The optimal fluoroscopic views to rule out intra-articular screw penetration during acetabular fracture fixation,International Orthopaedics

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The optimal fluoroscopic views to rule out intra-articular screw penetration during acetabular fracture fixation
International Orthopaedics ( IF 2.0 ) Pub Date : 2023-10-19 , DOI: 10.1007/s00264-023-06002-6
Aissam Elmhiregh ₁ , Ashraf T Hantouly ₁ , Osama Alzoubi ₁ , Bivin George ₁ , Mohsen Ahmadi ₂ , Ghalib Ahmed ₁

Affiliation

Purpose

To determine the ideal view(s) and the minimum number of intraoperative fluoroscopic views required to rule out any intra-articular screw violation in acetabular fractures fixation.

Methods

This study was conducted using a series of fluoroscopic examinations of pelvic synthetic models with screws positioned in different planes around the acetabulum. Ten screws were placed in the synthetic pelvis models in different planes of the acetabulum. Seven views were taken for each screw. Radiographic images were evaluated by 14 orthopaedic surgeons who were asked to assess joint violation and the view(s) required for assessment.

Results

The observers’ accuracy rate in identifying joint violation was 82.1% for the anterior part of the anterior column and the superior part of the posterior column, 89.3% for the posterior part of the anterior column and the inferior part of the posterior column, and 92.9% for the quadrilateral plate. The sensitivity was 100% for the anterior and posterior parts of the anterior column and the inferior part of the posterior column, 87.5% for the superior part of the posterior column, and 85.7% for the quadrilateral plate. The specificity was 100% for the quadrilateral plate, 80% for the superior part of the posterior column and the posterior part of the anterior column, 78.6% for the inferior part of the posterior column, and 66.7% for the anterior part of the anterior column. There was a strong overall interobserver and intra-observer agreement with intraclass correlation coefficient (ICC) of 0.709 and 0.86, respectively.

Conclusions

This study confirms the hypothesis that in a concave surface/joint fixation, such as the acetabulum, the probability of joint violation is unlikely if there is no evidence of it within a single fluoroscopic view. In acetabulum fracture fixation with a screw violating the joint, the screw’s presence was evident within the joint space in all fluoroscopic views. However, the absence of joint violation in one fluoroscopic view was adequate to rule out joint penetration.

中文翻译：

髋臼骨折固定过程中排除关节内螺钉穿透的最佳透视图

目的

确定排除髋臼骨折固定中任何关节内螺钉违规所需的理想视图和最少数量的术中透视视图。

方法

这项研究是通过对骨盆合成模型进行一系列荧光镜检查来进行的，这些模型的螺钉位于髋臼周围的不同平面上。十个螺钉被放置在合成骨盆模型中髋臼的不同平面上。对每个螺钉拍摄七个视图。放射线图像由 14 名骨科医生进行评估，他们被要求评估关节侵犯和评估所需的视图。

结果

观察者识别关节侵犯的准确率，前柱前部和后柱上部为82.1%，前柱后部和后柱下部为89.3%，前柱后部和后柱下部为92.9%。 % 对于四边形板。前柱前后部和后柱下部的敏感性为100%，后柱上部的敏感性为87.5%，四边形板的敏感性为85.7%。四边形板的特异性为100%，后柱上部分和前柱后部分的特异性为80%，后柱下部分的特异性为78.6%，前柱前部分的特异性为66.7%柱子。观察者间和观察者内的总体一致性很强，组内相关系数 (ICC) 分别为 0.709 和 0.86。