A New Computed Tomography-based Measure that Provides Insight into Hip Stability in Patients with Posterior Wall Acetabular Fractures

Author:

Jaeblon Todd12ORCID,Demyanovich Haley12ORCID,Bauer Brent12,Beer Robert12,Kufera Joseph3

Affiliation:

1. University of Maryland Capital Region Medical Center, Department of Orthopaedic Traumatology, Largo MD

2. University of Maryland, Baltimore, School of Medicine, Department of Orthopaedics, Baltimore MD

3. National Study Center for Trauma and EMS, University of Maryland, Baltimore, Baltimore, MD Corresponding Author and reprints: Todd Jaeblon, DO, Department of Orthopaedic Traumatology, University of Maryland Capital Region Medical Center, 901 Harry S Truman Dr South, Largo MD, 20774. Office: (410) 706-3935, Fax: (410) 706-1610, ()

Abstract

Objective: Describe the technique and results of a new sagittal plane computed tomography (CT) based angular measure for predicting stability following posterior wall acetabular fractures (PWF). Design: Retrospective review Setting: Academic Level II Trauma center Patients: Fifty-eight consecutive patients with PWF (AO/OTA class 62A.1), 98% were high energy injuries. Intervention: A new sagittal CT (sCT) measure of PWF based upon the angle subtending the joint center, cranial and caudal fracture exits. Outcome measures and Comparisons: Hip incongruity or dislocation demonstrated using gold standard test, exam under anesthesia (EUA), or instability on static images. Prediction of hip instability utilizing a sCT angular measure based upon cranial and caudal fracture exits was compared to previous axial CT (aCT) measures suggestive of increased risk for instability including PW size >50%, and those with cranial exit within 5.0 mm of the acetabular dome. Results: There were 32 operative and 26 nonoperatively treated fractures. Thirty were determined to be unstable, and 28 stable following EUA. Measurements of >70° using the sCT angular measure predicted instability in 28/28 patients, and ≤70° predicted stability in 30/30 patients (sensitivity 100% specificity 100%). Prevalence of EUA confirmed instability for subgroups with PWF based on prior aCT measures were as follows: ≥50% wall involvement 11/16 (sensitivity 67% specificity 60%; 95%CI 45-89%/45-75%), fracture within 5.0 mm of dome 5/18 (sensitivity 86%, specificity 73%; 95%CI 71-100%/59-87%), fracture within 5.0 mm of dome and ≥50% involvement 1/9 (sensitivity 89%, specificity 56%, 95%CI 69-100%/24-88%). Conclusion: In a sample of 58 mostly high energy posterior wall fractures all having had an EUA, a new sagittal angular CT measurement of ≤70° predicted hip stability and >70° predicted instability with 100% sensitivity and specificity. Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Publisher

Ovid Technologies (Wolters Kluwer Health)

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3