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Low incidence of cortical impaction associated with posterior wall acetabular fractures
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Results showed 4% of patients with posterior wall acetabular fracture dislocation had associated posterosuperior cortical impaction.
Jonathan G. Eastman, MD, and colleagues reviewed the medical records and CT scans of the abdomen and pelvis of 97 patients who sustained an isolated posterior wall acetabular fracture dislocation from July 2007 until July 2017. Researchers evaluated each pelvic CT scan for impaction of the extra-articular posterosuperior acetabular cortical surface associated with posterior wall acetabular fracture-dislocations. Researchers also assessed reduction accuracy for each patient with cortical impaction using postoperative CT scans, and reviewed the final attending radiology report for notation of cortical impaction.
Results showed areas of cortical impaction on preoperative CT imaging were identified in 4.12% of patients. Researchers found one anatomical reduction, two imperfect reductions and one poor reduction on postoperative CT scans. Cortical impaction was not commented on in any of the final attending radiologist reports, according to results.
Although results showed substantial variability in the size of the area of impaction, Eastman noted it is important to detect the size through detailed evaluation of the preoperative CT scan as patients with large areas of impacted cortical bone have a diminished amount of bone remaining to obtain an appropriate cortical read and subsequent articular reduction.
“Noting where the available cortical reads are going to exist will allow the surgeon to make an appropriate preoperative plan including position, surgical approach, need for greater trochanteric osteotomy and to either ignore or restore the altered cortical reads present,” Eastman told Healio.com/Orthopedics. “Doing this preoperatively will avoid the potential problems that could occur intraoperatively and allow the surgeon to obtain the best reduction and hopefully, lead to the most optimal surgical and clinical result.” – by Casey Tingle
Disclosure: Eastman reports no relevant financial disclosures.
Perspective
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Reza Firoozabadi, MD
This paper highlights the importance of preoperative assessment of the imaging and planning accordingly. As the authors mention, impressive fracture displacement and/or comminution can result in the surgeon overlooking subtle findings, such as the described extra-articular cortical impaction. This can result in altered reduction reads and potential articular malreductions. If the extra-articular cortical impaction is identified, then alternative cranial/caudal fracture reads can be utilized and if those reads are compromised, then the area of impaction can be corrected.
Associate professor
University of Washington/Harborview Medical Center
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