Article  PubMed  Google Scholar 

  12. Kalra MK, Rizzo SM, Novelline RA (2005) Reducing radiation dose in emergency computed tomography with automatic exposure control techniques. Emerg Radiol 11:267–274

    Article  PubMed  Google Scholar 

  13. Saini S (2004) Multi-detector row CT: principles and practice for abdominal applications. Radiology 233:323–327

    Article  PubMed  Google Scholar 

  14. Theocharopoulos N, Perisinakis K, Damilakis J, Karampekios S, Gourtsoyiannis N (2006) Dosimetric characteristics of a 16-slice computed tomography scanner. Eur Radiol 16:2575–2585

    Article  PubMed  Google Scholar 

  15. Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296

    PubMed  CAS  Google Scholar 

  16. Khursheed A, Hillier MC, Shrimpton PC, Wall BF (2002) Influence of patient age on normalized effective doses calculated for CT examinations. Br J Radiol 75:819–830

    PubMed  CAS  Google Scholar 

  17. Hunter JC, Brandser EA, Tran KA (1997) Pelvic and acetabular trauma. Radiol Clin North Am 35:559–590

    PubMed  CAS  Google Scholar 

  18. Reilly MC, Olson SA, Tornetta P3, Matta JM (2000) Superior gluteal artery in the extended iliofemoral approach. J Orthop Trauma 14:259–263

    Article  PubMed  CAS  Google Scholar 

  19. Giannoudis PV, Da Costa AA, Raman R, Mohamed AK, Smith RM (2005) Double-crush syndrome after acetabular fractures. A sign of poor prognosis. J Bone Jt Surg Br 87:401–407

    Article  CAS  Google Scholar 

  20. Fassler PR, Swiontkowski MF, Kilroy AW, Routt MLJ (1993) Injury of the sciatic nerve associated with acetabular fracture. J Bone Jt Surg Am 75:1157–1166

    CAS  Google Scholar 

  21. Gruson KI, Moed BR (2003) Injury of the femoral nerve associated with acetabular fracture. J Bone Jt Surg Am 85-A:428–431

    Google Scholar 

  22. Potter HG, Montgomery KD, Heise CW, Helfet DL (1994) MR imaging of acetabular fractures: value in detecting femoral head injury, intraarticular fragments, and sciatic nerve injury. AJR Am J Roentgenol 163:881–886

    PubMed  CAS  Google Scholar 

  23. Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res 151:81–106

    PubMed  Google Scholar 

  24. Brandser E, Marsh JL (1998) Acetabular fractures: easier classification with a systematic approach. AJR Am J Roentgenol 171:1217–1228

    PubMed  CAS  Google Scholar 

  25. Mayo KA (1987) Fractures of the acetabulum. Orthop Clin North Am 18:43–57

    PubMed  CAS  Google Scholar 

  26. Martinez CR, Di Pasquale TG, Helfet DL, Graham AW, Sanders RW, Ray LD (1992) Evaluation of acetabular fractures with two- and three-dimensional CT. Radiographics 12:227–242

    PubMed  CAS  Google Scholar 

  27. Goulet JA, Bray TJ (1989) Complex acetabular fractures. Clin Orthop Relat Res 240:9–20

    PubMed  Google Scholar 

  28. Mears DC, Rubash H (1986) Pelvic and acetabular fractures. Slack, Thorofare, NJ

    Google Scholar 

  29. Olson SA, Matta JM (1998) Surgical treatment of fractures of the acetabulum. In: Browner BD, Jupiter JB, Levine AM, Trafton PG (eds) Skeletal trauma, 2nd edn. Saunders, Philadelphia, pp 1181–1222

    Google Scholar 

  30. Letournel E, Judet R (1993) Fractures of the acetabulum, 2nd edn. Springer, Berlin Heidelberg New York

    Google Scholar 

  31. Tile M (1995) Classification of acetabular fractures. In: Tile M (ed) Fractures of the pelvis and acetabulum. Williams & Wilkins, Baltimore, MD, pp 259–304

    Google Scholar 

  32. Brandser E, El-Khoury G, Marsh J (1995) Acetabular fractures: a systematic approach to classification. Emerg Radiol 2:18–28

    Article  Google Scholar 

  33. Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Jt Surg Am 78:1632–1645

    CAS  Google Scholar 

  34. Matta JM (1990) Acetabulum. In: Muller ME, Allgower M, Sneider R, Willenegger H (eds) Manual of internal fixation; techniques recommended by the AO-ASIF group, 3rd edn. Springer, Berlin Heidelberg New York, pp 504–505

