CT-guided fixation of pelvic fractures after high-energy trauma, by interventional radiologists: technical and clinical outcome

Objective The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma. Materials and methods Consecutive patients who were treated...

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Bibliographic Details
Published in:European radiology 2020-02, Vol.30 (2), p.961-970
Main Authors: Dekimpe, Chloé, Andreani, Olivier, De Dompsure, Regis Bernard, Lemmex, Devin Byron, Layet, Vivien, Foti, Pauline, Amoretti, Nicolas
Format: Article
Language:English
Subjects:
Acetabulum
Anesthesia
Clinical outcomes
Complications
Diagnostic Radiology
Disjunction
Energy
Exposure
Fixation
Fluoroscopy
Fractures
Imaging
Internal Medicine
Interventional
Interventional Radiology
Medicine
Medicine & Public Health
Neuroradiology
Pain
Patients
Placement
Radiation
Radiation effects
Radiology
Sacrum
Safety
Screws
Trauma
Ultrasound
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Summary:Objective The aim of our study was to evaluate screw placement accuracy, safety, complications, and clinical outcomes including functional and pain score, in 32 patients treated with CT-guided pelvic ring fixation after high-energy trauma. Materials and methods Consecutive patients who were treated by CT-guided fixation of sacral or acetabular fractures after high-energy trauma were included. All procedures were performed under general anesthesia, with dual CT and fluoroscopic guidance, by interventional radiologists. Fractures were minimally displaced or reduced unstable posterior pelvic ring disruptions, with or without sacroiliac disjunction (Tile B or C) and minimally displaced acetabular fractures. The primary outcome evaluated was screw accuracy. Secondary outcomes included patient radiation exposure, duration of the procedure, complications, clinical functional score (Majeed score), and pain scale (VAS, visual analog scale) evaluation during a follow-up period from 4 to 30 months postoperatively. Results Thirty-two patients were included (mean age 46) and 62 screws were inserted. Screw placement was correct in 90.3% of patients (95% of screws). Mean procedure duration was 67 min and mean patient radiation exposure was 965 mGy cm. Mean follow-up was 13 months and no complications were observed. The mean Majeed score at final follow-up was 84/100 and the mean VAS was 1.6/10. Conclusion This technique is an effective and safe procedure in specific cases of pelvic ring and acetabulum fractures. It allows accurate screw placement in a minimally invasive manner, leading to effective management of poly-traumatized patients. Key Points • CT-guided pelvic ring fixation, including sacroiliac and acetabular fractures, is an effective and safe procedure. • It allows accurate and minimally invasive screw placement, leading to effective management of poly-traumatized patients. • Multidisciplinary cooperation is essential to ensure efficiency and safety.
ISSN:0938-7994
1432-1084
DOI:10.1007/s00330-019-06439-7