Abstract

STRYDOM, Sven et al. Measurement of functional acetabular column sizes using a 3D CT model, for guiding percutaneous screw fixation of acetabular fractures using fluoroscopy. SA orthop. j. [online]. 2024, vol.23, n.1, pp.37-42. ISSN 2309-8309.  http://dx.doi.org/10.17159/2309-8309/2024/v23n1a6.

BACKGROUND: Percutaneous acetabular screw fixation remains a technically challenging procedure, despite good outcomes being reported with appropriate patient selection. In the developing world, where intraoperative computer tomography (CT) guidance (O-arm) and dedicated screws are not readily available, this procedure becomes even more challenging, as surgeons often place screws under fluoroscopic guidance only. Additionally, incorrect screw sizing can lead to cortical breaching with catastrophic vascular damage and other serious consequences. This study aimed to demonstrate how surgeons working with intraoperative fluoroscopy can use preoperative three-dimensional (3D) reconstructed CT scans to plan and safely insert screws into these 'functional fluoroscopic corridors', and to compare column sizes for screw selection in the South African population to existing literature. METHODS: A retrospective study using data obtained from CT scans of adult patients was performed. Three-dimensional reconstructions of the pelvis were used to create a novel technique of simulating the 'functional' bone corridors used during fluoroscopic surgery in order to take the measurements of the anterior and posterior acetabular columns in 301 patients (163 male and 138 female). Exclusion criteria were: any previous trauma and fractures of the pelvis, congenital abnormalities and tumours involving the bony pelvis. We also demonstrate the use of this technique in a clinical case. RESULTS: Our study confirmed that column sizes in the South African population are in keeping with previous publications. We demonstrate how this novel preoperative 3D-CT planning technique can be used to identify intraoperative surgical corridors using fluoroscopy. CONCLUSION: Although column sizes in the South African population are shown to be in keeping with international literature, our study demonstrates a novel technique for using 3D CT reconstructions preoperatively, in the same orientation used intraoperatively with fluoroscopy, to help guide screw size choice and placement. This technique shows promise for reducing cortical breaches in settings where intraoperative O-arms are not available, as appropriately sized screws can be preselected on an individualised basis. Level of evidence: Level 3

Keywords : acetabular fractures; percutaneous fixation; acetabular columns; acetabular column sizes; 3D CT reconstruction.

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