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How to improve the performance of acetabulum fracture diagnoses: investigating the use of three-dimensional CT-scan reconstructions

Abstract

Purpose

The classification of acetabular fractures remains a challenge for the junior radiologist, although he is the first line of diagnosis in Emergency Department. The advantages of three-dimensional reconstructions have yet to be evaluated on a large scale.

Method

A total of 212 fractures were classified according to Letournel and Judet by a senior orthopaedic surgeon, a senior radiologist, and a resident radiologist. The CT scans were first analysed in 2D and then a second time using 2D + 3D reconstructions of the acetabulum excluding the femoral head.

Results

3D reconstructions improved correct classification not only for the radiologist resident (+ 5%) but also for senior radiologist and orthopaedist (+ 2 and + 3%). 3D reconstructions also more significantly improved the diagnoses of complex fractures (+ 8.3%) compared to simple fractures (+ 0.4%).

Conclusions

3D reconstructions have improved the routine diagnosis of acetabular fractures, especially for junior radiologist or in cases of complex fractures.

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References

  1. Laird A, Keating JF (2005) Acetabular fractures: a 16-year prospective epidemiological study. J Bone Joint Surg Br 87(7):969–973

    CAS  Article  Google Scholar 

  2. Rinne PP, Laitinen MK, Huttunen T, Kannus P, Mattila VM (2017) The incidence and trauma mechanisms of acetabular fractures: a nationwide study in Finland between 1997 and 2014. Injury 48(10):2157–2161

    Article  Google Scholar 

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

    Google Scholar 

  4. 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(2):386–391

    Article  Google Scholar 

  5. O’Toole RV et al (2010) Evaluation of computed tomography for determining the diagnosis of acetabular fractures. J Orthop Trauma 24(5):284–290

    Article  Google Scholar 

  6. Schäffler A et al (2013) CT-based classification aid for acetabular fractures: evaluation and clinical testing. Unfallchirurg 116(11):1006–1014

    Article  Google Scholar 

  7. Hüfner T, Pohlemann T, Gänsslen A, Assassi P, Prokop M, Tscherne H (1999) The value of CT in classification and decision making in acetabulum fractures. A systematic analysis. Unfallchirurg 102(2):124–131

    Article  Google Scholar 

  8. Prasartritha T, Chaivanichsiri P (2013) The study of broken quadrilateral surface in fractures of the acetabulum. Int Orthop 37(6):1127–1134

    Article  Google Scholar 

  9. Garrett J, Halvorson J, Carroll E, Webb LX (2012) Value of 3-D CT in classifying acetabular fractures during orthopedic residency training. Orthopedics 35(5):e615-620

    Article  Google Scholar 

  10. Sebaaly A, Riouallon G, Zaraa M, Upex P, Marteau V, Jouffroy P (2018) Standardized three dimensional computerised tomography scanner reconstructions increase the accuracy of acetabular fracture classification. Int Orthop 42(8):1957–1965

    Article  Google Scholar 

  11. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    CAS  Article  Google Scholar 

  12. Ly TV, Stover MD, Sims SH, Reilly MC (2011) The use of an algorithm for classifying acetabular fractures: a role for resident education? Clin Orthop 469(8):2371–2376

    Article  Google Scholar 

  13. Kickuth R, Laufer U, Hartung G, Gruening C, Stueckle C, Kirchner J (2002) 3D CT versus axial helical CT versus conventional tomography in the classification of acetabular fractures: a ROC analysis. Clin Radiol 57(2):140–145

    Article  Google Scholar 

  14. Boudissa M et al (2017) Epidemiology and treatment of acetabular fractures in a level-1 trauma centre: retrospective study of 414 patients over 10 years. Orthop Traumatol Surg Res OTSR 103(3):335–339

    CAS  Article  Google Scholar 

  15. Mauffrey C et al (2014) The epidemiology and injury patterns of acetabular fractures: are the USA and China comparable? Clin Orthop 472(11):3332–3337

    Article  Google Scholar 

  16. Kelly J, Ladurner A, Rickman M (2020) Surgical management of acetabular fractures - a contemporary literature review. Injury 51(10):2267–2277

    CAS  Article  Google Scholar 

  17. Boudissa M, Courvoisier A, Chabanas M, Tonetti J (2018) Computer assisted surgery in preoperative planning of acetabular fracture surgery: state of the art. Expert Rev Med Devices 15(1):81–89

    CAS  Article  Google Scholar 

  18. Cimerman M, Kristan A, Jug M, Tomaževič M (2021) Fractures of the acetabulum: from yesterday to tomorrow. Int Orthop 45(4):1057–1064

    Article  Google Scholar 

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Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Marie Faruch Bilfeld, Camille Minet, Nicolas Reina, and Gauthier Gracia. The first draft of the manuscript was written by Camille Minet and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marie Faruch-Bilfeld.

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Highlights.

• 3D CT with femoral head exclusion improves acetabulum fracture detection and classification.

• 3D CT with femoral head exclusion reconstruction is simple and fast.

• 3D CT femoral head reconstruction is useful for both young radiologists and experienced seniors.

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Minet, C., Reina, N., Gracia, G. et al. How to improve the performance of acetabulum fracture diagnoses: investigating the use of three-dimensional CT-scan reconstructions. Emerg Radiol (2022). https://doi.org/10.1007/s10140-022-02068-8

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  • DOI: https://doi.org/10.1007/s10140-022-02068-8

Keywords

  • Acetabulum fractures
  • Letournel and Judet classification
  • Three-dimensional CT-scan reconstructions