Intraoperative 3D Fluoroscopy Reduces Revision Rates and Improves Reduction Quality in Acetabular Fracture Fixation.

Abstract

To evaluate whether the use of intraoperative 3D fluoroscopy during acetabular fracture fixation reduces the rate of unplanned returns to the operating room and improves radiographic quality of reduction without increasing operative time or blood loss. Design: Retrospective comparative study. Single urban Level I trauma center. Patients with operatively treated acetabular fractures (OTA/AO 62) between 2017 and 2025. Patients were divided into two cohorts: those treated before and after the implementation of intraoperative 3D fluoroscopy (Cios Spin, Siemens, Germany).Outcome Measures and Comparisons: Primary outcome was the rate of unplanned return to the operating room. Secondary outcomes included postoperative residual joint gap, presence of intra-articular loose bodies, implant malposition, operative time, and estimated blood loss (EBL). These outcomes were compared between the two cohorts. 177 patients were included between 2017 and 2025, 148 patients treated before (control group) and 29 after the implementation of intraoperative 3D fluoroscopy (3D fluoro group). The mean age was 41.1 ±17.4 years old in the control group with 117 men (79%) vs 42.8 ±18.1 years old (p=0.55) in the 3D fluoro group, with 20 men (68.9%, p=0.34). The rate of unplanned return to the operating room was significantly lower in the 3D fluoroscopy group (0%) compared to the control group (15.5%) (p = 0.01). Postoperative CT scan (obtained in 148/148 in the control group and 22/29 in the 3D fluoroscopy group) demonstrated better fracture reduction in the 3D fluoroscopy group (mean residual gap: 3.4 ± 1.9 mm vs 4.5 ± 2.4 mm; p = 0.03). There were no significant differences in operative time (200.6 ±99.8 vs 221.2 ±114.4; p=0.49) or EBL (641.6 ±637.1 vs 674 ±572; p=0.67) between groups. Intraoperative findings seen on the 3D fluoroscopy such as malreduction, loose bodies or misplaced hardware led to modification of the surgical plan in 29% of cases where the 3D fluoroscopy was used. The use of intraoperative 3D fluoroscopy allowed intraoperative identification and correction of malreductions, implant malposition and removal of loose bodies, reducing the need for revision surgery and improving quality of reduction in acetabular fracture fixation. Its use did not increase operative time or blood loss, suggesting clinical and potentially economic benefits that may support broader adoption. Therapeutic Level III.