OTA 2008 Posters

Scientific Poster #55 Pelvis OTA-2008

Use of Intraoperative 3-Dimensional CT Imaging in the Treatment of Pelvic Fractures

Gil R. Ortega, MD, MPH1 (n); Anthony S. Rhorer, MD1 (e-Smith + Nephew, Medtronic);
Brian Miller, MD1 (n); Daniel Kendoff, MD2 (n);
1Sonoran Orthopaedic Trauma Surgeons, Scottsdale Osborn Trauma Center,
Scottsdale, Arizona, USA;
2Hospital for Special Surgery, New York City, New York, USA

Introduction: In patients with unstable pelvic fractures that require operative stabilization, fluoroscopic imaging is required to assess operative reduction and internal fixation. However, in certain cases that involve fracture communition, osteoporotic bone, and/or obese patients, fluoroscopic imaging may not be optimal for an accurate assessment of fracture reduction and internal fixation. Postoperative CT imaging may enhance the surgeon’s perspective of the operative reduction and internal fixation; however, a return to the operating room may be required if the postoperative CT demonstrates an error in reduction and/or internal fixation.

Purpose: The aim of this study was to demonstrate the value of intraoperative CT examination using the Siemens ISO-C 3-dimensional imaging system in the treatment of pelvic fractures.

Methods: 14 pelvic fractures were treated with open or closed reductions and internal fixation with various techniques. Standard fluoroscopic imaging was compared to the ISO-C CT imaging to assess fracture reductions and internal fixation.

Results: After review of intraoperative, standard fluoroscopic images, 14 of 14 cases seemed to demonstrate accurate pelvic fracture reductions and internal fixation. However, after these cases were determined to be accurate via the standard fluoroscopic images, the intraoperative images obtained usingthe ISO-C CT imaging system demonstrated that one case, a zone II pelvic fracture with communition, did not have an accurate reduction and placement of a guidewire for final screw fixation. Therefore, a repeat reduction maneuver was performed with improvement of the pelvic fracture reduction and final screw fixation that was confirmed with repeat intraoperative ISO-C CT imaging. The average time for setup, CT scan, and interpretation was 9 minutes and 34 seconds. In addition, the ISO-C CT imaging system confirmed accurate pelvic fracture reduction and internal fixation in two cases involving obese patients and two cases involving osteoporotic bone, which were challenging to accurately assess with standard fluoroscopic imaging alone.

Conclusion and Significance: Our preliminary use of intraoperative 3-dimensional CT imaging has demonstrated an improvement in the surgeon’s ability to visualize complex pelvic fracture reduction and internal fixation when compared to standard fluoroscopic images. We believe the Siemens ISO-C 3-dimensional CT imaging system may be helpful for orthopaedic surgeons who perform complex pelvic fracture fixation when viewing the bony anatomy and internal instrumentation without relying on postoperative CT to determine if operative reductions and internal fixation are indeed accurate.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.