Unlocking the third dimension of acetabular fracture surgery

Acetabular fractures are fractures involving the hip socket. Accurate determination of the initial and residual displacement is important for determining the treatment strategy, for determining the prognosis in terms of clinical outcome, and for comparing the treatment results internationally. Radiographic analysis led to a significantly smaller fracture displacement compared to the CT measurements. Different observers did not agree on the size of the fracture displacement and therewith did not agree on the indication for and the result of surgery. Therefore 3D measurements were developed to determine the fracture displacement in acetabular fracture surgery. The 3D gap area, which represents the 3D surface area between all fracture fragments, had an excellent inter- and intra-observer reliability and is independently associated with the risk of conversion to a total hip arthroplasty.The aim of surgical treatment is an anatomical reconstruction of the joint. A systematic review comparing 3D-assisted acetabular fracture surgery and conventional surgery demonstrated that 3D-assisted surgery reduces operation time, intraoperative blood loss, fluoroscopy usage, and complications. Evidence for the improvement of fracture reduction and functional outcomes is limited. Patient-specific implants with surgical guides accurately translate the virtual surgical planning to the actual surgery. Moreover, the fracture reduction was good, patients retained their native hip, and reported good physical functioning at follow-up. Yet, this workflow not widely available. Thus, an alternative approach in which patient-specific surgical drilling guides were designed and applied to pre-contoured conventional implants was investigated and resulted in accurate screw placement during acetabular fracture surgery