Computed tomography image guided surgery in complex acetabular fractures

Eleven complex acetabular fractures in 10 patients were treated by open red uction with internal fixation incorporating computed tomography image guide d software intraoperatively, Each of the implants placed under image guidan ce was found to be accurate and without penetration of the pelvis or joint space. The setup time for the system was minimal. Accuracy in the range of 1 mm was found when registration was precise (eight cases) and was in the r ange of 3.5 mm when registration was only approximate (three cases). Added benefits included reduced intraoperative fluoroscopic time, less need for m ore extensive dissection, and obviation of additional surgical approaches i n some cases, Compared with a series of similar fractures treated before th is image guided series, the reduction in operative time was significant, Fo r patients with complex anterior and posterior combined fractures, the aver age operation times with and without application of three-dimensional imagi ng technique were, respectively, 5 hours 15 minutes and 6 hours 14 minutes, revealing 16% less operative time for those who had surgery using image gu idance. In the single column fracture group, the operation time for those w ith three-dimensional imaging application, was 2 hours 58 minutes and for t hose with traditional surgery, 3 hours 42 minutes, indicating 20% less oper ative time for those with imaging modality. Intraoperative computed tomogra phy guided imagery was found to be an accurate and suitable method for use in the operative treatment of complex acetabular fractures with substantial displacement.