Intraoperative fluoroscopy to evaluate fracture reduction and hardware placement during acetabular surgery

Objectives: To evaluate use of intraoperative fluoroscopy during acetabular surgery to determine fracture reduction and accurate placement of screws. Design: Retrospective. Setting: Level I trauma center. Participants: Thirty patients with thirty-two acetabular fractures. Intervention: Patients were evaluated with fluoroscopy during surgery to assess fracture reduction and screw placement. Anterior-posterior (AP), oblique, and lateral pelvic fluoroscopic images were obtained intraoperatively. Postoperative radiographs were used to verify fluoroscopic findings; computed tomography (CT) scans were used as the control to assess intra-articular screw placement. Main Outcome Measurements: Radiographic and clinical assessment of fracture reduction and screw placement. Results: Intraoperative fluoroscopy confirmed the extra-articular position of all screws evaluated. Postoperative CT scans confirmed the extra-articular placement of all screws assessed by fluoroscopy. Quality of reduction using intraoperative fluoroscopic images had a 100 percent correlation with reduction on final radiographs. One patient, with two screws placed without fluoroscopic evaluation, had intra-articular placement requiring revision surgery. Conclusions: Intraoperative fluoroscopy is effective in evaluating both acetabular fracture reduction and hardware placement.