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Are Routine Postoperative CT Scans Warranted for All Patients After Operative Fixation of Pelvic Ring Injuries?

OBJECTIVE
The purpose of this study is to evaluate the efficacy of routine postoperative computed topography (CT) scan after percutaneous fixation of unstable pelvic ring injuries.


DESIGN
Retrospective Chart Review SETTING:: Level I Trauma CenterPatients/Participants: A total of 362 consecutive patients underwent operative fixation of unstable pelvic ring injuries during the study period.


INTERVENTION
Postoperative CT scan of the pelvis was obtained in 331 (91%) of the 362 patients treated operatively for unstable pelvic ring injuries.


MAIN OUTCOME MEASUREMENTS
Revision surgery based on routine postoperative CT scan.


RESULTS
Two patients (0.55%) returned to the operating room on the basis of postoperative CT scans due to malpositioned implants. There were no significant differences of age, gender, body mass index, Injury Severity Score (ISS), mechanism of injury, smoking status, or diabetes status between those who did and did not undergo revision surgery. A dysmorphic pelvis was identified in 154 (47%) patients. Both patients undergoing revision surgery were determined to have a dysmorphic pelvis while no patients with normal pelvic anatomy returned to the operating room based on postoperative CT (2/154, 1.3% vs. 0/177, 0%, p=0.22).


CONCLUSION
While there remains a role for postoperative CT scans in the appropriately selected patient, in the hands of experienced orthopaedic traumatologists, patients with adequate intra-operative fluoroscopy and a non-dysmorphic pelvis may not require routine postoperative three-dimensional imaging.


LEVEL OF EVIDENCE
Diagnostic Level IV.