BACKGROUND Acetabular fractures pose diagnostic and surgical challenges.They are classified using the Judet-Letournel system,which is based solely on X-ray.However,computed tomography(CT)imaging is now more widely uti...BACKGROUND Acetabular fractures pose diagnostic and surgical challenges.They are classified using the Judet-Letournel system,which is based solely on X-ray.However,computed tomography(CT)imaging is now more widely utilized in diagnosing these injuries.The emergence of 3-dimensional(3-D)printing technology in varying orthopedic fields has provided surgeons a solid model that improves their spatial understanding of complex fractures and ability to plan preoperatively.AIM To evaluate the reliability of the Judet-Letournel classification system of acetabular fractures,when using either CT imaging or 3-D printed models.METHODS Seven patients with acetabular fractures underwent pelvic CT imaging,which was then used to create solid,3-D printed models.Eighteen orthopaedic trauma surgeons responded to questionnaires regarding fracture classification and preferred surgical approach.The same questionnaire was completed using only CT imaging,and two weeks later,using only 3-D printed models.The inter-and intra-observer agreement rates were then analyzed.RESULTS Inter-observer agreement rates based on CT imaging or 3-D printed models were moderate for fracture classification:κ=0.44,κ=0.55,respectively(P<0.001)and fair for preferred surgical approach:κ=0.34,κ=0.29,respectively(P<0.005).Intra-observer agreement rates for fracture classification and preferred surgical approach comparing CT imaging or 3-D printed models were moderate:κ=0.48,κ=0.41,respectively.No significant difference in intra-observer agreement was detected when comparing orthopedic pelvic specialists to general orthopedic traumatologists.CONCLUSION The Judet-Letournel classification demonstrated only moderate rates of agreement.The use of 3-D printed models increased the inter-observer agreement rates with respect to fracture classification,but decreased it with respect to the preferred surgical approach.This study highlights the role of 3-D printed models in acetabular fractures by improving spatial understanding of these complex injuries,thus providing more reliable fracture diagnoses and alternative viewpoints for pre-operative planning.展开更多
文摘BACKGROUND Acetabular fractures pose diagnostic and surgical challenges.They are classified using the Judet-Letournel system,which is based solely on X-ray.However,computed tomography(CT)imaging is now more widely utilized in diagnosing these injuries.The emergence of 3-dimensional(3-D)printing technology in varying orthopedic fields has provided surgeons a solid model that improves their spatial understanding of complex fractures and ability to plan preoperatively.AIM To evaluate the reliability of the Judet-Letournel classification system of acetabular fractures,when using either CT imaging or 3-D printed models.METHODS Seven patients with acetabular fractures underwent pelvic CT imaging,which was then used to create solid,3-D printed models.Eighteen orthopaedic trauma surgeons responded to questionnaires regarding fracture classification and preferred surgical approach.The same questionnaire was completed using only CT imaging,and two weeks later,using only 3-D printed models.The inter-and intra-observer agreement rates were then analyzed.RESULTS Inter-observer agreement rates based on CT imaging or 3-D printed models were moderate for fracture classification:κ=0.44,κ=0.55,respectively(P<0.001)and fair for preferred surgical approach:κ=0.34,κ=0.29,respectively(P<0.005).Intra-observer agreement rates for fracture classification and preferred surgical approach comparing CT imaging or 3-D printed models were moderate:κ=0.48,κ=0.41,respectively.No significant difference in intra-observer agreement was detected when comparing orthopedic pelvic specialists to general orthopedic traumatologists.CONCLUSION The Judet-Letournel classification demonstrated only moderate rates of agreement.The use of 3-D printed models increased the inter-observer agreement rates with respect to fracture classification,but decreased it with respect to the preferred surgical approach.This study highlights the role of 3-D printed models in acetabular fractures by improving spatial understanding of these complex injuries,thus providing more reliable fracture diagnoses and alternative viewpoints for pre-operative planning.