    Google Scholar 

  35. Wedegärtner U, Gatzka C, Rueger JM, Adam G (2003) Multislice CT (MSCT) in der Detektion und Klassifikation von Becken- und Azetabulumfrakturen [Multislice CT (MSCT) in the detection and classification of pelvic and acetabular fractures]. RöFo Fortschr Geb Röntgenstrahlen Neuen Bildgeb Verfahr 175:105–111

    Article  Google Scholar 

  36. Harris JH Jr, Lee JS, Coupe KJ, Trotscher T (2004) Acetabular fractures revisited: part 1, redefinition of the Letournel anterior column. AJR Am J Roentgenol 182:1363–1366

    PubMed  Google Scholar 

  37. Harris JH Jr, Coupe KJ, Lee JS, Trotscher T (2004) Acetabular fractures revisited: part 2, a new CT-based classification. AJR Am J Roentgenol 182:1367–1375

    PubMed  Google Scholar 

  38. Geijer M, El-Khoury GY (2007) Imaging of acetabular fractures. Contemp Diagn Radiol 30(20)

  39. Beaule PE, Dorey FJ, Matta JM (2003) Letournel classification for acetabular fractures. Assessment of interobserver and intraobserver reliability. J Bone Jt Surg Am 85-A:1704–1709

    Google Scholar 

  40. Harley JD, Mack LA, Winquist RA (1982) CT of acetabular fractures: comparison with conventional radiography. AJR Am J Roentgenol 138:413–417

    PubMed  CAS  Google Scholar 

  41. Mack LA, Harley JD, Winquist RA (1982) CT of acetabular fractures: analysis of fracture patterns. AJR Am J Roentgenol 138:407–412

    PubMed  CAS  Google Scholar 

  42. Griffiths HJ, Standertskjöld-Nordenstam CG, Burke J, Lamont B, Kimmel J (1984) Computed tomography in the management of acetabular fractures. Skelet Radiol 11:22–31

    Article  CAS  Google Scholar 

  43. Borrelli J Jr, Goldfarb C, Catalano L, Evanoff BA (2002) Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma 16:449–456

    Article  PubMed  Google Scholar 

  44. Leschka S, Alkadhi H, Boehm T, Marincek B, Wildermuth S (2005) Coronal ultra-thick multiplanar CT reconstructions (MPR) of the pelvis in the multiple trauma patient: an alternative for the initial conventional radiograph. RöFo Fortschr Geb Röntgenstrahlen Neuen Bildgeb Verfahr 177:1405–1411

    Article  CAS  Google Scholar 

  45. Mullis BH, Dahners LE (2006) Hip arthroscopy to remove loose bodies after traumatic dislocation. J Orthop Trauma 20:22–26

    Article  PubMed  Google Scholar 

  46. Collinge C, Tornetta P3 (2004) Soft tissue injuries associated with pelvic fractures. Orthop Clin North Am 35:451–456

    Article  PubMed  Google Scholar 

  47. Stöckle U, König B, Schäffler A, Zschernack T, Haas NP (2006) Klinische Erfahrungen mit dem Siremobil Iso-C(3D)-Bildwandler in der Beckenchirurgie [Clinical experience with the Siremobil Iso-C(3D) imaging system in pelvic surgery]. Unfallchirurg 109:30–40

    Article  PubMed  Google Scholar 

  48. Borrelli JJ, Ricci WM, Steger-May K, Totty WG, Goldfarb C (2005) Postoperative radiographic assessment of acetabular fractures: a comparison of plain radiographs and CT scans. J Orthop Trauma 19:299–304

    PubMed  Google Scholar 

  49. Ohashi K, El-Khoury GY, Bennett DL, Restrepo JM, Berbaum KS (2005) Orthopedic hardware complications diagnosed with multi-detector row CT. Radiology 237:570–577

    Article  PubMed  Google Scholar 

  50. Letournel E, Judet R (1974) Les fractures du cotyle. Masson, Paris

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Acknowledgement

Our thanks to Erika Geijer for Fig. 7.

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Authors and Affiliations

  1. Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Mats Geijer

  2. Department of Radiology, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Georges Y. El-Khoury

  3. Department of Radiology, Lund University Hospital, 22185, Lund, Sweden

    Mats Geijer

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  2. Georges Y. El-Khoury
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Correspondence to Mats Geijer.

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Geijer, M., El-Khoury, G.Y. Imaging of the acetabulum in the era of multidetector computed tomography. Emerg Radiol 14, 271–287 (2007). https://doi.org/10.1007/s10140-007-0638-5

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