Session VII - Pelvis

Fri., 10/6/06 Pelvis, Paper #43, 4:06 pm

Comparison of Judet Radiographs to CT-Reconstructed Judet Images for the Diagnosis of Acetabular Fractures

Rena Stewart, MD1 (n); Aaron Mast, MD2 (n); Aaron Coats2 (n);
1University of Alabama at Birmingham, Birmingham, Alabama, USA;
2Indiana University Medical Center, Indianapolis, Indiana, USA

Purpose: Despite increasing use of computed tomography (CT), Judet radiographs continue to be an integral part of diagnosis and classification of acetabular fractures. Unfortunately, Judet radiographs have several shortcomings. To overcome these challenges, CT-reconstructed Judet images were created from CT scan data using 3-dimensional modeling software. The resulting images are nearly indistinguishable from their "real" counterparts and are devoid of the majority of the artifacts and complications. The purpose of this study is to determine if CT-reconstructed Judets are of equal diagnostic accuracy compared to traditional Judet films.

Methods: Sixty orthopaedic surgeons (53 fellowship-trained traumatologists, 7 residents) were asked to review 24 image sets from 11 subjects with acetabular fractures. AP pelvis, axial CT, and Judet images were presented in a random order. Half of the Judet images were traditional radiographs and half CT-reconstructed images. Participants were asked to classify each image set according to the Judet-Letournel system. The results were compared with the fracture pattern determined intraoperatively.

Results: Results showed no statistically significant differences between the classification selected using traditional versus CT-reconstructed Judet images for 10 of the 11 fractures. In one case of a T-type fracture, the CT-reconstructed images were statistically more accurate (ie, agreed with intraoperative finding) than the traditional Judet images (P <0.003). Chi square analysis showed that the number of surgeons who attained >80% diagnostic accuracy was statistically greater with CT-reconstructed images than with traditional Judet radiographs (P <0.025).

Conclusion/Significance: These results indicate that Judet images can be re-created from preexisting axial CT data and provide images of equal or better clinical accuracy for diagnosis and classification of acetabular fractures. Use of reconstructed CT images has significant potential benefits, including a reduced consumption of resources, reduced patient radiation exposure, elimination of artifact such as bladder contrast, and elimination of positioning complications such as pain and risk of dislocation.

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.