Diagnostic performance of digital tomosynthesis for postoperative assessment of acetabular fractures and pelvic ring injuries.

Introduction: Digital tomosynthesis (DTS) has broad non-orthopaedic applications and has seen limited use within orthopaedics for imaging of the wrist. The utility of DTS for assessing reduction and hardware placement following operative treatment of pelvic ring injuries and acetabular fractures has not previously been investigated.
Methods: All operatively treated acetabular fractures and pelvic ring injuries that underwent surgical fixation within a one-year time span received both a computed tomography (CT) scan and a DTS scan as part of their routine postoperative imaging workup. Three orthopaedic traumatologists independently reviewed the images for face-value clinical utility. Radimetrics and PCXMC software were utilized on a subset of the study population's DTS and CT studies to calculate the effective and organ radiation doses delivered.
Results: 52 patients (22 acetabular fractures, 22 pelvic ring injuries, 7 pelvic ring and acetabular fractures, 2 femoral head & acetabular fractures) were included. DTS was considered adequate to assess reduction 83% of the time, hardware position 83% of the time, and sufficient to replace the CT scan 67% of the time. DTS was associated with an 8.3 times lower effective radiation dose than CT. All organ doses were lower for DTS than CT.
Discussion: DTS appears to have face-value clinical utility for assessing reduction and hardware position following surgical treatment of acetabular fractures and pelvic ring injuries. Given that DTS is associated with significantly lower radiation doses to patients, further study utilizing more objective criteria is warranted.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
(© 2024 Coscia, Schweppe, Anari, Kneeland, Horan, Mehta and Ahn.)